Date Last Updated: 11/04/06
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Do physical therapies benefit people with chronic or recurrent headache?

Treatment in brief
Physical therapies for chronic or recurrent headache include (but are not limited to) massage, trigger point therapy, electrical modalities, reflexology, spinal manipulation, therapeutic heat or cold, and exercise therapy.  

Chronic or recurrent headache
Headache is one of the most common medical complaints in the general population.

Headaches can be divided into primary or secondary types. A primary headache is a headache that is not caused by a disease or other medical condition. A secondary headache is a headache that is due to underlying disease.

Tension-type headache is the most common primary headache and accounts for 90% of all headaches. Migraine is the second most common primary headache (Steiner 2002). Tension-type headache and migraine can cause a significant amount of pain and disability and may lead to a reduced quality of life. It should be noted that symptoms of migraine and tension-type headache often overlap and a diagnosis is sometimes difficult.

There are various treatment approaches for primary headaches. Various medications are used to relieve the pain of tension-type headache and migraine, and prevent headaches from recurring. While these medications are generally effective for most people, some people do not experience adequate relief. Other people may experience uncomfortable side effects.

Many people use physical therapies in addition to (or instead of) medications to treat headache. There are many different types of physical treatments. Some of these are administered by health professionals such as physiotherapists or practitioners of complementary medicine such as osteopaths. Other physical treatments are self-administered.

Physical therapies
Various physical therapies have been used in the treatment of people with chronic or recurrent headache. These include (but are not limited to) massage, trigger point therapy, electrical modalities, reflexology, spinal manipulation, therapeutic heat and cold, and exercise therapy. Often, the precise way these physical therapies work is poorly understood. Many practitioners of complementary medicine believe that direct mechanical pressure and effects mediated by the nervous system can reduce muscular and mental tension, and therefore benefit people with headache.

The evidence

Migraine headache
There is level 3 evidence from a systematic review that spinal manipulation may be effective for the prevention of migraine.

There is weaker level 3 evidence from a systematic review that pulsating electromagnetic fields and the combination of transcutaneous electrical nerve stimulation (TENS) plus electrical neurotransmitter modulation may have some benefit for the prevention of migraine.

Tension-type headache
There is level 3 evidence from a systematic review that spinal manipulation may be of some benefit in the prevention of chronic tension-type headache.

There is weaker level 3 evidence from a systematic review that the following physical therapies may also be of some benefit in preventing chronic tension-type headache:

• therapeutic touch
• cranial electrotherapy
• TENS plus electrical neurotransmitter modulation
• regimen of auto-massage, TENS and stretching.

Other important issues
Based on trial results, non-invasive physical therapies appear to have little risk of serious side effects. Their relative cost-effectiveness is not known.

 Key Messages

There is inadequate evidence to make definitive conclusions about the use of non-invasive physical therapies for chronic or recurrent headache	1
There is some evidence that certain types of non-invasive physical therapies may be of some benefit for preventing tension-type headache or migraine	3
Spinal manipulation, in particular, may be effective for preventing migraine	3
Non-invasive physical therapies for people with chronic or recurrent headaches appear to have little risk of serious side effects	3

 

Key: Levels of evidence

 

 

 

 

Sources
The information in this summary was developed by assessing:

The Cochrane review: Non-invasive physical treatments for chronic/recurrent headache – 2005
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001878/frame.html

 

Date    20 Jun 2006                Last updated 20 Jun 2006

 

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