title: Spinal manipulations for tension-type headaches: a systematic review of randomized controlled trials.
abstract: OBJECTIVE
  The objective of this systematic review was to assess the effectiveness of spinal manipulations as treatment option for tension type headaches.
  
  
  METHODS
  Eight databases were searched from their inception to May 2011. All randomized trials were considered, if they investigated spinal manipulations performed by any type of healthcare professional for treating tension type headaches in human subjects. The selection of studies, data extraction, and validation were performed independently by two reviewers. The Cochrane tool and the Jadad score were used to assess methodological quality of trials.
  
  
  RESULTS
  Five randomized clinical trials (RCTs) met the inclusion criteria. Their methodological quality was mostly high and ranged between 2 and 4 on the Jadad score. Four RCTs suggested that spinal manipulations are more effective than drug therapy, spinal manipulation plus placebo, sham spinal manipulation plus amitriptyline or sham spinal manipulation plus placebo, usual care or no intervention. One RCT showed no difference in daily hours of headache, pain intensity, and daily analgesic use compared to soft tissue therapy plus placebo laser.
  
  
  CONCLUSIONS
  The evidence that spinal manipulation alleviates tension type headaches is encouraging, but inconclusive. The low quantity of the available data prevent firm conclusion.
authors.affiliation: Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United Kingdom. Paul.Posadzki@pcmd.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Posadzki
authors.forename: E
authors.initials: E
authors.lastname: Ernst
mesh_terms: D006801:Humans; D020393:Manipulation, Spinal; D017063:Outcome Assessment, Health Care; D018781:Tension-Type Headache / Q000628:therapy*