title: Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review.
abstract: BACKGROUND
  Tension-type headache (TTH) is a disease with a great incidence on quality of life and with a significant socioeconomic impact.
  
  
  OBJECTIVE
  The aim of this review is to determine the effectiveness of physical therapy by using manual therapy (MT) for the relief of TTH.
  
  
  METHODS
  A review was done identifying randomized controlled trials through searches in MEDLINE, PEDro, Cochrane and CINAHL (January 2002 - April 2012).
  
  
  METHODS
  English-language studies, with adult patients and number of subjects not under 11, diagnosed with episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) were included.
  
  
  METHODS
  Initial search was undertaken with the words Effectiveness, Tension-type headache, and Manual therapy (39 studies). In addition, a search which included terms related to treatments such as physiotherapy, physical therapy, spinal manipulation was performed (25 studies).
  
  
  RESULTS
  From the two searches 9 studies met the inclusion criteria and were analysed finding statistically significant results: 1) myofascial release, cervical traction, neck muscles trigger points in cervical thoracic muscles and stretching; 2) Superficial heat and massage, connective tissue manipulation and vertebral Cyriax mobilization; 3) cervical or thoracic spinal manipulation and cervical chin-occipital manual traction; 4) massage, progressive relaxation and gentle stretching, program of active exercises of shoulder, neck and pericranial muscles; 5) massage, passive rhythmic mobilization techniques, cervical, thoracic and lumbopelvic postural correction and cranio-cervical exercises; 6) progressive muscular relaxation combined with joint mobilization, functional, muscle energy, and strain/counterstrain techniques, and cranial osteopathic treatment; 7) massage focused on relieving myofascial trigger point activity; 8) pressure release and muscle energy in suboccipital muscles; 9) combination of mobilizations of the cervical and thoracic spine, exercises and postural correction. All studies used a combination of different techniques and none analyzed treatments separately, also all the studies have assessed aspects related to TTH beyond frequency and intensity of pain.
  
  
  CONCLUSIONS
  The findings from these studies showed evidence that physiotherapy with articulatory MT, combined with cervical muscle stretching and massage are effective for this disease in different aspects related with TTH. No evidence was found of the effectiveness of the techniques applied separately.
authors: Physiotherapy Department, University of Valencia C/Gascó Oliag, 5. PC: 46010 Valencia, Spain.
authors: Gemma
authors: G
authors: Victoria Espí-López
authors: Physiotherapy Department, University of Valencia C/Gascó Oliag, 5. PC: 46010 Valencia, Spain.
authors: Anna
authors: A
authors: Arnal-Gómez
authors: Nursing and Physiotherapy Department, University of Illes Balears Carretera de Valldemossa, km 7,5. PC: 07122 Palma de Mallorca, Islas Baleares, Spain.
authors: Teresa
authors: T
authors: Arbós-Berenguer
authors: Nursing and Physiotherapy Department, University of Illes Balears Carretera de Valldemossa, km 7,5. PC: 07122 Palma de Mallorca, Islas Baleares, Spain.
authors: Ángel Arturo López
authors: ÁAL
authors: González
authors: Occupational Health Service, Correos Group of Valencia Pza. Ayuntamiento, 24. PC: 46002 Valencia, Spain.
authors: Teófila
authors: T
authors: Vicente-Herrero
keywords: Effectiveness; Manual therapy; Physical therapy; Tension-type headache