Osteopathy and Tension-type Headaches


Osteopathy, specifically manual joint mobilisation, may have a positive effect on quality of life and headache frequency for adults with tension-type headaches.


Tension-type Headache (TTH), Osteopathy, Manual Joint mobilisation techniques, Headache frequency, Quality of life, systematic review, meta analysis.


Tension type Headache (TTH) is ranked as the second most prevalent health condition worldwide. There has been a lack of evidence for the effectiveness of manual therapy for TTH but this latest review suggests that Manual Joint mobilisation techniques may decrease frequency of headache occurance and improve quality of life.

A systematic literature review was conducted in february 2020 based on the PICO framework (Population, Intervention, Comparison and Outcome) and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodology followed the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Six relevant Randomised Controlled Trials (RCT) were found after a searching databases EMBASE, PsycINFO, MEDLINE, CINAHL and PEDRO.

Only RCTs of sufficient quality were included in the review. Patients,18 years or older, diagnosed with TTH according to the International Classification of Headache disorder were included. Manual joint mobilisation techniques were compared to no mobilisation technique, other treatment, treatment as usual, placebo or sham intervention. Headache Frequency was measured in days per month of headache. Both Quality of Life and Headache frequency were assessed at the end of treatment.

Manual joint mobilisation techniques were defined as any manual technique, mobilisation or manipulation within normal range of motion of the joint, aimed at affecting the joints, muscles and connective tissues of the neck, chest and lower back.

Results found that manual joint mobilisation had a positive effect on both headache frequency and quality of life. However, the certainty of evidence was very low due to risk of bias, inconsistency and imprecision. A weak recommendation is therefore made by the review for manual joint mobilisation techniques as a supplement to medical treatment for adult patients with

The review also assessed the effectivness of supervised physical activity, psychological treatment, acupuncture and patient education on TTH.Patient education was defined as information about the TTH, treatment, medication over use, self care, lifestyle, physical activity, regular diet and sleep. The review found that no RCTs had been conducted for Patient education but that clinical experience suggests that patient education may have a positive effect on the patients ability to manage their disease. Supervised physical activity was defined as planned, repeated and structured physical activity. Two RCTs were found and results showed potential effect of reducing headache intensity. However, the risk of bias and imprecision was high so the certainty of evidence is very low.

All non-pharmacological interventions were found to be safe. The certainty of evidence was found to be low or very low due to risk of bias and imprecision.

From an osteopathic perspective it is interesting that patient education, supervised physical activity and manual jount mobilisation, as well as being safe for patients, may positivly affect frequency of tension type headaches as well as improve quality of life.


Krøll, L.S., Callesen, H.E., Carlsen, L.N. et al. Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta- analysis. J Headache Pain 22, 96 (2021). https://doi.org/10.1186/ s10194-021-01298-4

Caroline Frost September 2021