Manual therapy and quality of life in people with headache: systematic review and meta-analysis of randomized controlled trials

Key points

1. 01Pooled results from randomized trials favored manual therapy over usual care or placebo on headache-related quality of life.
2. 02Benefits were clearest for tension-type headache and migraine, while cervicogenic headache results were inconsistent.
3. 03Improvements were measured on general headache-impact tools rather than disease-specific quality-of-life scales.
4. 04GRADE certainty was rated very low, mostly because the trials were small and at risk of bias.
5. 05Authors call for future trials using disease-specific quality-of-life outcomes.

How it was conducted

Design

Systematic review and meta-analysis of randomized controlled trials, following PRISMA

Databases

MEDLINE, Cochrane, and PEDro

Comparison

Manual therapy versus usual care or placebo

Outcomes

Health-related quality of life via HIT-6, HDI, MIDAS, and SF-12/36

Quality appraisal

Cochrane Risk of Bias and GRADE certainty rating

Studies included

10 RCTs identified, 7 pooled in meta-analysis

What they found

• On the HIT-6, manual therapy showed a significant mean difference favoring treatment of -3.67 post-treatment and -2.47 at follow-up.
• On the HDI, manual therapy showed a significant mean difference of -4.01 post-treatment and -5.62 at follow-up.
• Results on the other scales (including MIDAS and SF-12/36) were inconclusive.
• Cervicogenic headache findings were inconsistent across trials.

Limitations

• Overall certainty of evidence was rated very low by GRADE.
• Only 7 of the 10 included trials could be pooled in the meta-analysis.
• Benefits were captured on general headache-impact tools, not disease-specific quality-of-life measures.
• Included trials were small and at risk of bias, limiting confidence in the effect sizes.

Why it matters

For patients

If you have tension-type headache or migraine, hands-on physiotherapy may modestly improve how much headaches affect your daily life, but it is not a guaranteed fix.

For clinicians

Manual therapy can be considered as an adjunct for tension-type headache and migraine quality of life, while recognizing the evidence is very low certainty and weakest for cervicogenic headache.

For readers

Early pooled evidence points toward a small quality-of-life benefit from manual therapy in headache, pending higher-quality trials with disease-specific outcomes.