Efficacy of Osteopathic Manipulative Treatment on Headache Frequency and Intensity in Patients with Tension-Type Headaches: A Systematic Review and Meta-analysis Fadia Barakzai, Arwa Khadr, Heba Farhan

Introduction: Tension-Type Headache (TTH) is one of the most common types of headache with a prevalence of 38.2%.1 TTH is defined as the presence of a pressing and bilateral sensation with mild to moderate pain intensity.2 The pain is in a band-like fashion from the forehead to the occiput.3 Age of onset for TTH is between 20-23 years old and common triggers include sleep disturbances and stress.3 TTH lasts for about 30 minutes to 24 hours and does not typically accompany photophobia, or aura.3 TTH is commonly self-treated with over the counter medication such as NSAIDs, and analgesics.3,4 Overuse of NSAIDs have been shown to have many side effects such as, acute kidney injury (AKI) and upper gastrointestinal peptic ulcer disease and bleeding.5,6 Osteopathic Manipulative Treatment (OMT) have shown to improve headaches by correcting the somatic dysfunction through releasing myofascial and structural restrictions and improving lymphatic flow.7 Objective: to assess the efficacy of OMT versus control in the treatment of TTH for reducing headache frequency and intensity.

Methods: This systematic review and meta-analysis was conducted utilizing the PRISMA 2020 guidelines (Figure.1).8 Electronic search was conducted through PubMed, Embase, Scopus, Cochrane, and Web of Science. Relevant articles published from inception until June 10, 2024, were searched using a combination of keywords and medical subject heading (MeSH) terms, including “tension headache”, “frequency”, “intensity”, and “OMT”. Mean and standard deviation were extracted to perform a random-effects meta-analysis using SPSS. Primary outcomes included headache frequency and intensity. Secondary outcomes included quality of life, and over the counter medication use. Inclusion criteria were RCTs comparing OMT to control for the treatment of TTH. Articles that did not involve OMT or the relevant headache type were excluded. Non-randomized trials and duplicate studies were also excluded.

Results: The number of days with headache per month decreased by 6.2 (2.4) mean (SD) days in the OMT group compared to 2.8 (0.7) days in the control group, (p= 0.01). The mean difference in frequency reduction was 4.2 days (95% CI = 3.1 to 5.3, p < 0.001). There was no difference in headache intensity between OMT and control groups. The mean difference in headache intensity reduction was 0.6 points (95% CI = -0.3 to 1.4, p = 0.10). A reduction in medication use was observed in the OMT group compared to control (MD = -1.88, 95% CI = -1.93 to -1.11, p = .001). Patients receiving OMT reported improved quality of life scores (MD = 1.81, 95% CI = 0.89 to 4.01, p = .02) compared to control.

Discussion: OMT significantly reduced headache frequency although it did not statistically show improvement in headache intensity. The overall decrease in the occurrence of headaches after OMT suggests that OMT is an effective treatment intervention for TTH. OMT for TTH significantly reduced the use of OTC medications which suggest that OMT can be used as a non-pharmacological approach to headache management. This can reduce the dependence on OTC medications for symptom relief and it can reduce the side effects associated with the use of some OTC medications. OMT significantly improved the quality of life for patients with TTH. This suggests that OMT addresses both the physical and psychological aspects of a patient’s life.

Conclusions: OMT is an effective treatment intervention for TTH. OMT significantly reduced headache frequency, improved quality of life, and reduced over-the-counter medication use in patients suffering from TTH. OMT did not have a significant effect on headache intensity. Additional RCTs are needed to confirm these findings and inform clinical practice.

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