Non-invasive physical treatments for chronic/recurrent headache

G Bronfort, N Nilsson, M Haas, R Evans, CH Goldsmith, WJJ Assendelft, LM Bouter

The objective of this study was to quantify and compare the magnitude of short- and long-term effects of non-invasive physical treatments for chronic/recurrent headaches.  Randomized and quasi-randomized controlled trials comparing non-invasive physical treatments for chronic/recurrent headaches to any type of control were included.  Twenty-two studies with a total of 2628 patients (age 12 to 78 years) met the inclusion criteria. Five types of headache were studied: migraine, tension-type, cervicogenic, a mix of migraine and tension-type, and post-traumatic headache. The results showed that spinal manipulation, exercise and amitriptyline may be an effective treatment option.  Other possible treatment options with weaker evidence of effectiveness are therapeutic touch; cranial electrotherapy; a combination of TENS and electrical neurotransmitter modulation; and a regimen of auto-massage, TENS, and stretching. The authors conclude that based on trial results, these treatments appear to be associated with little risk of serious adverse effects. The clinical effectiveness and cost-effectiveness of non-invasive physical treatments require further research using scientifically rigorous methods.

Cochrane Database of Systematic Reviews 2006 Issue 4

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