Reviewed by Mark Boyland PT, DPT, CSCS

Physical Therapists can assist with many patient complaints, and this also includes headaches.  This review specifically focused on tension type headaches but there are several headache types.  Tension type headaches are classified as headaches which present on both of sides of the head, are non pulsing, mild to moderate intensity, don’t get worse with motion, or may be associated with nausea/vomiting depending on how long you’ve had tension type headaches.  Also, those who have tension type headaches may also present with light/noise sensitivity but not both at the same time.  Those who have tension type headaches may have at least 10 episodes per year with duration of headaches lasting 30 minutes to 7 days.  In short headaches aren’t a pleasant experience especially if they can last upwards of 7 days.  Despite our ability to classify headaches we are not exactly sure what causes them which makes treating them a challenge.  This review found exactly that, and that while there is no treatment standard in physical therapy for tension type headaches interventions that address the neck, jaw, and thoracic spine are common treatment trends.  Not having a standard of treatment provides benefits for our patients as we can customize your treatment plan based on your preferences and dysfunctions as opposed to a cookie cutter model.

This systematic review examined the available trials and found that treatments benefits were divided into short, medium, and long term.  While there was no definition provided for short term effects, medium term was defined between 8 weeks and 3 months, and long term was defined as beyond 36 weeks. Treatment interventions included manual therapy including myofascial release of cervical tissues, joint mobilization/manipulation of the cervical and thoracic spine, as well as progressive relaxation of the jaw and cervicothoracic musculature which included patient education as well as other modalities. 

With al this said many of the interventions studied had improvements in headache frequency and intensity which is again a good thing for out patients. Unfortunately due to the nature of randomized control trials and systematic reviews the quality of evidence was low for several of the randomized control trials and that no specific recommendations can be made based on their findings.  This is the joy of research.  However ,with all this said, while many can have tension type headaches, not all symptoms and dysfunctions are the same between all patients and therefore our treatments should be tailored to our patients.

Patient summary: Your therapist will likely address your neck, midback, and jaw during your sessions.  You should expect interventions to include manual therapy including soft tissue and joint mobilization will be applied.  There’s also going to be some exercises including relaxation, mobilization, and stabilization will be included.