Pharmacological and Non-Pharmacological approaches to manage Tension-Type Headache: a Systematic Review.

INTRODUCTION

Tension-Type Headaches (TTH), particularly in its chronic form, constitutes a persistent pain syndrome that can substantially impair physical, cognitive, emotional, and social functioning. Although this is the most common type of headache, there is a lack of clear consensus on the optimal long-term treatment strategy.

OBJECTIVES

A systematic review was conducted to evaluate the evidence for the effectiveness of pharmacological and non-pharmacological treatments in patients diagnosed with episodic or chronic TTH, focusing on improvements in headache pain and related clinical outcomes.

METHODS

A search across five electronic databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL, and PsycNET) was conducted to identify randomized clinical trials (RCTs). The review was registered in PROSPERO, followed PRISMA guidelines and used the Cochrane Risk of bias 2 tool. Due to significant clinical and methodological heterogeneity, a narrative synthesis was performed following the Synthesis Without Meta-analysis (SWiM) framework, and the certainty of evidence was appraised using the GRADE approach.

RESULTS AND

CONCLUSIONS

Ninety-three RCTs were included, most of which had a moderate to low risk of bias. Based on the findings of this systematic review, the evidence suggests that pharmacological, manual, and behavioral therapies each have specific indications. These approaches can be combined in an individualized manner according to each patient's needs, with the aim of maximizing long-term symptom reduction, minimizing side effects, and ultimately improving quality of life in individuals with TTH.