Mesa-Jiménez Juan A, Lozano-López Cristina, Angulo-Díaz-Parreño Santiago, Rodríguez-Fernández Ángel L, De-la-Hoz-Aizpurua Jose L, Fernández-de-Las-Peñas Cesar
Department of Physical Therapy, Universidad San-Pablo CEU, Spain Máster Oficial en Dolor Orofacial y Disfunción Cráneo-Mandibular, Universidad San-Pablo CEU, Spain.
Máster Oficial en Dolor Orofacial y Disfunción Cráneo-Mandibular, Universidad San-Pablo CEU, Spain.
Cephalalgia. 2015 Dec;35(14):1323-32. doi: 10.1177/0333102415576226. Epub 2015 Mar 6.
Manual therapies are generally requested by patients with tension type headache.
To compare the efficacy of multimodal manual therapy vs. pharmacological care for the management of tension type headache pain by conducting a meta-analysis of randomized controlled trials.
PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, PEDro and SCOPUS were searched from their inception until June 2014. All randomized controlled trials comparing any manual therapy vs. medication care for treating tension type headache adults were included. Data were extracted and methodological quality assessed independently by two reviewers. We pooled headache frequency as the main outcome and also intensity and duration. The weighted mean difference between manual therapy and pharmacological care was used to determine effect sizes.
Five randomized controlled trials met our inclusion criteria and were included in the meta-analysis. Pooled analyses found that manual therapies were more effective than pharmacological care in reducing frequency (weighted mean difference -0.8036, 95% confidence interval -1.66 to -0.44; three trials), intensity (weighted mean difference -0.5974, 95% confidence interval -0.8875 to -0.3073; five trials) and duration (weighted mean difference -0.5558, 95% confidence interval -0.9124 to -0.1992; three trials) of the headache immediately after treatment. No differences were found at longer follow-up for headache intensity (weighted mean difference -0.3498, 95% confidence interval -1.106 to 0.407; three trials).
Manual therapies were associated with moderate effectiveness at short term, but similar effectiveness at longer follow-up for reducing headache frequency, intensity and duration in tension type headache than pharmacological medical drug care. However, due to the heterogeneity of the interventions, these results should be considered with caution at this stage.
紧张型头痛患者通常会要求进行手法治疗。
通过对随机对照试验进行荟萃分析，比较多模式手法治疗与药物治疗在缓解紧张型头痛疼痛方面的疗效。
检索了PubMed、MEDLINE、EMBASE、AMED、CINAHL、EBSCO、Cochrane系统评价数据库、Cochrane协作试验注册库、PEDro和SCOPUS，检索时间从各数据库建库至2014年6月。纳入所有比较任何手法治疗与药物治疗对成年紧张型头痛患者疗效的随机对照试验。由两名评价者独立提取数据并评估方法学质量。我们将头痛频率作为主要结局指标，同时纳入强度和持续时间。采用手法治疗与药物治疗之间的加权平均差来确定效应量。
五项随机对照试验符合我们的纳入标准，并被纳入荟萃分析。汇总分析发现，手法治疗在降低治疗后即刻头痛的频率（加权平均差-0.8036，95%置信区间-1.66至-0.44；三项试验）、强度（加权平均差-0.5974，95%置信区间-0.8875至-0.3073；五项试验）和持续时间（加权平均差-0.5558，95%置信区间-0.9124至-0.1992；三项试验）方面比药物治疗更有效。在更长随访期内，头痛强度方面未发现差异（加权平均差-0.3498，95%置信区间-1.106至0.407；三项试验）。
手法治疗在短期内具有中等疗效，但在更长随访期内，与药物治疗相比，在降低紧张型头痛的频率、强度和持续时间方面疗效相似。然而，由于干预措施的异质性，现阶段应谨慎看待这些结果。
