The effectiveness of physiotherapy and manipulation in patients with tension‐type headache: a systematic reviewLenssinck, Marie‐Louise B.a; Damen, Léoniea,*; Verhagen, Arianne P.a; Berger, Marjolein Y.a; Passchier, Janb; Koes, Bart W.aPain: December 2004 - Volume 112 - Issue 3 - p 381–388 doi: 10.1016/j.pain.2004.09.026 Article Abstract Author Information The study design is a systematic review of randomised clinical trials (RCTs). The objectives of the present study are to assess the effectiveness of physiotherapy and (spinal) manipulation in patients with tension‐type headache (TTH). No systematic review exists concerning the effectiveness of physiotherapy and (spinal) manipulation primarily focussing on TTH. Literature was searched using a computerised search of MEDLINE, EMBASE and the Cochrane library. Only RCTs including physiotherapy and/or (spinal) manipulation used in the treatment of TTH in adults were selected. Two reviewers independently assessed the methodological quality of the RCTs using the Delphi‐list. A study was considered of high quality if it satisfied at least six points on the methodological quality list. Twelve publications met the inclusion criteria, including three dual or overlapping publications resulting in eight studies included. These studies showed a large variety of interventions, such as chiropractic spinal manipulation, connective tissue manipulation or physiotherapy. Only two studies were considered to be of high quality, but showed inconsistent results. Because of clinical heterogeneity and poor methodological quality in many studies, it appeared to be not possible to draw valid conclusions. Therefore, we conclude that there is insufficient evidence to either support or refute the effectiveness of physiotherapy and (spinal) manipulation in patients with TTH. aDepartment of General Practice, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands bDepartment of Medical Psychology and Psychotherapy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands *Corresponding author. Tel.: +31 10 463 2135; fax: +31 10 463 2127. E‐mail: email@example.com Submitted March 31, 2004; revised July 29, 2004; accepted September 17, 2004. © 2004 Lippincott Williams & Wilkins, Inc.