It was with great interest that we read the article published by Lozano López et al.,1 which presents a systematic review of the literature supporting manual therapy as an effective alternative pain relief technique in patients with tension-type headache (TTH). The most frequently used manual therapy techniques in the analysed studies were joint treatment, soft tissue mobilisation techniques, and muscle exercises.2 Although these techniques have been shown to have a positive effect on TTH, the heterogeneity of patients’ symptoms has not permitted the adoption of a standard protocol with a specific technique. In fact, many of these studies report better results when combining 2 or more manual techniques.3 We agree that the diversity of interventions does not allow us to determine which technique was the most effective for TTH. In our view, however, results are significant in that applying these techniques decreased not only pain intensity but also headache frequency.4
Although the true cause of TTH is still to be determined, the frequent co-presence of such symptoms as trigger points in the head and neck,5 cervical rigidity, and inhibition of local stabilising muscles underscores the need for a manual therapy programme addressing each of the many problems associated with TTH.
Manual therapy is a widespread treatment approach in some countries. However, in Peru and other countries in which manual therapy is a new specialty, treatment protocols for TTH are usually limited to pharmacological treatment and do not include physiotherapeutic management of the symptoms associated with TTH. Increasing numbers of manual therapists and further studies of manual therapy will be necessary to generate evidence and draw conclusions about the usefulness of this technique for managing TTH and associated symptoms.
Conflicts of interestThe authors of this letter have no conflicts of interest to declare.
The authors would like to thank their families for their support during medical training.
Please cite this article as: Caballero-Calixto L, Antón-Puescas P, Reyna-Ormeño J. Efecto de la terapia manual en la cefalea tensional. Neurología. 2017;32:201–202.
