The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

EHMTI-0091. Physiotherapy interventions for headaches: a systematic review and meta-analysis

  • K Luedtke1 and
  • A May1
The Journal of Headache and Pain201415(Suppl 1):D38

Published: 18 September 2014


MigrainePain IntensityPhysical TreatmentMultidisciplinary InterventionPool Effect


Headaches are a common condition with high socioeconomic impact.

Guidelines recommend medication but rarely include physiotherapy. However, patients report pain relief from exercises, mobilisation and massage. A systematic review with a literature search up to 11/2002 concluded that physical treatments may be effective but that further research might change this result.


To evaluate the current level of evidence for physiotherapy on headache symptoms.


Search strategy with pre-defined key terms conducted in MEDLINE, CENTRAL, PeDRO, reference lists of retrieved articles, and journal contents. Controlled trials, employing physiotherapy interventions for the reduction of headaches published in any language between 11/2002 and 04/2014 were included. Studies using chiropractic, osteopathic or acupuncture techniques were excluded. Quality was evaluated using the Cochrane risk of bias tool.


Twenty-two trials were eligible, 19 reported outcome measures allowing combination in a meta-analysis. Physiotherapy included mobilisation, exercises, relaxation, massage, and physiotherapy as part of a multidisciplinary intervention. Headache types included migraine, TTH, CGH and mixed/undefined headache populations. A meta-analysis for pain reduction found a pooled effect size of -9.97 on a 0-100 VAS (95%CI -18.55; -1.38). Frequency was reduced by -2.78 days/months (95%CI -4.69; -0.87), duration by -7.52 hours/attack (95%CI -10.49; -4.55). Sub-analyses indicated effectiveness for the reduction of pain intensity, frequency and duration of migraine, TTH, CGH and mixed/undefined headache populations.


There is a high level of evidence that physiotherapy is effective for headache reduction. Physiotherapy is low-cost has no side-effects and potentially reduces medication use and work absenteeism.

No conflict of interest.

Authors’ Affiliations

Institute of Systems Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany


© Luedtke and May; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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