Physical Treatments Reduce Pain in Children with Tension-Type Headache: A Systematic Review and Meta-Analysis.

Tension-type headache is common in children, and physiotherapists and parents often want to know whether physical treatments, rather than medication, can help. This review pooled findings from 17 controlled trials involving 1,815 children, comparing various physical treatments against placebo, no treatment, or another active comparison, with 11 of these trials contributing to the pooled statistical analysis. Overall, physical treatments were associated with more than double the likelihood of at least a 50% reduction in pain compared with control conditions. Relaxation training, the most frequently studied approach, showed a notably strong effect, and occlusal appliances (mouth splints) appeared helpful specifically in children who had tension-type headache alongside jaw joint problems.

The certainty of this evidence was rated moderate overall, and because comparisons often involved no treatment or attention-limited controls, some of the benefit may reflect increased contact or expectation rather than the treatment itself.

If your child has tension-type headaches, you may wonder whether things like relaxation exercises or physical therapies could help, separate from pain medicine. A group of researchers gathered results from 17 studies involving more than 1,800 children to look at exactly this question, testing different physical treatments against doing nothing, a placebo, or another comparison approach. The combined results were encouraging: children given physical treatments were substantially more likely to have their pain reduced by half or more, compared with children in control groups.

Relaxation training, the most-studied treatment, stood out as particularly helpful, and for children whose headaches occurred alongside jaw problems, a dental appliance also showed benefit. The evidence supporting these findings was rated as moderate quality, meaning it's fairly trustworthy but not the strongest possible. It's also worth knowing that some children in these studies received extra attention or care simply by taking part, which could account for part of the improvement seen, not just the treatment itself.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

For clinicians managing paediatric tension-type headache, a recurring question is whether physical interventions add measurable value beyond reassurance or usual care. This systematic review and meta-analysis, drawing on 17 randomised and non-randomised controlled trials (1,815 participants, with 11 trials contributing to pooled analyses), found that physical treatments were associated with a risk ratio of 2.37 (95% CI: 1.69 to 3.33) for achieving a 50% or greater reduction in pain compared with control conditions. Relaxation training was the most extensively evaluated modality and produced the strongest pooled effect (RR: 3.00, 95% CI: 1.94 to 4.63).

In the subset of children with concurrent temporomandibular disorder, occlusal appliances also showed a significant effect (RR: 2.58, 95% CI: 1.37 to 4.85). These are subgroup or intervention-specific findings within the broader pooled result, not evidence that combining treatments confers additional benefit, and the abstract does not establish that one intervention outperformed another head-to-head. The overall evidence quality was graded moderate using GRADE criteria.

Because many trials compared active treatment against no intervention or placebo rather than an attention-matched control, nonspecific effects such as therapist contact or expectation cannot be excluded as contributors to the observed pain reduction.