Pharmacological and Non-Pharmacological approaches to manage Tension-Type Headache: a Systematic Review

Tension-Type Headaches (TTH), particularly in its chronic form, constitutes a persistent pain syndrome that can substantially impair physical, cognitive, emotional, and social functioning. Although this is the most common type of headache, there is a lack of clear consensus on the optimal long-term treatment strategy.

A systematic review was conducted to evaluate the evidence for the effectiveness of pharmacological and non-pharmacological treatments in patients diagnosed with episodic or chronic TTH, focusing on improvements in headache pain and related clinical outcomes.

A search across five electronic databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL, and PsycNET) was conducted to identify randomized clinical trials (RCTs). The review was registered in PROSPERO, followed PRISMA guidelines and used the Cochrane Risk of bias 2 tool. Due to significant clinical and methodological heterogeneity, a narrative synthesis was performed following the Synthesis Without Meta-analysis (SWiM) framework, and the certainty of evidence was appraised using the GRADE approach.