Based on this review, the following four expert opinions were presented:
- Physical therapy is more effective than massage therapy or acupuncture for the treatment of tension-type headache and appears to be most beneficial for patients with a high frequency of headache attacks.
- Physical therapy is most effective for the treatment of migraine when combined with other treatments, such as thermal biofeedback, relaxation training and exercise.
- Chiropractic manipulation demonstrated a trend towards benefit in the treatment of tension-type headache, but evidence is weak. Chiropractic manipulation is probably more effective in the treatment of tension-type headache than it is in the treatment of migraine.
- In general, strong evidence is lacking regarding the efficacy of these treatments in reducing headache frequency, intensity, duration and disability in many commonly encountered clinical situations.
The report further suggests that many of the published case series and controlled studies are of low quality; that physical treatments are unlikely to pose a significant risk, with the exception of high velocity chiropractic manipulation of the neck. And that in most cases, the use of physical modalities should complement rather than replace better validated forms of therapy, given the absence of high quality research.