Clinical features of manual therapy interventions in people with tension-type headache: A scoping review

BACKGROUND: Tension-type headache is the most prevalent primary headache, often managed with manual therapy. However, intervention protocols vary widely, and the clinical rationale is often unclear. OBJECTIVE: This scoping review aimed to map the characteristics of manual therapy interventions applied in randomized controlled trials for tension-type headache. METHODS: A comprehensive search was conducted across PubMed, Embase, Scopus, and Web of Science. The last search was performed on September 14, 2025. The protocol was prospectively registered in the Open Science Framework (OSF registration: https://osf.io/w7xs5). Trials involving manual therapy for adults with tension-type headache were included. Data were extracted on intervention type, dosage, target structures, therapist background, and outcomes. RESULTS: Thirty-three trials involving 1852 participants were included. Manual therapy techniques ranged from spinal manipulation and myofascial release to suboccipital inhibition and friction massage. Treatment dosage varied considerably in frequency and duration. Most studies targeted cervical or suboccipital structures, with few addressing temporomandibular or postural components. Considerable variability was also observed in outcome measures. CONCLUSION: The review highlights the diversity of manual therapy techniques, targeted structures, treatment dosages, and therapist backgrounds in the management of tension-type headache. The heterogeneity and limited mechanistic rationale in the included studies restrict interpretability. Future research should focus on mechanism-informed, individualized interventions with standardized reporting.