BACKGROUND: There has been a lot of research on physical therapy for tension-type headaches. However, the efficacy of physical therapy on the suboccipital region remains unclear. OBJECTIVE: To establish the effectiveness of physical therapy on the suboccipital area of patients with tension-type headache. METHODS: Databases including the Cochrane Library, Medline/PubMed, CNKI, Embase, and Google Scholar were searched. After independent study selection by 2 authors, data were extracted and collected independently. On 1 hand, authors compared the treatment of the suboccipital area with control group. On the other hand, the efficacy of several physical therapy techniques on the suboccipital region was compared. The quality of the included studies was assessed using the Cochrane Handbook. RevMan 5.3 software was used for data analysis. The primary outcome measures were the cervical range of motion, the visual analog scale, and headache disability inventory. RESULTS: Six randomized controlled trials with a total of 505 participants were included. Suboccipital soft-tissue inhibition technique (SIT) plus occiput-atlas-axis global manipulation (OAA) was more effective than SIT in increasing craniocervical extension at 4 weeks post-treatment, the overall mean differences (MD) was 3.61, 95% confidence interval (CI) 0.89 to 6.34. There was no difference at 8 weeks post-treatment (MD 2.38, 95% CI -1.02 to 5.78, p = 0.17). SIT was more effective than SIT+OAA in increasing cervical flexion at 4-week post-treatment (MD -3.36, 95% CI -6.65 to -0.05). SIT+OAA was more effective than SIT on decreasing intensity of pain at 4-week post-treatment (MD -0.91, 95% CI -1.78 to -0.04), but no difference at 8-week (MD -0.43, 95% CI -1.18 to 0.33, p = 0.27). SIT + OAA was more effective than SIT in reducing the functional score of the headache disability inventory at 4-week post-treatment (MD -4.47, 95% CI -8.44 to -0.50). These results may indicate that the SIT+OAA combined therapy is more effective in short term (4-week), no major difference in longer term (8-week). CONCLUSION: Combined therapy may be more suitable for the treatment of tension-type headache.

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