PURPOSE: To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type headache (TTH). METHODS: Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized controlled trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and standardized mean differences (SMD) were calculated for meta-analysis. RESULTS: Fifteen studies were included with a total sample of 1,131 individuals. High velocity and low amplitude techniques were not superior to no treatment on reducing pain intensity (SMD 0.01, low evidence) and frequency (SMD -0.27, moderate evidence). Soft tissue interventions were superior to no treatment on reducing pain intensity (SMD -0.86, low evidence) and frequency of pain (SMD -1.45, low evidence). Dry needling was superior to no treatment on reducing pain intensity (SMD -5.16, moderate evidence) and frequency (SMD -2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache. CONCLUSION: Manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache.

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