https://orcid.org/0000-0002-5903-8842
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Qing-Feng Tao, Can Hua, Di Qin, Chao-Rong Xie, Yun-Zhou Shi, Min Chen, Hui Zheng, Disentangling preventive effects of differential exercise types on tension-type headache: a component network meta-analysis of randomized controlled trials, Postgraduate Medical Journal, 2025;, qgaf055, https://doi.org/10.1093/postmj/qgaf055
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Abstract
The effectiveness of exercise for tension-type headache (TTH) is unclear because of the complexity of exercise regimens—usually the combination of different types of exercise. We aimed to estimate the effectiveness of exercise for TTH and to test the incremental effect of each type of exercise by component network meta-analysis (CNMA).
We searched Ovid Medline, Embase, and the Cochrane Library from database inception to 25 December 2023, and a supplementary search was conducted on 10 February 2025. We included randomized controlled trials of exercise, including aerobic, resistance, and stretching exercise, in adults with TTH. The primary outcome was headache frequency, and secondary outcomes were headache intensity and medication use.
Twelve trials with 759 participants were included. There were no significant differences between exercise and usual care in reducing headache frequency at the end of treatment with very low certainty evidence (mean difference [MD] −2.30, 95% [confidence interval] CI −8.86 to 4.26), while CNMA suggested that resistance exercise significantly reduced headache frequency (incremental mean difference [iMD] −6.00, 95% CI −9.10 to −2.90) and stretching exercise increased headache frequency (iMD 4.60, 95% CI 1.20 to 8.00). Exercise was better than usual care in reducing headache intensity (MD −2.29, 95% CI −3.23 to −1.34); the CNMA suggested that no single type of exercise had the greatest effect.
Resistance exercise could be considered an effective and accessible treatment for patients with TTH. But our study was limited by heterogeneity and inconsistency of results, and more studies are warranted.
What is already known on this topic
At present, the treatment of tension-type headache (TTH) primarily relies on medications, which, however, comes with significant side effects and a considerable economic burden.
Exercise has been utilized in the management of TTH, yet there is a lack of comprehensive synthesis and analysis to substantiate its efficacy.
Existing studies often combine various forms of exercise, and the specific effects of different exercise modalities on TTH remain unclear.
What this study adds
Our network meta-analysis found that exercise had a larger effect size than usual care in reducing headache intensity.
Our component network meta-analysis suggested that resistance exercise can significantly reduce headache frequency, and stretching exercise can increase headache frequency.
How this study might affect research, practice, or policy
This study provides evidence supporting the recommendation of exercise, particularly resistance exercise, in primary care for the management of TTH.
