Conservative treatments of children with episodic tension–type headache

We aimed to assess the effectiveness of conservative treatments in children with tension–type headaches (TTH). We searched Medline, Embase and the Cochrane Library and performed reference checking. Two independent authors assessed trial quality and extracted data. Analysis was carried out according to type of intervention. In total we included 11 trials (427 TTH patients, age between 7–18 years) in this review. None of the studies were considered to be of high quality. Eight studies evaluated the effectiveness of relaxation training. Four studies included a waiting list or no treatment control group and in one study a placebo was used. We found conflicting evidence about the effectiveness of relaxation therapy when compared with no treatment or other treatments, with Relative Risks varying from 1.4 (0.6–3.2) to 10.6 (1.6–71.3). With regard to all other interventions evaluated (such as biofeedback, cognitive therapy or flupirtin) no evidence is found for or against their effectiveness.