Background: The effectiveness of Mulligan manual therapy has been investigated in cervicogenic headache but not in tension-type headache (TTH).

Objective: To compare the effectiveness of exercise + Mulligan manual therapy over exercise or exercise + sham in episodic TTH.

Methods: Using a randomized clinical trial design, 99 subjects with episodic TTH received six sessions of allocated intervention over 4 weeks. Headache frequency, intensity, duration, medication intake, disability, upper cervical rotation, pressure-pain thresholds, and patient satisfaction were assessed at baseline, 4 weeks, 3, and 6 months.

Results: Headache frequency reduced significantly in group exercise + Mulligan manual therapy compared to group exercise post-intervention (MD -1.0 day, 95% CI -2.0 to -0.0) (p = .002), and at 3-month follow-up (MD -1 days, 95% CI -2.0 to 0.0) (p = .002), but only at post-intervention compared to group exercise + sham (MD 1.0 day, 95% CI 0.0 to 2.0) (p = .008). The clinical relevance is unclear as between-group differences did not reach a clinical threshold. No difference was observed at 6 months (p > .17). A similar trend was observed for other outcomes. There was no difference between groups exercise and exercise + sham for any outcome (p > .17).

Conclusion: In episodic TTH, exercise + Mulligan manual therapy provided short-term clinically uncertain improvements in headache parameters. These results differ to studies of cervicogenic headache. Unsuitability of Mulligan manual therapy for underlying pathophysiological mechanisms in episodic TTH may explain these results. Practitioners should consider Mulligan manual therapy for selected patients and only as part of evidence-based multimodal management of episodic TTH.

Trial registration: CTRI/2019/06/019506.

Keywords: Episodic tension-type headache; Mulligan manual therapy; headache; manual therapy; mobilization.

背景：Mulligan 手法治疗在颈源性头痛中的有效性已被研究，但尚未在紧张型头痛（TTH）中进行过研究。

目的：比较运动 + Mulligan 手法治疗与单独运动或运动 + 假疗法对发作性 TTH 的效果。

方法：采用随机临床试验设计，99 名患有发作性 TTH 的受试者接受了为期 4 周的六次分配干预。在基线、4 周、3 个月和 6 个月时评估头痛频率、强度、持续时间、药物摄入量、残疾程度、上颈椎旋转范围、压力痛阈值以及患者满意度。

结果：与单独运动组相比，运动 + Mulligan 手法治疗组在干预后头痛频率显著减少（MD -1.0 天，95% CI -2.0 至 -0.0）(p = .002)，并在 3 个月随访时也减少了 (MD -1 天, 95% CI -2.0 至 0.0) (p = .002), 但仅在干预后与运动 + 假疗法组相比有所减少（MD 1.0 天，95% CI 0.0 至 2.0）(p = .008)。由于组间差异未达到临床阈值，其临床意义尚不清楚。6 个月时没有观察到差异 (p > .17)。其他结果也显示出类似的趋势。对于任何结果而言，运动组和运动 + 假疗法组之间无显著差异（p > .17）。

结论：在发作性 TTH 中，运动 + Mulligan 手法治疗提供了短期的、临床意义不确定的头痛参数改善。这些结果不同于对颈源性头痛的研究结果。Mulligan 手法治疗对于发作性 TTH 的潜在病理生理机制不适用可能是导致这些结果的原因。从业人员应考虑为特定患者选择性地使用 Mulligan 手法治疗，但仅作为证据支持的多模式治疗方案的一部分。

试验注册：CTRI/2019/06/019506.

关键词：发作性紧张型头痛；Mulligan 手法治疗；头痛；手法治疗；松动术。