In recent years, there has been an increasing knowledge in the pathogenesis and better management of chronic
headaches. Current scientific evidence supports the role of
manual therapies in the management of tension type and
cervicogenic headache, but the results are still conflicting. These inconsistent results can be related to the fact that maybe not all
manual therapies are appropriate for all types of
headaches; or maybe not all patients with
headache will benefit from
manual therapies. There are preliminary data suggesting that patients with a lower degree of sensitization will benefit to a greater extent from
manual therapies, although more studies are needed. In fact, there is evidence demonstrating the presence of peripheral and central sensitization in
chronic headaches, particularly in tension type. Clinical management of patients with
headache needs to extend beyond local tissue-based pathology, to incorporate strategies directed at normalizing central nervous system sensitivity. In such a scenario, this paper exposes some examples of
manual therapies for tension type and
cervicogenic headache, based on a
nociceptive pain rationale, for modulating central nervous system
hypersensitivity: trigger point
therapy, joint mobilization, joint manipulation, exercise, and cognitive
pain approaches.