Abstract
BACKGROUND: To assess the efficacy of psychological interventions for Tension-Type Headache (TTH) via a systematic review and meta-analysis. METHODS: PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to June 2025 for randomized controlled trials (RCTs) comparing psychological interventions with controls in patients with TTH. The primary outcome was the number of headache days per month, while secondary outcomes were headache intensity and the treatment response rate. The second version of the Cochrane Risk-of-Bias Tool (RoB 2.0) was used to assess the risk of bias, and GRADE was used to assess the quality of evidence. RESULTS: Nineteen studies with 1069 participants were included. For the primary outcome, psychological interventions reduced the number of headache days per month compared to controls (5 studies, MD=-4.53, 95% CI: -5.52 to -3.54, p < 0.01, I(2) = 35%), with moderate-quality evidence. For secondary outcomes, the treatment response rate was higher in the intervention group (7 studies, RR = 2.43, 95% CI: 1.32 to 4.48, p < 0.01, I²=41%). Psychological interventions also decreased headache intensity compared to controls (10 studies, MD=-1.88, 95% CI: -2.72 to -1.04, p < 0.01, I²=93%). Subgroup analysis of headache intensity indicated significant differences between interventions (P = 0.01), suggesting effect heterogeneity across psychological modalities. CONCLUSIONS: Psychological interventions effectively reduce the number of headache days, headache intensity, and improve response rates in TTH. Psychological interventions are an effective non-pharmacological approach for managing TTH, although heterogeneity in some outcomes warrants further high quality trials.