The Efficacy of Structured Exercise Program Versus Aerobic Exercise in Tension-Type Headache: A Randomised Clinical Trial

Background: Despite the widespread use of exercise in managing tension-type headache, there remains a lack of research on the effectiveness of combined structured exercise programs. The aim of this study was to investigate the effects of a structured exercise program versus aerobic exercise of equal duration on tension-type headache (TTH). Methods: Fifty-four female participants aged between 18 and 55 years were randomised to receive a 12-week exercise program, conducted twice a week for 45 min per session. The Structured Exercise Group (SEG) participated in a combination of aerobic, strengthening, and stretching exercises, whereas the Aerobic Exercise Group (AEG) performed only aerobic exercises. The primary outcome measure was the Headache Impact Test (HIT-6), a quality-of-life questionnaire. Secondary outcome measures included headache intensity, disability level, pressure pain threshold, proprioception, muscle strength, cervical posture, exercise capacity, anxiety, and depression. Results: Both groups showed statistically significant improvements in quality of life, pain intensity, disability, anxiety, depression, exercise capacity, pressure pain threshold, and proprioception (p < 0.05). Between-group comparisons revealed that the SEG demonstrated significantly greater improvements in quality of life, pressure pain threshold, proprioception, muscle strength, and posture (p < 0.05), whereas the AEG showed superior gains in exercise capacity (p < 0.05). Conclusion: Both exercise programs appear similarly effective for self-reported outcomes. Based on clinical measurement results, we recommend incorporating strengthening and stretching exercises into the aerobic exercise program and extending the duration to 12 weeks for additional benefits. Significance Statement: This study highlights the clinical value of supervised, physiotherapist-led exercise and the integration of personalised, multi-component strategies in managing tension-type headache. While both structured and aerobic programs improved pain, activity, and participation, the structured approach provided additional benefits in pressure pain threshold, proprioception, muscle strength, and posture. Tailoring interventions to individual clinical needs and extending the duration beyond 8 weeks may further enhance outcomes.