Introduction: Tension -type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension -type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension -type headache. Development: We conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients' well-being and improving the outcome measures analysed. Conclusions: Manual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension -type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach. 2018 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC -ND license (http://creativecommons.org/ticenses/by-nc-nd/ 1.00.