Efficacy of conservative physiotherapeutic approaches in hormonal-related headaches: a scoping review protocol
Authors: Yousif Marzia Stella , Bagnoli Cecilia , Innocenti Tiziano , Bizzarri Paolo 
Published: January 2022

ABSTRACTIntroductionHeadache is one of the most common and disabling conditions worldwide, as described by the World Health Organization report. The risk of suffering from headache has been described to increase from twofold to threefold in adult women compared to men, depending on the studies. These gender differences have been linked to environmental, genetic, epigenetic, and hormonal aspects. Sex hormones can enhance headaches mainly through sensitization of the trigemino-vascular system and modulation of the blood vessel factors, with significant clinical consequences. International guidelines suggest several pharmacological and non-pharmacological treatments in the management of headache disorders as acute or preventive therapies. Few studies have been conducted on the efficacy and effectiveness of therapies in managing hormonal-related headaches to date. Therefore, this scoping review (ScR) aims to summarize the evidence regarding the efficacy of conservative physiotherapeutic approaches on this topic in the domain of gender medicine, which studies sex influences on pathophysiology, clinical signs, prevention, and therapy of diseases.Methods and analysisThe ScR will be performed following the 6-stage methodology suggested by Arksey and O’Malley and the extensions to the original framework recommended by the Joanna Briggs Institute. MEDLINE, Cochrane Central, Scopus, CINHAL, Embase and PEDro databases will be searched. Additional records will be identified through searching in grey literature and the reference lists of all relevant studies. No study design, publication type, language nor date restrictions will be applied. Two reviewers will independently screen all abstracts and full-text studies for inclusion. The research team will develop a data collection form to extract the studies’ characteristics. A tabular and accompanying narrative summary of the information will be provided. This protocol received input from all authors who have expertise in research methodology and specific knowledge in the field.Ethics and disseminationThis study does not require ethical approval as we will not collect personal data. It will summarize information from publicly available studies in line with the nature of the study’s methodology. Regarding dissemination activities, the results of this review will be submitted for publication in a peer-reviewed journal, presented at relevant conferences in the field and disseminated through working groups, webinars and partners.Strengths and limitations of this studyThis will be the first ScR to provide a comprehensive overview of all studies dealing with conservative physiotherapeutic approaches in hormonal-related headaches.Results from this study will provide gender-specific and age-specific evidence of efficacyThe results will add meaningful information for clinicians for the management of this condition and researchers to direct future research.A robust clinical recommendation will be possibly prevented due to limitations of the available literature.