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Purpose: This narrative review examined the physiological mechanisms and clinical effectiveness of manual therapy, exercise therapy, adjunctive modalities, multimodal programs, and neurofeedback interventions in adults with tension-type headaches (TTH). Methods: We systematically searched PubMed, DBpia, KISS, and Google Scholar for studies published between January 2015 and April 2025. Eligible studies included adult TTH populations, physiotherapeutic interventions, and clinical outcomes, such as headache intensity, frequency, disability, and quality of life. Four independent reviewers screened, evaluated, and extracted the data. Fourteen studies met the criteria and data were synthesized according to intervention category. Results: Randomized controlled trials and systematic reviews consistently demonstrated that manual therapy, such as suboccipital inhibition, joint mobilization, soft tissue mobilization, and neural techniques, reduced headache intensity and pressure pain sensitivity. Exercise therapy, including deep cervical flexor training and postural stabilization, decreased headache frequency and improved functional measures. Adjunctive and multimodal approaches (TENS, AVE, relaxation, and biofeedback) further supported reductions in the headache burden, with improvements in disability indices (HDI, HIT-6) and quality of life (SF-12/36). TENS demonstrated enhanced effects when combined with physiotherapy, whereas AVE facilitated β-band suppression, α-band enhancement, and autonomic stabilization (HRV, skin conductance, skin temperature). Infra-low-frequency neurofeedback resulted in session-wise reductions in headache probability (~8% per session, p<.001) and strengthened corticolimbic connectivity. Evidence quality varied because of heterogeneity and short follow-up durations. Conclusion: Physiotherapy for TTH is clinically effective, and multimodal strategies offer superior and sustained outcomes. Integrating peripheral regulation (manual or exercise therapy) with central modulation (neurofeedback) is a synergistic and theoretically grounded treatment strategy. Future studies should standardize neurofeedback protocols and incorporate long-term follow-up to reinforce the evidence for central–peripheral integrated management.