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Tension Headache

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Principal Proposed Natural Treatments

Herbs and Supplements to Avoid

Modern life is stressful, and tension headaches are one result of that stress. People with such headaches often describe a sensation like a tight band around the head; this band may in fact exist as a contracted muscle. Other characteristics of tension headache include aching, dull, or throbbing pain, usually concentrated in the forehead, temples, or base of the skull. Symptoms may overlap those of migraine , cluster , or sinus headaches, and medical advice may be necessary to distinguish between them.

Medical treatment for tension headaches generally involves the use of nonsteroidal anti-inflammatory drugs and possibly muscle relaxants. Physicians may also recommend physical therapy techniques in hopes of addressing the causes of tension headaches, such as muscle tension in the neck or jaw.

Principal Proposed Natural Treatments

Both acupuncture and chiropractic have undergone significant evaluation as treatments for tension headaches.

Acupuncture

Placebo-controlled studies of acupuncture for tension headaches have yielded mixed results. One study compared six sessions of traditional acupuncture against sham acupuncture in 18 people with chronic tension headache. 1 The real treatment caused a 31% reduction in pain and was found to be significantly more effective than placebo. And, a study of 29 students suffering from various types of headaches found that a single acupuncture treatment decreased the number of days during which headaches occurred, as well as total use of medications. 2 A statistically insignificant reduction in the number of days of attacks was seen in the placebo group. Another small study, which involved 40 people with chronic daily headache, found that acupuncture point injections with Cathami-Semen (safflower seed) twice weekly for 4 weeks resulted in a 33% increase in headache-free days compared to the control group (that received regular saline acupuncture). 44

Another study enrolled 43 children with headaches ( migraine or tension) and compared laser acupuncture against placebo laser acupuncture. 37 An individualized treatment approach based on the principles of traditional Chinese medicine was used. The results indicated that use of real laser acupuncture was statistically more effective than placebo acupuncture. And, in a very large randomized trial involving 3,182 headache patients, the group that received 15 individualized acupuncture sessions over 3 months experienced significantly fewer headache days and less pain compared to the group receiving usual care. 40 However, despite its large size and positive results, this study did not include a placebo group.

On the negative side, a study of 39 participants with tension headache found no convincing evidence that acupuncture was helpful. 3 In addition, a single-blind study of 50 participants with tension headache found that a special brief-acupuncture style given once a week for 6 weeks did not reduce headache frequency. 4 Several other trials also failed to find evidence of benefit with various forms of acupuncture. 57,35-36 And, in a 2008 analysis of 5 randomized controlled trials that were considered highest in quality, researchers determined that real acupuncture has limited effectiveness over sham acupuncture for tension headache. 38 While it is clear that many headache patients benefit from acupuncture, at present it is unclear whether or not this represents more than a placebo effect.

A review of 9 randomized controlled trials studying patients with migraine and tension headache found that acupuncture decreased pain compared to sham or no acupuncture. The results are more positive than negative, but the quality of the studies was undetermined. 48

For more information on this method, see the full acupuncture article.

Chiropractic Spinal Manipulation

Neck tension can cause tension and pain in the head. Such “cervicogenic headaches” overlap closely with tension headaches. Chiropractic spinal manipulation has shown some promise for these conditions, but the evidence is incomplete and somewhat contradictory.

In a controlled trial of 150 participants, investigators compared spinal manipulation to the drug amitriptyline for the treatment of chronic tension-type headaches. 8 By the end of the 6-week treatment period, participants in both groups had improved similarly. However, 4 weeks after treatment was stopped, people who had received spinal manipulation showed statistically significantly better reduction in headache intensity and frequency and used fewer over-the-counter medications than those who had used the amitriptyline.

In another positive trial, 53 participants with cervicogenic headaches received chiropractic spinal manipulation or laser acupuncture plus massage. 9 Chiropractic manipulation was more effective.

However, a similar study of 75 participants with recurrent tension headaches found no difference between the two groups. 10 Other, smaller studies of spinal manipulation have been reported as well, with mixed results. 11

In a more recent controlled trial, 200 people with cervicogenic headaches were randomly assigned to receive one of four therapies: manipulation, a special exercise technique, exercise plus manipulation, or no therapy. 12 Each participant received at least eight to 12 treatments over a period of 6 weeks.

A review of 5 randomized trials with 348 patients found that spinal manipulation was more effective than medication ( amitriptyline ), manipulation with placebo, sham manipulation with placebo, standard treatment, or no treatment. However, there was no significant difference in headache pain or intensity when comparing spinal manipulation to soft tissue therapy with placebo laser. 47

Many approaches produced better results than no treatment, and approximately the same effect as each other. While these results may sound promising, in fact they prove nothing at all, since any treatment whatsoever will generally produce better results than no treatment due to the power of suggestion. Ordinarily, researchers get around this problem by using double-blind, placebo-controlled trials (For more information on this important subject, see Why Does This Database Rely on Double-blind Studies? ) While it isn’t possible to do a truly double-blind trial of chiropractic, the better trials noted previously used a form of placebo treatment, making them more reliable than this one.

For more information on this method, see the full chiropractic article.

Other Proposed Natural Treatments

A number of other alternative treatments have undergone some evaluation for their usefulness in the treatment of tension headaches.

Several techniques in the category of body-mind medicine have shown promise for the treatment of tension headaches. These include hypnosis , biofeedback , and relaxation therapies . 13-25,34,39,41 For example, a randomized trial found evidence to support the use of relaxation therapy in improving sleep and well-being in people with tension headaches. 45

A careful review of multiple controlled studies found that biofeedback is useful for tension headaches, particularly when combined with other relaxation therapies. 42 Another review of 20 control trials found psychological interventions, such as cognitive behavioral therapy, biofeedback, relaxation and coping strategies, to be associated with reduced chronic headache or migraine pain in 589 children. These treatments were compared to placebo, standard treatment, waiting list control, or other active treatments. 43

A topical ointment known as Tiger Balm® is a popular remedy for headaches, muscle pain, and other conditions. Tiger Balm contains the aromatic substances camphor, menthol, cajaput, and clove oil, making it a form of aromatherapy . A double-blind study enrolling 57 people with acute tension headache compared Tiger Balm (applied to the forehead) against placebo ointment, as well as against the drug acetaminophen (Tylenol). 26 The placebo ointment contained mint essence to make it smell similarly to Tiger Balm. Real Tiger Balm proved more effective than placebo. In addition, it was just as effective as acetaminophen, and more rapid acting.

Another form of aromatherapy, peppermint oil applied to the forehead, has also shown promise, but current studies remain highly preliminary. 27,28

Therapeutic touch (TT) is a form of “energy healing” popular in the American nursing community. In a blinded study, 60 participants with tension headaches were randomly assigned to receive either therapeutic touch or a placebo form of the therapy. 29 The true therapy proved to be more effective than placebo.

A study of 28 people with tension headaches compared one session of osteopathic manipulation to two forms of sham treatment and found evidence that real treatment provided a greater improvement in headache pain. 30 Another small randomized trial with 63 patients compared two myofascial release techniques to a control group. Myofascial release treatments resulted in fewer headaches for the 4-week trial period compared to the control group. 46

Prolotherapy , massage , and reflexology (a special form of massage) have all been recommended for the treatment of tension headaches, but there is little evidence to support their use.

The herb butterbur is thought to have antispasmodic and anti-inflammatory properties, making it potentially useful for tension headaches. 31,32

The supplement 5-HTP has shown some promise for migraine headaches. However, an 8-week, double-blind, placebo-controlled trial of 65 people with tension headaches found that 5-HTP did not significantly reduce the number of headaches experienced. 33 It did, however, reduce participants' need to use other pain-relieving medications.

Herbs and Supplements to Avoid

The herb kava is sometimes suggested as a muscle relaxant and stress reducer. However, there is no meaningful evidence that kava is effective for tension headaches (or any form of muscle tension), and it has been taken off the market in many countries for safety reasons: its use has been linked with severe liver damage.

Finally, numerous herbs and supplements may interact adversely with prescription drugs used to treat tension headaches. For more information on this potential risk, see the individual drug articles in the Drug Interactions section of this database.

Revision Information

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    Spinhoven P, Linssen AC, Van Dyck R, et al. Autogenic training and self-hypnosis in the control of tension headache. Gen Hosp Psychiatry. 1992;14:408–415.

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    Ter Kuile MM, Spinhoven P, Linssen AC, et al. Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups. Pain. 1994;58:331–340.

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  • 30

    Hoyt WH, Shaffer F, Bard DA, et al. Osteopathic manipulation in the treatment of muscle-contraction headache. J Am Osteopath Assoc. 1979;78:322–325.

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