• Headache, Tension
Principal Proposed Natural Treatments
• Acupuncture; Chiropractic
Other Proposed Natural Treatments
• BODY-MIND THERAPIES: Biofeedback; Hypnosis; Relaxation Therapies
• 5-HTP; Aromatherapy; Butterbur; Massage; Osteopathic Manipulation; Prolotherapy; Therapeutic Touch
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
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 Similar results were found in a review of 12 randomized trials of 2,349 patients with periodic or chronic tension headache. Acupuncture compared to sham acupuncture and usual care was associated with marginally improved response rates and fewer headache days.50
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.
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 Similar results were found in a randomized trial including 62 people with tension headache who were randomized to myofascial head and neck massages, ultrasound, or waitlist. Those receiving massage reported fewer headaches than those that received ultrasound or were on waitlist.49
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.
References [ + ]
1. Hansen PE, Hansen JH. Acupuncture treatment of chronic tension headache—a controlled cross-over trial. Cephalalgia. 1985;5:137–142.
2. Jensen LB, Melsen B, Jensen SB. Effect of acupuncture on headache measured by reduction in number of attacks and use of drugs. Scand J Dent Res. 1979;87:373–380.
3. Karst M, Rollnik JD, Fink M, et al. Pressure pain threshold and needle acupuncture in chronic tension-type headache—a double-blind placebo-controlled study. Pain. 2000;88:199–203.
4. White AR, Resch KL, Chan JC, et al. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia. 2000;20:632–637.
5. Melchart D, Linde K, Fischer P, et al. Acupuncture for recurrent headaches: a systematic review of randomized controlled trials. Cephalalgia. 1999;19:779–786.
6. Ahonen E, Hakumaki M, Mahlamaki S, et al. Effectiveness of acupuncture and physiotherapy on myogenic headache: a comparative study. Acupunct Electrother Res. 1984;9:141–150.
7. Tavola T, Gala C, Conte G, et al. Traditional Chinese acupuncture in tension-type headache: a controlled study. Pain. 1992;48:325–329.
8. Boline PD, Kassak K, Bronfort G, et al. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995;18:148–154.
9. Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther. 1997;20:326–330.
10. Bove G, Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. JAMA. 1998;280:1576–1579.
11. Astin J, Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalalgia. 2002;22:617–623.
12. Jull G, Trott P, Potter H, et al. A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache. Spine. 2002;27:1835–1843.
13. Blanchard EB, Applebaum KA, Radnitz CL, et al. Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache. J. Consult Clin Psychol. 1990;58:210–215.
14. Blanchard EB, Nicholson NL, Taylor AE, et al. The role of regular home practice in the relaxation treatment of tension headache. J Consult Clin Psychol. 1991;59:467–470.
15. Bussone G, Grazzi L, D’Amico D, et al. Biofeedback-assisted relaxation training for young adolescents with tension-type headache: a controlled study. Cephalalgia. 1998;18:463–467.
16. Duckro PN, Cantwell-Simmons E. A review of studies evaluating biofeedback and relaxation training in the management of pediatric headache. Headache. 1989;29:428–433.
17. Hermann C, Blanchard EB. Biofeedback in the treatment of headache and other childhood pain. Appl Psychophysiol Biofeedback. 2002;27:143–162.
18. Holroyd, KA, Nash JM, Pingel JD, et al. A comparison of pharmacological (amitriptyline HCL) and nonpharmacological (cognitive-behavioral) therapies for chronic tension headaches. J Consult Clin Psychol. 1991;59:387–393.
19. Janssen K. Differential effectiveness of EMG-feedback versus combined EMG-feedback and relaxation instructions in the treatment of tension headache. J Psychosom Res. 1983;27:243–253.
20. Lake AE 3rd. Behavioral and nonpharmacologic treatments of headache. Med Clin North Am. 2001;85:1055–1075.
21. Melis PM, Rooimans W, Spierings EL, et al. Treatment of chronic tension-type headache with hypnotherapy: a single-blind time controlled study. Headache. 1991;31:686–689.
22. Rokicki LA, Holroyd KA, France CR, et al. Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache. Appl Pschophysiol Biofeedback. 1997;22:21–41.
23. 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.
24. 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.
25. Zitman FG, van Dyck R, Spinhoven P, et al. Hypnosis and autogenic training in the treatment of tension headaches: a two-phase constructive design study with follow-up. J Psychosom Res. 1992;36:219–228.
26. Schattner P, Randerson D. Tiger Balm as a treatment of tension headache. A clinical trial in general practice. Aust Fam Physician. 1996;25:216, 218, 220.
27. Gobel H, Fresenius J, Heinze A, et al. Effectiveness of Oleum menthae piperitae and paracetamol in therapy of headache of the tension type. Nervenarzt. 1996;67:672–681.
28. Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. 1994;14:228–234.
29. Keller E, Bzdek VM. Effects of therapeutic touch on tension headache pain. Nurs. Res. 1986;35:101–106.
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.
31. Reglin F. Butterbur root—a pain reliever with wide-range application possibilities. Praxis-Telegram. 1998;1:13–14.
32. Carle R. Plant-based antiphlogistics and spasmolytics [translated from German]. Z Phytother. 1988;9:67–76.
33. Ribeiro CA. L-5-Hydroxytryptophan in the prophylaxis of chronic tension-type headache: a double-blind, randomized, placebo-controlled study. Headache. 2000;40:451–456.
34. Reich BA. Non-invasive treatment of vascular and muscle contraction headache: a comparative longitudinal clinical study. Headache. 1989;29:34–41.
35. Melchart D, Streng A, Hoppe A et al. Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ. 2005 Jul 29 [Epub ahead of print].
36. Ebneshahidi NS, Heshmatipour M, Moghaddami A et al. The effects of laser acupuncture on chronic tension headache--a randomised controlled trial. Acupunct Med. 2005;23:13-8..
37. Gottschling S, Meyer S, Gribova I, et al. Laser acupuncture in children with headache: A double-blind, randomized, bicenter, placebo-controlled trial. Pain. 2007 Nov 15. [Epub ahead of print]
38. Davis MA, Kononowech RW, Rolin SA, et al. Acupuncture for tension-type headache: a meta-analysis of randomized, controlled trials. J Pain. 2008 May 20.
39. Nestoriuc Y, Rief W, Martin A. Meta-analysis of biofeedback for tension-type headache: Efficacy, specificity, and treatment moderators. J Consult Clin Psychol. 2008;76:379-396.
40. Jena S, Witt C, Brinkhaus B, et al. Acupuncture in patients with headache. Cephalalgia. 2008 Jul 2.
41. Nestoriuc Y, Martin A, Rief W, et al. Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2008 Aug 26.
42. Nestoriuc Y, Martin A, Rief W, et al. Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2008 Aug 26.
43. Eccleston C, Palermo T, Williams A, Lewandowski A, Morley S. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews. 2009;CD003968.
44. Park JM, Park SU, Jung WS, Moon SK. Carthami-Semen acupuncture point injection for chronic daily headache: a pilot, randomised, double-blind, controlled trial. Complement Ther Med. 2011;19 Suppl 1:S19-25.
45. Söderberg EI, Carlsson JY, Stener-Victorin E, Dahlöf C. Subjective well-being in patients with chronic tension-type headache: effect of acupuncture, physical training, and relaxation training. Clin J Pain. 2011;27(5):448-456.
46. Ajimsha MS. Effectiveness of direct vs indirect technique myofascial release in the management of tension-type headache. J Bodyw Mov Ther. 2011 Oct;15(4):431.
47. Posadzki P, Ernst E. Spinal manipulations for tension-type headaches: a systematic review of randomized controlled trials. Complement Ther Med. 2012 Aug;20(4):232.
48. Vickers AJ, Cronin AM, Maschino AC. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444-1453
49. Moraska AF, Stenerson L, et al. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: A randomized, placebo-controlled clinical trial. Clin J Pain. 2015;31(2):159-168.
50. Linde K1, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016;4:CD007587.
Last reviewed December 2015 by EBSCO CAM Review Board