Tension Headache
Related Terms
• Headache, Tension
Tension headache is a spreading, steady head pain that can be mild or severe. It may happen often or only once and a while. They do not get in the way of daily activities.
They are treated with medicine. Some people may turn to natural therapies to prevent headaches or further ease pain.
Natural Therapies
May Be Effective
These therapies may be effective:
- Acupuncture uses thin needles in specific body points. It may reduce headache frequency.A1-A5
- Aromatherapy is the use of aromatic plant extracts and essential oils. Tiger balm, a combination of camphor, menthol, cajaput, and clove oil, may reduce headache frequency and the use of pain relievers.B1
- Cognitive behavioral therapy is a way of reframing negative thought patterns to change unwanted behaviors.L1, L2
- EMG Biofeedback teaches a person to control the body’s responses to reduce headache frequency and the use of pain relievers.D1-D3
- Hypnosis relaxation is a mental state like sleep that allows a person's thoughts to be influenced by another person. It may reduce headache frequency prevent headaches if used often.E1
- Manual therapies is a physical treatment often used by physical therapists to treat pain by moving the muscles and joints.M1-M3
- Massage, especially Thai traditional massage, may reduce headache frequency.F1
- Mindfulness meditation is a way of paying attention to the present without judgement. It may reduce pain intensity.G1, G2
- Myofascial release is a manual therapy often used in massage. It may reduce headache frequency, duration, and the use of pain relievers when it is done to the facial muscles.H1-H3
- Relaxation training is any method that helps a person to relax. It may improve sleep and well being.I1, I2
- Spinal Manipulation is when practitioners use their hands or a device to put force on a joint of the spine. It may reduce headache frequency and pain.C1-C5
- Therapeutic touch uses the body's energy shield to heal without physical contact. It may reduce headache pain.J1
5-HTP (5-Hydroxytryptophan) is an amino acid used to build serotonin in the body. It may reduce the frequency of headaches and the use of pain relievers.K1
May Not Be Effective
These therapies may not provide benefit:
- Autogenic training teaches the body to respond to verbal commands.O1
- Dry needling is the use of a needle without medication or injection to ease pain.N1
Not Enough Data to Assess
- Physiotherapy P1
Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.
Herbs and Supplements to Be Used With Caution
Talk to your doctor about any supplements or therapy you would like to use. Some can interfere with treatment or make conditions worse.
References [ + ]
Acupuncture
A1. Linde K, Allais G, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016;4:CD007587. A2.
A2. Millstine D, Cen CY, et al. Complementary and integrative medicine in the management of headache. BMJ 2017;357:j1805.
A3. Krishnan A, Silver N. Headache (chronic tension-type). BMJ Clin Evid. 2009 Jul 22;2009. pii: 1205. PMC2907789.
A4. Baxter GD, Bleakley C, et al. Clinical effectiveness of laser acupuncture: a systematic review. J Acupunct Meridian Stud. 2008 Dec;1(2):65-82.
A5. Davis MA, Kononowech RW, et al. Acupuncture for tension-type headache: a meta-analysis of randomized, controlled trials. J Pain. 2008 Aug;9(8):667-677.
Tiger Balm
B1. Schattner P, Randerson D. Tiger Balm as a treatment of tension headache. A clinical trial in general practice. Aust Fam Physician. 1996;25(2):216.
Spinal Manipulation
C1. Vernon H, Jansz G, et al. A randomized, placebo-controlled clinical trial of chiropractic and medical prophylactic treatment of adults with tension-type headache: results from a stopped trial. J Manipulative Physiol Ther. 2009;32(5):344-351.
C2. Posadzki P, Ernst E. Spinal manipulations for tension-type headaches: a systematic review of randomized controlled trials. Complement Ther Med. 2012;(4):232-239.
C3. Clar C, Tsertsvadze A, et al. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Therap. 2014;22(1):12.
C4. Vernon H, Borody C, et al. A randomized pragmatic clinical trial of chiropractic care for headaches with and without a self-acupressure pillow. J Manipulative Physiol Therap. 2015;38(9):637-643.
C5. Lenssinck ML, Damen L, et al. The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review. Pain. 2004 Dec;112(3):381-388.
EMG Biofeedback
D1. Nestoriuc Y, Rief W, et al. Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol. 2008;76(4):379-396.
D2. Verhagen AP, Damen L, et al. Behavioral treatments of chronic tension-type headache in adults: are they beneficial? CNS Neurosci Ther. 2009;15(2):183-205.
D3. Nestoriuc Y, Martin A, et al. Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2008 Sep;33(3):125-140.
Hypnotic Relaxation
E1. Ezra Y, Gotkine M, et al. Hypnotic relaxation vs amitriptyline for tension-type headache: let the patient choose. Headache. 2012;52(5):785-791.
Massage
F1. Chatchawan U, Eungpinichpong W, et al. Effects of Thai traditional massage on pressure pain threshold and headache intensity in patients with chronic tension-type and migraine headaches. J Altern Complement Med. 2014;20(6):486-492.
Mindfulness Meditation
G1. Gu Q, Hou JC, et al. Mindfulness meditation for primary headache pain: a meta-analysis. Chin Med J (Engl). 2018;131(7):829-838.
G2. Probyn K, Bowers H, et al. Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components. BMJ Open. 2017 Aug 11;7(8):e016670.
Myofascial Release
H1. Ghanbari A, Rahimijaberi A, et al. The effect of trigger point management by positional release therapy on tension type headache. NeuroRehabilitation. 2012;30(4):333-339.
H2. 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.
H3. Moraska AF, Schmiege SJ, et al. Responsiveness of myofascial trigger points to single and multiple trigger point release massages: a randomized placebo controlled trial. Am J Phys Med Rehabil. 2017;96(9):639-645.
Relaxation Training
I1. Söderberg EI, Carlsson JY, et al. 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.
I2. Verhagen AP, Damen L, et al. Conservative treatments of children with episodic tension-type headache. A systematic review. J Neurol. 2005 Oct;252(10):1147-1154.
Therapeutic Touch
J1. Keller E, Bzdek VM. Effects of therapeutic touch on tension headache pain. Nurs Res. 1986;35(2):101-106.
5-Hydroxytryptophan
K1. Ribeiro CA. L-5-Hydroxytryptophan in the prophylaxis of chronic tension-type headache: a double-blind, randomized, placebo-controlled study. For the Portuguese Head Society. Headache. 2000;40(6):451-456.
Cognitive Behavioral Therapy
L1. Probyn K, Bowers H, et al. Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components. BMJ Open. 2017 Aug 11;7(8):e016670.
L2. Krishnan A, Silver N. Headache (chronic tension-type). BMJ Clin Evid. 2009 Jul 22;2009. pii: 1205. PMC2907789.
Manual Therapy
M1. Mesa-Jiménez JA, Lozano-López C, et al. Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia. 2015 Dec;35(14):1323-1332.
M2. Lozano López C, Mesa Jiménez J, et al. Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013. Neurologia. 2016 Jul-Aug;31(6):357-369.
M3. Fernández-de-Las-Peñas C, Alonso-Blanco C, et al. Are manual therapies effective in reducing pain from tension-type headache?: a systematic review. Clin J Pain. 2006 Mar-Apr;22(3):278-285.
Dry Needling
N1. France S, Bown J, et al. Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension-type headache: a systematic review. Cephalalgia. 2014 Oct;34(12):994-1003.
Autogenic Training
O1. Kanji N, White AR, et al. Autogenic training for tension type headaches: a systematic review of controlled trials. Complement Ther Med. 2006 Jun;14(2):144-150.
Physiotherapy
P1. Lenssinck ML, Damen L, et al. The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review. Pain. 2004 Dec;112(3):381-388.
Last reviewed December 2019 by EBSCO NAT Review Board
Eric Hurwitz, DC
Last Updated: 6/29/2020