Introduction
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 among them.
Medical treatment for tension headaches generally involves the use of
nonsteroidal
anti-inflammatory drugs and sometimes 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 with sham acupuncture in eighteen people with chronic
tension headache. The real treatment caused a 31 percent reduction in pain and was
found to be significantly more effective than placebo. A study of twenty-nine
students with various types of headaches found that a single acupuncture treatment
decreased the number of days during which headaches occurred and the total use of
medications. A statistically insignificant reduction in the number of days of
attacks was seen in the placebo group.
Another study enrolled forty-three children with headaches (migraine or
tension) and compared laser acupuncture with placebo laser acupuncture. An
individualized treatment approach based on the principles of traditional Chinese
medicine was used. The results indicated that the use of real
laser acupuncture was statistically more effective than placebo acupuncture. In a
large randomized trial involving 3,182 headache patients, the group that received
fifteen individualized acupuncture sessions in three months experienced
significantly fewer headache days and less pain compared to the group receiving
usual care. However, despite its large size and positive results, this study did
not include a placebo group.
On the negative side, a study of thirty-nine participants with a tension headache found no convincing evidence that acupuncture was helpful. In addition, a single-blind study of fifty participants with tension headache found that a special brief-acupuncture style given once a week for six weeks did not reduce headache frequency. Several other trials also failed to find evidence of benefit with various forms of acupuncture.
In a 2008 analysis of five randomized controlled trials that were considered highest in quality, researchers determined that real acupuncture has limited effectiveness over sham acupuncture for tension headache. 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.
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. By the end of the six-week treatment period, participants in both groups had improved similarly. However, four weeks after treatment was stopped, people who had received spinal manipulation showed statistically 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, fifty-three participants with cervicogenic headaches
received chiropractic spinal manipulation or laser acupuncture plus
massage. Chiropractic manipulation was more effective.
However, a similar study of seventy-five participants with recurrent tension
headaches found no difference between the two groups. Other, smaller studies of
spinal manipulation have been reported too, with mixed results.
In a later controlled trial, two hundred people with cervicogenic headaches
were randomly assigned to receive one of four therapies: manipulation, a special
exercise technique, exercise plus manipulation, or no therapy. Each participant
received a minimum of eight to twelve treatments in a six-week period. All three
treatment approaches produced better results than no treatment, and all had
approximately the same effect. While these results may sound promising, in fact
they prove nothing, since any treatment will generally produce better results than
no treatment because of the power of suggestion. Ordinarily, researchers get
around this problem by using double-blind, placebo-controlled
trials. While it is not possible to do a truly double-blind
trial of chiropractic, the better foregoing trials used a form of
placebo treatment, making them more reliable than this one.
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. These techniques include
hypnosis, biofeedback, and relaxation techniques,
often used with each other. In a careful review of multiple controlled studies,
researchers concluded that biofeedback is useful for tension headaches,
particularly when combined with other relaxation therapies. Another review of
twenty 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 with placebo, standard treatment, waiting list control,
or other active treatments.
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 fifty-seven people with acute tension headache
compared Tiger Balm (applied to the forehead) with placebo ointment and with the
drug acetaminophen (Tylenol). The placebo ointment contained mint
essence to make it smell like Tiger Balm. Real Tiger Balm proved more effective
than placebo. In addition, it was just as effective as acetaminophen and acted
more rapidly. Another form of aromatherapy, peppermint oil applied to the
forehead, has also shown promise, but studies remain highly preliminary.
Therapeutic
touch is a form of energy healing popular in the American
nursing community. In a blinded study, sixty participants with tension headaches
were randomly assigned to receive either therapeutic touch or a placebo form of
the therapy. The true therapy proved to be more effective than placebo.
A study of twenty-eight people with tension headaches compared one session of
osteopathic
manipulation to two forms of sham treatment and found
evidence that the real treatment provided a greater improvement in headache pain.
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.
The supplement 5-hydroxytryptophan (5-HTP) has shown some promise for
migraine headaches. However, an eight-week, double-blind, placebo-controlled trial
of sixty-five people with tension headaches found that 5-HTP did not significantly
reduce the number of headaches experienced. 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.
Bibliography
Astin, J., and E. Ernst. “The Effectiveness of Spinal Manipulation for the Treatment of Headache Disorders.” Cephalalgia 22 (2002): 617-623.
Davis, M. A., et al. “Acupuncture for Tension-Type Headache.” Journal of Pain 9 (2008): 667-677.
Eccleston, C., et al. “Psychological Therapies for the Management of Chronic and Recurrent Pain in Children and Adolescents.” Cochrane Database of Systematic Reviews (2009): CD003968. Available through EBSCO DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/dynamed.
Gottschling, S., et al. “Laser Acupuncture in Children with Headache.” Pain 137 (2008): 405-412.
Jena, S., et al. “Acupuncture in Patients with Headache.” Cephalalgia 28 (2008): 969-979.
Nestoriuc, Y., W. Rief, and A. Martin. “Meta-analysis of Biofeedback for Tension-Type Headache: Efficacy, Specificity, and Treatment Moderators.” Journal of Consulting and Clinical Psychology 76 (2008): 379-396.
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