Skip to main content

Advertisement

SpringerLink
Log in

Complementary and Alternative Approaches to the Treatment of Tension-Type Headache

  • Tension-Type Headache (KA Henry, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

While pharmacotherapy with nonsteroidal anti-inflammatories (NSAIDs) and tricyclic antidepressants comprises the traditional treatment of tension-type headaches (TTH), the use of other therapeutic approaches in combination with medications can increase the success of treatment. Patients with comorbid mood disorders and frequent headaches may particularly benefit from some nonpharmacologic approaches. This review focuses on complementary and alternative approaches to tension-type headache treatment, including psychological therapies, acupuncture, and physical treatments. The current evidence indicates that EMG biofeedback (BFB) is effective in the treatment of TTH, and cognitive behavioral therapy and relaxation training may also be beneficial. Physical therapy and acupuncture may be considered in patients with frequent TTH, but the scientific basis is limited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Langemark M, Olesen J, Poulsen DL, Beck P. Clinical characterization of patients with chronic tension headache. Headache. 1988;28:590–6.

    Article  PubMed  CAS  Google Scholar 

  2. Hammill JM, Cook TM, Rosecrance JC. Effectiveness of a physical therapy regimen in the treatment of tension-type headache. Headache. 1996;36:149–53.

    Article  PubMed  CAS  Google Scholar 

  3. Nash JM. Psychologic and behavioral management of tension-type headache: treatment procedures. Curr Pain Headache Rep. 2003;7:475–81.

    Article  PubMed  Google Scholar 

  4. •• Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J. EFNS guideline on the treatment of tension-type headache – Report of an EFNS task force. Eur J Neurol. 2010;17:1318–25. An excellent review of evidence of alternative treatments for TTH.

    PubMed  CAS  Google Scholar 

  5. Mosley TH, Grotheus CA, Meeks WM. Treatment of tension headache in the elderly: a controlled evaluation of relaxation training and relaxation combined with cognitive-behavior therapy. J Clin Geropsychol. 1995;1:175–88.

    Google Scholar 

  6. Nicholson NL, Blanchard EB. A controlled evaluation of behavioral treatment of chronic headache in the elderly. Behav Ther. 1993;24:67–76.

    Article  Google Scholar 

  7. Andrasik F, Grazzi L, Usai S, Bussone G. Pharmacological treatment compared to behavioural treatment for juvenile tension-type headache: results at two-year follow-up. Neurol Sci. 2007;28 Suppl 2:S235–8.

    Article  PubMed  Google Scholar 

  8. Trautmann E, Lackschewitz H, Kroner-Herwig B. Psychological treatment of recurrent headache in children and adolescents–a meta-analysis. Cephalalgia. 2006;26:1411–26.

    Article  PubMed  CAS  Google Scholar 

  9. •• Holroyd KA, Martin PR, Nash JM. Psychological treatments for tension-type headache. In: Olesen J, Tfelt-Hansen P, Welch KMA, editors. The headaches. 3rd ed. Lippincott, Williams & Wilkins: Philadelphia; 2006. p. 711–9. A very good comprehensive review of psychological treatments in TTH.

    Google Scholar 

  10. Nestoriuc Y, Rief W, Martin A. Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol. 2008;76:379–96.

    Article  PubMed  Google Scholar 

  11. • Nestoriuc Y, Martin A, Rief W, Andrasik F. Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2008;33:125–40. Good review of evidence for BFB.

    Article  PubMed  Google Scholar 

  12. LaVaque TJ, Hammond DC, Trudeau D, et al. Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological interventions. Efficacy task force. Appl Psycho-physiol Biofeedback. 2002;27:273–81.

    Article  Google Scholar 

  13. Jensen R, Roth JM. Physiotherapy of tension-type headaches. In: Olesen J, Tfelt-Hansen P, Welch KMA, editors. The headaches. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins; 2006. p. 721–5.

    Google Scholar 

  14. Schultz J, Luthe W. Autogenic training: a psychophysiologic approach in psychotherapy. New York: Grune & Stratton; 1959.

    Google Scholar 

  15. Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW. Behavioral treatments of chronic tension-type headache in adults: are they beneficial? CNS Neurosci Ther. 2009;15:183–205.

    Article  PubMed  Google Scholar 

  16. Wallasch TM, Angeli A, Kropp P. Outcomes of a headache-specific cross-sectional multidisciplinary treatment program. Headache. 2012;52:1094–105.

    Article  PubMed  Google Scholar 

  17. Beck AT. Cognitive therapy and the emotional disorders. New York: International Universities Press; 1976.

    Google Scholar 

  18. Meichenbaum DA. Cognitive behavior modification: an integrative approach. New York: Plenum; 1977.

    Google Scholar 

  19. Bogaards MC, ter Kuile MM. Treatment of recurrent tension headache: a meta-analytic review. Clin J Pain. 1994;10:174–90.

    Article  PubMed  CAS  Google Scholar 

  20. McCrory D, Penzien D, Hasselblad V, Gray R. Behavioral and physical treatments for tension-type and cervicogenic headache. Des Moines: Foundation for Chiropractic Education and Research; 2001.

    Google Scholar 

  21. Holroyd KA. Assessment and psychologic management of recurrent headache disorders. J Consult Clin Psychol. 2002;70:656–77.

    Article  PubMed  Google Scholar 

  22. Bruhn P, Olesen J, Melgaard B. Controlled trial of EMG feedback in muscle contraction headache. Ann Neurol. 1979;6:34–6.

    Article  PubMed  CAS  Google Scholar 

  23. 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;59:387–93.

    Article  PubMed  CAS  Google Scholar 

  24. Holroyd KA, O’Donnell FJ, Stensland M, et al. Management of chronic tension-type headache with tricyclic antidepressant medication, stress-management therapy, and their combination: a randomized controlled trial. JAMA. 2001;285:2208–15.

    Article  PubMed  CAS  Google Scholar 

  25. Holroyd KA, Lipchik GL, Penzien DB. Behavioral management of recurrent headache disorders: Empirical basis for clinical practice. In: Dobson KS, Craig KD, editors. Best practice: Developing and promoting empirically supported interventions. Newbury Park: Sage; 1998. p. 193–212.

    Google Scholar 

  26. Melchart D, Streng A, Hoppe A, et al. Acupuncture in patients with tension-type headache: randomized controlled trial. BMJ. 2005;331:376–82.

    Article  PubMed  Google Scholar 

  27. • Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009;1:CD007587. Good review of acupuncture evidence.

    PubMed  Google Scholar 

  28. Bendtsen L, Jensen R, Olesen J. Qualitatively altered nociception in chronic myofascial pain. Pain. 1996;65:259–64.

    Article  PubMed  CAS  Google Scholar 

  29. Jensen R, Olesen J. Tension-type headache: an update on mechanisms and treatment. Curr Opin Neurol. 2000;13:285–89.

    Article  PubMed  CAS  Google Scholar 

  30. Jensen R, Rasmussen BK, Pedersen B, et al. Muscle tenderness and pressure pain thresholds in headache. A population study. Pain. 1993;52:193–9.

    Article  PubMed  CAS  Google Scholar 

  31. Jensen R, Rasussen BK, Olesen J. Myofascial tenderness and pressure-pain thresholds. In: Olesen J, Schoenen J, editors. Tension-type headache: Classification, mechanisms, and treatment. New York: Raven Press; 1993. p. 209–13.

    Google Scholar 

  32. Jensen R. Mechanisms of tension-type headache. Cephalalgia. 2001;21:786–9.

    Article  PubMed  CAS  Google Scholar 

  33. Jensen R. Pathogenic importance of muscular disorders in tension-type headache. Funct Neurol. 1994;9:175–82.

    PubMed  CAS  Google Scholar 

  34. Bendtsen L, Ashina M. Sensitization of myofascial pain pathoways in tension-type headache. In: Olesen J, Tfelt-Hansen P, Welch KMA, editors. The headaches. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 1999. p. 573–7.

    Google Scholar 

  35. Bendtsen L. Sensitizaton: its role in primary headaches. Curr Opin Invest Drugs. 2002;3:449–53.

    CAS  Google Scholar 

  36. Carlsson J, Fahlcrantz A, Augustinsson LE. Muscle tenderness in tension headache treated with acupuncture or physiotherapy. Cephalalgia. 1990;10:131–41.

    Article  PubMed  CAS  Google Scholar 

  37. Vernon HT. The effectiveness of chiropractic manipulation in the treatment of headache: an exploration of the literature. J Manipulative Physiol Ther. 1995;18:611–7.

    PubMed  CAS  Google Scholar 

  38. Bronfort G, Assendelft WJ, Evans R, et al. Efficacy of spinal manipulation for chronic headache: a systemic review. J Manipulative Physiol Ther. 2001;24:457–66.

    PubMed  CAS  Google Scholar 

  39. Astin JA, Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalalgia. 2002;22:617–23.

    Article  PubMed  CAS  Google Scholar 

  40. Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E. Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther. 2011;34:274–89.

    Article  PubMed  Google Scholar 

  41. Fenandez-de-Las-Penas C, Alonso-Blanco CL, Miangolarra JC, Barriga FJ, Pareja JA. Are manual therapies effective in reducing pain from tension-type headache? A systematic review. Clin J Pain. 2006;22:278–85.

    Article  Google Scholar 

  42. Lenssinck ML, Damen L, Verhagen AP, et al. The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review. Pain. 2004;112:381–8.

    Article  PubMed  Google Scholar 

  43. Torelli P, Jensen R, Olesen J. Physiotherapy for tension-type headache: a controlled study. Cephalalgia. 2004;24:29–36.

    Article  PubMed  CAS  Google Scholar 

  44. Niere K. Can subjective characteristics of benign headache predict manipulative physiotherapy treatment outcome? Austr J Physiother. 1998;44:87–93.

    Google Scholar 

  45. Biondi D. Physical treatments for headache: a structured review. Headache. 2005;45:738–46.

    Article  PubMed  Google Scholar 

  46. Van Ettekoven H, Lucas C. Efficacy of physiotherapy including a cranio-cervical training programme for tension-type headache: a randomized clinical trial. Cephalalgia. 2006;26:983–91.

    Article  PubMed  Google Scholar 

  47. Söderberg E, Carlsson J, Stener-Victorin E. Chronic tension-type headache treated with acupuncture, physical training and relaxation training: between group differences. Cephalalgia. 2006;26:1320–9.

    Article  PubMed  Google Scholar 

  48. http://www.mayoclinic.com/health/tension-headache/ds00304/dsection=lifestyle-and-home-remedies. Accessed July 2012.

  49. Michalsen A, Grossman P, Acil A, et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit. 2005;11:CR555–61.

    PubMed  Google Scholar 

  50. Bhatia R, Dureja GP, Tripathi M, et al. Role of teporalis muscle over activity in chronic tension type headache: effect of yoga based management. Indian J Physiol Pharmacol. 2007;51:333–44.

    PubMed  CAS  Google Scholar 

  51. Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E, Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1346–53.

    Article  PubMed  CAS  Google Scholar 

  52. Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. 1994;14:228–34.

    Article  PubMed  CAS  Google Scholar 

  53. Göbel H, Fresenius J, Heinze A, Dworschak M, Soyka D. Effectiveness of Oleum menthae piperitae and paracetamol in therapy of headache of the tension type. Nervenarzt. 1996;67:672–81.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Clinical Neurosciences, St Vincent’s Hospital Melbourne, P.O. Box 2900, Fitzroy, VIC, 3065, Australia

    Christina Sun-Edelstein

  2. Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Alexander Mauskop

  3. New York Headache Center, 30 East 76th Street, New York, NY, 10021, USA

    Alexander Mauskop

Authors
  1. Christina Sun-Edelstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander Mauskop
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina Sun-Edelstein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sun-Edelstein, C., Mauskop, A. Complementary and Alternative Approaches to the Treatment of Tension-Type Headache. Curr Pain Headache Rep 16, 539–544 (2012). https://doi.org/10.1007/s11916-012-0295-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-012-0295-6

Keywords

Search

Navigation