Lifestyle Changes:

Psychological and behavioral techniques, and lifestyle changes, can have a beneficial effect on tension-type headaches. These therapies can also enhance the effects of drug treatments. To date, relaxation training and biofeedback have the strongest evidence for improvement in tension-type headache outcomes.

Relaxation Training and Biofeedback

Relaxation training uses breathing exercises, guided imagery, and other techniques to help relax muscles and relieve stress. Biofeedback uses a device to record a patient’s bodily responses (heart rate, surface skin temperature, muscle tension). This information is then “fed back” to the patient through a sound or visual image. Through this feedback, patients learns to control their physical responses. In clinical studies, relaxation training and biofeedback, both alone and in combination, have led to improvements in tension-type headache.

Stress Management and Behavioral Training

Cognitive-behavioral therapy (CBT) teaches patients how to recognize and cope with stressors in their life. It can help patients understand how their thoughts and behavior patterns may affect their symptoms, and how to change the way the body responds to anticipated pain. CBT is often included in stress management techniques. Research indicates that CBT and stress management is most effective when combined with relaxation training or biofeedback.

Massage, Spinal Manipulation, and Physical Therapy

Massage can help relax tense muscles, and may be helpful during acute headache attacks, although there is little evidence for long-term benefits. Although some small studies have suggested that spinal manipulation by chiropractors or osteopaths may have some benefits for preventing tension-type headaches, there is insufficient evidence overall to confirm their effectiveness for tension-type headache pain reduction.

Evidence is stronger on the benefits of spinal manipulation for patients with headaches originating from nerve or muscular problems in the neck. Some researchers believe that tension-type headaches relieved by spinal manipulation are probably really caused by neck problems.

There has been little research evaluating the benefits of physical therapy for tension-type headache. Still, a physical therapist may be helpful in teaching specific exercises for strengthening and stretching muscles or improving posture. A physical therapist may also be able to advise on ergonomic changes to the patient’s workplace environment.

Acupuncture

An analysis of 26 trials of acupuncture suggested that it may have some benefit for tension headache, but the evidence to date is not completely convincing. Some studies comparing short-term acupuncture to sham (dummy) procedures report no benefits. A recent study suggested that acupuncture may help tension-type headache, but needling at non-acupuncture points worked just as well. This suggests a placebo effect may account for the headache relief experienced by acupuncture patients.

Acupuncture, hypnosis and biofeedback are all alternative ways to control pain. Acupuncture involves the insertion of tiny sterile needles, slightly thicker than a human hair, at specific points on the body.

Diet and Exercise

Good health habits -- including adequate sleep, healthy diet, regular exercise-- are helpful for reducing stress.. Some Quitting smoking is important in reducing the risks for all headaches.

Home Remedies

Heat or cold packs may be helpful. An ancient remedy for tension headaches uses pressure applied to the head (such as a headband or a towel wrapped around the head) plus either heat or cold. Some people report more relief with cold, others with heat. Packs can either be frozen or heated.

Herbal and Other Natural Remedies

Numerous herbal remedies are promoted for tension-type headache. It is important that anyone taking herbal or so-called natural remedies be aware of the lack of regulations governing their quality and effectiveness. Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the Food and Drug Administration (FDA) to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. Always check with your doctor before using any herbal remedies or dietary supplements.

Essential Oils. Some patients find relief using two drops of peppermint, eucalyptus, or lavender oil added to one cup of water. The patient soaks a cloth in the solution and applies it as a compress to the head.

Herbs. Feverfew and valerian are two popular herbal remedies for headache relief. There have been few studies to confirm the effectiveness of these or other herbs for headache treatment.

The following are special concerns for people taking these herbs:

• People who have a bleeding or blood clot disorder, or who take blood-thinning medications such as coumadin (Warfarin), should not take feverfew. Feverfew can interfere with these medications and can affect the time it takes blood to clot. Pregnant women or women hoping to become pregnant should not take this herb, as it may potentially harm the fetus.
• Valerian has sedative properties but can cause dizziness and drowsiness. High doses of valerian may cause blurred vision, excitability, vivid dreams, and changes in heart rhythm.