- Taking the supplement 5-hydroxytryptophan may lessen headache frequency and limit the need for pain-relieving medications.
Dose:Adults: 300 mg daily; children: 100 mg daily
5-HTP (5-hydroxytryptophan) may be helpful for tension-type headaches. A recent double-blind study of adults with chronic tension-type headaches found 300 mg per day of 5-HTP reduced the number of headache days by 36%, but this was not significantly different from the 29% reduction in the placebo group.4 (Headaches often improve significantly even when an inactive [placebo] treatment is given).5 Headache severity was also similarly reduced by either 5-HTP or placebo. In this study, 5-HTP was significantly superior to placebo only in reducing the need for pain-relieving medications during headaches. Previous double-blind research studied 5-HTP in groups of patients suffering from many different types of headache, including some with tension-type headaches. Results from these studies also found substantial, but nonsignificant benefits of 5-HTP compared with placebo using either 400 mg per day in adults6 or 100 mg per day in children.7
- In preliminary research, people with chronic tension-type headaches who were also suffering from severe vitamin D deficiency experienced an improvement in their symptoms after supplementing with vitamin D and calcium.
Dose:1,000 to 1,500 mg per day (plus the same amount of calcium)In a preliminary trial, eight patients had chronic tension-type headache in association with severe vitamin D deficiency. In each case, the headaches resolved after treatment with vitamin D3 (1,000 to 1,500 IU per day) and calcium (1,000 to 1,500 mg per day).8
- Peppermint is a soothing oil that appears to have pain-relieving effects when applied topically.
Dose:Spread a 10% oil solution across the temples three times over a 30-minute period
A preliminary report suggested that peppermint oil has relaxing and pain relieving effects, and may be useful as a topical remedy for tension-type headache.9 In a double-blind study, spreading a 10% peppermint oil solution across the temples three times over a 30-minute period was significantly better than placebo and as effective as acetaminophen in reducing headache pain.10 Similar use of an ointment combining menthol and other oils related to peppermint oil was also as effective as pain relieving medication and superior to placebo in another double-blind study.11
Studies treating tension-type headache with acupuncture have had mixed results.12 Two controlled trials of acupuncture compared to “fake” acupuncture found either significantly more pain reduction from real acupuncture13 or no difference between the two treatments.14 Two trials comparing acupuncture to traditional physical therapy (relaxation techniques, self-massage, cold therapy, transcutaneous electrical nerve stimulation [TENS], stretching, and/or preventive education) in tension-type headache patients found similar improvements from either treatment.15,16 Three controlled acupuncture trials treated patients with various types of headaches, including tension headache. Two of these studies,17,18 but not the third,19 found acupuncture significantly more effective.
Two preliminary studies20,21 reported benefits from using finger pressure on specific acupuncture points (acupressure) to relieve tension-type headache pain in some patients. However, no controlled research on this approach has been done.
Spinal manipulation may also help some tension-type headache sufferers. Several preliminary studies report reduction in frequency and severity of tension-type headaches with spinal manipulation.22,23,24,25,26,27 A controlled trial compared spinal manipulation to drug therapy for tension-type headaches.28 During the treatment period, both groups improved at similar significant rates, although the manipulation group complained of far fewer side effects. After a month following the end of treatment, only the manipulation group showed continued improvement. In another controlled trial, spinal manipulation resulted in fewer headache hours each day, decreased use of analgesics, and less intense pain per episode compared with massage.29 A third controlled study reported that spinal manipulation with muscle massage was equally as effective as massage plus a “fake” laser treatment, suggesting that manipulation did not provide additional benefit.30
As mentioned above, two controlled studies found physical therapy (relaxation techniques, self-massage, cold therapy, TENS, stretching, and/or preventive education) as useful as acupuncture in significantly reducing headache pain and frequency.15,16 A preliminary study also found that physical therapy, consisting of posture education, home exercises, massage, and stretching of the neck muscles, significantly improved tension headaches up to 12 months after treatment ended.33 Another preliminary study of massage, including deep penetrating techniques, reported significantly decreased pain in patients with chronic tension headache and neck pain.34 A controlled study of headache patients with muscle spasm in the neck and shoulders found that adding TENS to physical therapy (consisting of heat packs, massage, and ultrasound) brought a significantly faster and greater decline in headaches than physical therapy alone.35
Several controlled trials utilizing electromyogram (EMG)-biofeedback (which teaches people how to mentally relax their neck or head muscles) have shown this treatment to be helpful in about 50% of tension-type headache sufferers, both in adults36,37,38,39,40 and in children and adolescents.41,42 Progressive muscle relaxation is another muscle relaxation technique that has significantly reduced tension-type headache in controlled studies of adults,43,44 and children and adolescents.42,46
Relaxation with techniques for stress management was found to be significantly better than drug therapy in a controlled trial of chronic tension-type headache sufferers,47 although about half of all subjects continued to have headaches three to four days per week after the end of treatment.
Hypnotherapy was found to significantly reduce headache intensity and duration in chronic tension-type headache sufferers in one controlled trial.48
A large controlled study of tension headache patients compared relaxation therapies (including progressive muscle relaxation, hypnosis, and cognitive psychotherapy) with EMG-biofeedback, and found biofeedback to be significantly more effective than relaxation in decreasing headache pain and frequency.49
In a controlled trial, therapeutic touch, a type of hands-on healing, was found to significantly reduce tension headache pain for four hours following treatment.50 No further research has been done on this approach.
Reflexology, a specific treatment involving massage of various reflex zones on the feet, has only been investigated as a treatment for tension-type headache in one preliminary trial.51 A majority of people treated in this study reported being helped by this technique.
A controlled trial of homeopathy in headache patients, including tension-type headache, found no significant benefit of homeopathy compared to a placebo group.52