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Tension Headache (Holistic)

About This Condition

That dull ache in the back of your head may be a nagging sign of too much stress. How can you tame the tension and find relief? According to research or other evidence, the following self-care steps may be helpful.
  • Apply soothing oils

    Rub peppermint oil or an ointment containing aromatic oils on your forehead

  • Kick back and relax

    Try relaxation techniques such as meditation and biofeedback to control the effects of stress and reduce headache frequency and severity

  • Take 5-HTP

    300 mg a day of the nutritional supplement 5-hydroxytryptophan may lessen headache frequency and limit the need for pain-relieving medications (use 100 mg a day for children)

  • Manage your muscles

    Find a practitioner trained in massage or physical therapy to help unwind tight neck and shoulder muscles

  • Have your spine “inspected”

    Visit a chiropractor or other licensed practitioner trained in spinal manipulation to correct joint problems that may contribute to your headache


About This Condition

A tension-type headache is common and typically experienced as a dull, non-throbbing pain in the back of the neck or in a “headband” distribution.1 It may be associated with tender nodules in the neck called trigger-points,2 or with tenderness in the muscles around the head.3


People with a headache may have symptoms including uncomfortable sensations described as pain, throbbing, aching, dullness, heaviness, and tightness in the head. People with a headache may also experience discomfort that is often worsened by movement or pressure and may be associated with irritability, problems sleeping, and fatigue.

Healthy Lifestyle Tips

Tension-type headaches often occur more frequently and may become more severe during or following times of mental or emotional stress.4, 5, 6 Several controlled studies have found tension-type headache sufferers to report higher levels of stress,7, 8, 9 and to have significantly higher levels of depression or anxiety,10, 11, 12 significantly greater levels of suppressed anger,13 or significantly greater muscle tension14, 15 than those without headaches. Minimizing stress and getting enough sleep and regular exercise are often recommended to people with tension-type headaches. However, no research has investigated the effectiveness of these lifestyle changes.

One controlled study that included patients with muscle-contraction headache as well as other types of headache, revealed that smokers had significantly more severe headache episodes than nonsmokers.16 Although other studies have not found an association between smoking and headaches, stopping smoking is always a good idea for many health reasons.

Holistic Options

Studies treating tension-type headache with acupuncture have had mixed results.17 Two controlled trials of acupuncture compared to “fake” acupuncture found either significantly more pain reduction from real acupuncture18 or no difference between the two treatments.19 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.20, 21 Three controlled acupuncture trials treated patients with various types of headaches, including tension headache. Two of these studies,22, 23 but not the third,24 found acupuncture significantly more effective.

Two preliminary studies25, 26 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.27, 28, 29, 30, 31, 32 A controlled trial compared spinal manipulation to drug therapy for tension-type headaches.33 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.34 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.35

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.36, 37 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.38 Another preliminary study of massage, including deep penetrating techniques, reported significantly decreased pain in patients with chronic tension headache and neck pain.39 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.40

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 adults41, 42, 43, 44, 45 and in children and adolescents.46, 47 Progressive muscle relaxation is another muscle relaxation technique that has significantly reduced tension-type headache in controlled studies of adults,48, 49 and children and adolescents.50, 51

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,52 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.53

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.54

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.55 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.56 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.57


What Are Star Ratings?
Supplement Why
2 Stars
Adults: 300 mg daily; children: 100 mg daily
Taking the supplement 5-hydroxytryptophan may lessen headache frequency and limit the need for pain-relieving medications.

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. (Headaches often improve significantly even when an inactive [placebo] treatment is given). 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 adults or 100 mg per day in children.

2 Stars
Calcium and Vitamin D
1,000 to 1,500 mg per day (plus the same amount of calcium)
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.
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).
2 Stars
Spread a 10% oil solution across the temples three times over a 30-minute period
Peppermint is a soothing oil that appears to have pain-relieving effects when applied topically.

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. 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. 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.


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2. Davidoff RA. Trigger points and myofascial pain: toward understanding how they affect headaches. Cephalalgia 1998;18:436-48 [review].

3. Jensen R. Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia 1999;19:602-21 [review].

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5. Donias SH, Peioglou-Harmoussi S, Georgiadis G, Manos N. Differential emotional precipitation of migraine and tension-type headache attacks. Cephalalgia 1991;11:47-52.

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14. Rugh JD, Hatch JP, Moore PJ et al. The effects of psychological stress on electromyographic activity and negative affect in ambulatory tension-type headache patients. Headache 1990;30:216-9.

15. Hatch JP, Moore PJ, Borcherding S, et al. Electromyographic and affective responses of episodic tension-type headache patients and headache-free controls during stressful task performance. J Behav Med 1992;15:89-112.

16. Payne TJ, Stetson B, Stevens VM, et al. The impact of cigarette smoking on headache activity in headache patients. Headache 1991;31:329-32.

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27. Whittington W, Ellis WB, Molyneux TP. The effect of manipulation (toggle recoil technique) for headaches with upper cervical joint dysfunction: a pilot study. J Manipulative Physiol Ther 1994;17:369-75.

28. Schoensee SK, Jensen G, Nicholson G, et al. The effect of mobilization on cervical headaches. J Orthop Sports Phys Ther 1995;21:184-96.

29. Vernon HT. Manipulative therapy in the chiropractic treatment of headaches: a retrospective and prospective study. J Manipulative Physiol Ther 1982;5:109-12.

30. Mootz RD, Dhami MSI, Hess JA, et al. Chiropractic treatment of chronic episodic tension-type headache in male subjects: a case series analysis. J Can Chiro Assoc 1994;38:152-9.

31. Hoyt WH, Shaffer F, Bard DA, et al. Osteopathic manipulation in the treatment of muscle contraction headache. J Am Osteopath Assoc 1979;78:322-5.

32. Vernon HT. Spinal manipulation and headache of cervical origin. J Manipulative Physiol Ther 1989;12:455-68 [review].

33. Boline PD, Kassak K, Bronfort G, et al. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther 1995;18:148-54.

34. Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997;20:326-30.

35. Bove G, Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. JAMA 1998;280:1576-9.

36. Ahonen E, Hakumaki M, Mahlamaki S, et al. Effectiveness of acupuncture and physiotherapy on myogenic headache: a comparative study. Acupunct Electrother Res 1984;9:141-50.

37. Carlsson J, Augustinsson LE, Blomstrand C, Sullivan M. Health status in patients with tension headache treated with acupuncture or physiotherapy. Headache 1990;30:593-9.

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

39. Puustjarvi K, Airaksinen O, Pontinen PJ. The effects of massage in patients with chronic tension headache. Acupunct Electrother Res 1990;15:159-62.

40. Jay GW, Brunson J, Branson SJ. The effectiveness of physical therapy in the treatment of chronic daily headaches. Headache 1989;29:156-62.

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42. Bruhn P, Olesen J, Melgaard B. Controlled trial of EMG biofeedback in muscle contraction headache. Ann Neurol 1979;6:34-6.

43. Holroyd KA, Andrasik F, Noble J. A comparison of EMG biofeedback and a credible pseudotherapy in treating tension headache. J Behav Med 1980;3:29-39.

44. Carrobles JA, Cardona A, Santacreu J. Shaping and generalization procedures in the EMG-biofeedback treatment of tension headaches. Br J Clin Psychol 1981;20:49-56.

45. Janssen K. Differential effectiveness of EMG-feedback versus combined EMG-feedback and relaxation instructions in the treatment of tension headache. J Psychosom Res 1983;27:243-53.

46. Bussone G, Grazzi L, D'Amico D, et al. Biofeedback-assisted relaxation training for young adolescents with tension-type headache: a controlled study. Cephalalgia 1998;18:463-7.

47. Kroner-Herwig B, Mohn U, Pothmann R. Comparison of biofeedback and relaxation in the treatment of pediatric headache and the influence of parent involvement on outcome. Appl Psychophysiol Biofeedback 1998;23:143-57.

48. Blanchard EB, Applebaum KA, Radnitz CL, et al. Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache. J. Consult Clin Psychol 1990;58:210-5.

49. Blanchard EB, Nicholson NL, Taylor AE, et al. The role of regular home practice in the relaxation treatment of tension headache. J Consult Clin Psychol 1991;59:467-70.

50. Kroner-Herwig B, Mohn U, Pothmann R. Comparison of biofeedback and relaxation in the treatment of pediatric headache and the influence of parent involvement on outcome. Appl Psychophysiol Biofeedback 1998;23:143-57.

51. Larsson B, Melin L, Doberl A. Recurrent tension headache in adolescents treated with self-help relaxation training and a muscle relaxant drug. Headache 1990;30:665-71.

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53. Melis PML, Rooimans W, Spierings ELH, Hoogduin CAL. Treatment of chronic tension-type headache with hypnotherapy: a single-blind time controlled study. Headache 1991;31:686-9.

54. Reich BA. Non-invasive treatment of vascular and muscle contraction headache: a comparative longitudinal clinical study. Headache 1989;29:34-41

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