Tension Headache and Alternative Health Care Treatment Literature Review
Tension-type headache is very common and is typically experienced as a dull,
non-throbbing pain in the back of the neck or in a "headband" distribution. It may be associated with tender nodules in the neck
called trigger-points, or with tenderness in
the muscles around the head.
Symptoms
People with a headache may have symptoms
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.
Lifestyle
Tension-type headaches often occur more frequently and may become more severe
during or following times of mental or emotional stress. Several controlled studies
have found tension-type headache sufferers to report higher levels of stress,
1, 2, 3 and to
have significantly higher levels of depression or anxiety,
4, 5, 6 significantly
greater levels of suppressed anger, 7 or
significantly greater muscle tension 8,
9 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.
Supplements
L-5-hydroxytryptophan (5-HTP) 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%.
10 (Headaches often improve significantly even when
an inactive [placebo] treatment is given). 11
Headache severity was also similarly reduced by either 5-HTP or placebo. In this
study, 5-HTP was significantly superior to placebo 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 benefits of 5-HTP compared with
placebo using either 400 mg per day in adults 12
or 100 mg per day in children. 13
Essential Oils
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. 14
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.
15 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.
16
Other Alternatives
Studies treating tension-type headache with
acupuncture have been generally
favorable to acupuncture but with some contradictory results. 24
A controlled trials of acupuncture
compared to "fake" acupuncture found either significantly more pain reduction
from real acupuncture 25 or no difference
between the two treatments. 26
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. 27,
28 Three controlled acupuncture trials treated
patients with various types of headaches, including tension headache. Two of
these studies, 29, 30 found acupuncture
significantly more effective.
Two preliminary studies 32, 33
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.
34,
35, 36, 37,
38, 39 A controlled trial
compared spinal manipulation to drug therapy for tension-type headaches.
40 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.
41 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.
42
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. 43, 44 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.
45 Another preliminary study of
massage, including deep penetrating techniques,
reported significantly decreased pain in patients with chronic tension headache
and neck pain. 46 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. 47
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
adults 48, 49,
50, 51, 52 and in children
and adolescents. 53, 54
Progressive muscle relaxation is another muscle relaxation technique that has
significantly reduced tension-type headache in controlled studies of adults,
55, 56 and children and
adolescents. 57, 58
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, 59 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.
60
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.
61
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. 62 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. 63 A majority of
people treated in this study reported being helped by this technique.
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Our herbal heat packs are perfectly suited to Moist heat therapy.
When not to use a heating pad
Local application of heat is not advised in patients with decreased sensation
or circulatory impairment. It is also contraindicated over areas of malignancy
and not advisable in acute injury. Generally cold therapy is preferred in an
recent injury. Keep one of our packs in the freezer for cold therapy. Some
conditions respond best to an alternating treatment of cold therapy and a
heating pad. Usual application is about 20 minutes, not more than 30
minutes.
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