Headaches

Click Here

Go see someone

Visiting a practitioner

Headaches are often a reason people consult a complementary practitioner. This can be quite an elusive symptom as many headaches come and go. However there is a reasonable evidence that natural treatments can be helpful in some cases.

A lot depends on the skill of the practitioner and how you feel about working with them. Complementary therapies are not widely available through the NHS, so a typical session could cost you from £40 to £80. Nevertheless, some people say they have found having time with a practitioner very helpful.

You should always look for a practitioner who is properly trained and registered with the relevant professional body.

 

Supported care options

Acupuncture

Summary
Acupuncture is a traditional form of treatment that began in China thousands of years ago. Thin needles are inserted into the skin at special points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.

Evidence
There has been quite a lot of research on acupuncture for tension headaches. The results indicate that acupuncture can help make tension headaches less frequent and less severe.

Safety
Acupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Find out more
The following professional organisations can help you find a qualified practitioner:

Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society

View the evidence

Acupuncture for tension-type headache.
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007587. DOI: 10.1002/14651858.CD007587.
SR of 11 trials with 2317 participants. Conclusions: acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.
Link to Abstract

Autogenic training (AT)

Summary
AT classes require time and discipline, but may have greater benefits than simple muscle relaxation. In AT classes you learn to create feelings of warmth and heaviness throughout your body, and this is said to bring about very deep physical relaxation, mental peace and a quietening of negative thoughts. AT uses simple phrases that you repeat to yourself as you release tension from each part of your body.

Evidence
The evidence from research is mixed, but autogenic training might be helpful to some people with tension headaches.

Safety
AT is best learned from an experienced teacher in a small class. There are no safety issues, though anyone with a long-term mental health problem should get advice from their psychiatrist before starting AT.

Cost
You will have to pay for the classes but once you have learned this technique you can practise it at home at no cost.

Further information
The British Autogenic Society (BAS) is the professional and educational organisation for autogenic therapists in the UK.

View the evidence

Behavioral treatments of chronic tension-type headache in adults: are they beneficial?
Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW. CNS Neurosci Ther. 2009 Summer;15(2):183-205.
SR, 44 trials of behavioral treatments (e.g., relaxation, electromyographic biofeedback, and cognitive behavioral training) Conclusions: there is conflicting evidence that relaxation is better than no treatment, waiting list, or placebo.
Link to Abstract

Autogenic training for tension type headaches: a systematic review of controlled trials.
Kanji N. White AR. Ernst E. Complementary Therapies in Medicine. 14(2):144-50, 2006 Jun.
This review concludes that there is no evidence to suggest that autogenic training is superior to other interventions for prevention of tension headaches.
Link to Abstract

Massage

Summary
There are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils.

Evidence
Massage may help with pain when combined with other physical treatments such as manipulation.

Safety
Massage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.

Cost
Monthly cost will depend on how regularly you receive treatments.

Further information
It is important to find a qualified practitioner such as one registered with The General Council for Soft Tissue Therapies.

View the evidence

Non-invasive physical treatments for chronic/recurrent headache.
Branfort G, Nilsson N, Haas M, Evans RL, Goldsmith CH, Assendelft WJJ, Bouter LM. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001878. DOI: 10.1002/14651858.CD001878.pub2.
Cochrane SR of 22 studies with a total of 2628 patients. Conclusions: Weaker evidence suggests that other treatments may also be effective: a combination of self-massage/TENS/stretching for tension-type headache.
Link to Abstract

Physiotherapy

Summary
Physiotherapists use exercises and stretches to improve strength, flexibility and stiffness. Often these exercises need to be done at home at least once daily for many weeks or months. Some physiotherapists can provide massage, hydrotherapy in a special pool, many use soft lasers, electrotherapy or ultrasound to speed up healing. A lot of physiotherapists use acupuncture techniques as well. Ask your physiotherapist what sort of methods they have available.

Tension headaches often start in the muscles of the neck and shoulders. So particular neck exercises may help relax these trigger points and so help with your tension headaches.

Evidence
Certain exercises may help prevent tension headaches. They may also reduce the severity of headaches..

Safety
Physical treatments are generally safe if practised by a trained therapist.

Cost
The exercises are simple, but they need to be done every day. They cost nothing once you have learned to do them. However you need advice for particular neck exercises for tension headaches and your GP can refer you to an NHS physiotherapist. Private physiotherapy is available in all areas. A half hour appointment will vary in cost between £30 and £60. Monthly cost will depend on duration of the treatment.

Further information
It is important to find a qualified practitioner such as one registered with The Chartered Society of Physiotherapy.

View the evidence

Socio-economic factors, lifestyle, and headache disorders – a population-based study in Sweden.
Molarius A, Tegelberg A, Ohrvik J. Headache. 2008 Nov-Dec;48(10):1426-37. Epub 2008 Jul 1.
Random sample of people with self-reported recurrent headache/migraine 43,770 respondents. Conclusions: Of lifestyle factors, physical inactivity was strongly associated with headache disorders independent of economic and psychosocial factors.
Link to Abstract

Does exercise therapy improve headache? a systematic review with meta-analysis.
Fricton J, Velly A, Ouyang W, Look JO. Curr Pain Headache Rep. 2009 Dec;13(6):413-9.
Systematic review and meta-analysis of 10 RCTs involving exercise for tension-type headache and temporomandibular disorder muscle pain. Conclusions: Therapeutic exercises, particularly stretching and posture exercise, have modest positive therapeutic effects for headache and TMD muscle pain compared to controls.
Link to Abstract

Non-invasive physical treatments for chronic/recurrent headache.
Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJ, Bouter LM. Cochrane Database Syst Rev. 2004;(3):CD001878.
SR of 22 studies with a total of 2628 patients, five types of headache studied. For the prophylactic treatment of cervicogenic headache, there is evidence that both neck exercise (low-intensity endurance training) and spinal manipulation are effective in the short and long term when compared to no treatment.
Link to Abstract

Psychological training

Summary
Some people find their headaches are directly triggered by conflicts or emotional distress. If you get headaches every day, you tend to expect them, and psychological approaches may be useful to help counter this and if you have severe long-term headaches.

When people think of ‘talking therapies’ they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says “CBT can help you to change how you think (‘cognitive’) and what you do (‘behavioural’)”. For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

Evidence
There is no good evidence that cognitive behavioural therapy (CBT) helps people with headaches. But it may help you manage stress that triggers them.

Safety
CBT techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.

Cost
In most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions

Further information
It is important to find a qualified counsellor or psychologist. Contact The British Psychological Society.

View the evidence

Behavioral treatments of chronic tension-type headache in adults: Are they beneficial?
Verhagen A.P., Damen L., Berger M.Y., Passchier J., Koes B.W. CNS Neuroscience and Therapeutics. 15(2)(pp 183-205), 2009.
SR or 44 trials (2618 patients). Conclusions: no indications that relaxation, EMG biofeedback, or cognitive behavioural treatment is better than no treatment, waiting list, or placebo controls.
Link to Abstract

Spinal manipulation (including chiropractic and osteopathy)

Summary
Osteopathy and chiropractic are hands-on approaches to diagnosis and treatment that focus on the way the muscles and joints work. They are both based on the idea that pain often comes from physical strains and tensions in the body, rather than from inflammation or damage caused by disease. Treatment by an osteopath or a chiropractor often involves spinal manipulation. If tender points in your neck seem to affect your headaches, these approaches might help relieve the pain.

Evidence
Two studies have suggested that spinal manipulation is helpful compared with other kinds of treatments.

Safety
Side-effects are rare and mainly linked to manipulation of the neck. Some people experience mild after-effects (aches) from the treatment but they usually last less than 48 hours.

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Further information
Both osteopathy and chiropractic are state-regulated professions and allhave to be registered with either The General Chiropractic Council or the General Osteopathic Council.

View the evidence

Non-invasive physical treatments for chronic/recurrent headache.
Bronfort G, Nilsson N, Haas M, Evans RL, Goldsmith CH, Assendelft WJJ, Bouter LM. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001878. DOI: 10.1002/14651858.CD001878.pub2.
Cochrane SR of 22 studies with a total of 2628 patients. Conclusions: Spinal manipulation may be effective for migraine and chronic tension-type headache. Both spinal manipulation and neck exercises may be effective for cervicogenic headache.
Link to Abstract

Spinal manipulative therapy in the management of cervicogenic headache.
Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado M L, Pareja J A. Headache.2005;45(9):1260-1263.
SR of 2 trials. Conclusions: Spinal manipulative therapy might be effective in reducing headache intensity, headache duration, medication intake and headache frequency (judged as overly positive by DARE).
Link to Abstract

Effectiveness of physiotherapy and spinal manipulation in patients with tension-type headache: an update of a systematic review.
Verhagen AP, van Heest M, van der Have D, Lenssinck ML, Berger MY, Verkerk K, Passchier J, Koes BW. Nederlands Tijdschrift voor Fysiotherapie 2009 Jun;119(3):85-92.
SR, 12 trials, range of interventions. Conclusions: Not possible to draw firm conclusions about the efficacy of manipulation and physiotherapy for the treatment of tension-type headache.
Link to Abstract

The effectiveness of physiotherapy and manipulation in patients with tension-type headache: A systematic review.
Lenssinck M.-L.B., Damen L., Verhagen A.P., Berger M.Y., Passchier J., Koes B.W. Pain. 112(3)(pp 381-388), 2004.
SR, 8 studies included. Only two studies were considered to be of high quality, but showed inconsistent results. Conclusions: there is insufficient evidence to either support or refute the efficacy of physiotherapy and (spinal) manipulation in patients with TTH.
Link to Abstract

Physical treatments for headache: a structured review.
Biondi DM. Headache 45 (6): 73846. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
This 2005 structured review found only weak for chiropractic manipulation in tension headache, but that it was probably more useful for tension headache than for migraine.
Link to Abstract

The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials.
Astin J A, Ernst E. Cephalalgia.2002;22(8):617-623.
SR, 2 trials in tension headache. Both positive but low quality. Conclusions: It is unclear whether or not spinal manipulation is an effective treatment for headache disorders.
Link to Abstract

 

Tai chi

Summary
Tai chi is also known as ‘moving meditation’. It is a series of slow, graceful, controlled movements, which develop strength, balance, posture and inner peace. It is a discipline that has to be learned in a class from a teacher and can then be practised at home.

Evidence
One trial showed that tai chi may help reduce the pain of tension headaches.

Safety
Tai chi is safe for most people. Though tai chi is slow and gentle, anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and build up gently.

Cost
Once you have learned the movements, you can do the exercises at home, at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services. You can also contact the The Tai Chi Union..

View the evidence

The effectiveness of Tai Chi for chronic musculoskeletal pain conditions: a systematic review and meta-analysis.
Hall A. Maher C. Latimer J. Ferreira M. Arthritis & Rheumatism. 61(6):717-24, 2009 Jun 15.
SR of range of conditions, included 1 trial of people with chronic TTH. Conclusions: extent to which tai chi benefits other conditions (than arthritis) is unclear.
Link to Abstract

A randomized controlled trial of Tai Chi for tension headaches. Evidence-based Complementary and Alternative Medicine.
Abbott R.B., Hui K.-K., Hays R.D., Li M.-D., Pan T. Evid Based Complement Altern Med 4(1)(pp 107-113), 2007.
RCT, 47 patients with tension headache, Tai chi instruction or wait list control. Conclusions: A 15 week intervention of Tai Chi practice was effective in reducing headache impact and also effective in improving perceptions of some aspects of physical and mental health.
Link to Abstract

 

Yoga

Summary
Yoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.

Evidence
Only a few small studies have been carried out on yoga in people with tension headaches. It is not certain whether yoga can help prevent or manage headaches. But it may help you relax, reduce your stress level and help you cope with headaches.

Safety
Yoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.

Cost
You will have to pay for the classes but once you have learned this technique you can practise it at home at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.

View the evidence

Efficacy of yoga therapy in the management of headaches.
Latha, Dr; Kaliappan, K. V. Journal of Indian Psychology. Vol.10(1-2), Jan-Jul 1992, pp. 41-47.
RCT, 20 patients with migraine and tension headaches, yoga therapy and no treatment control. There was significant reduction in the headache activity, medication intake, symptoms, and stress perception for the therapy group. They also showed significant improvement in coping behavior.

Role of temporalis muscle over activity in chronic tension type headache: Effect of yoga based management.
Bhatia R., Dureja G.P., Tripathi M., Bhattacharjee M., Bijlani R.L., Mathur R. Indian Journal of Physiology and Pharmacology. 51(4)(pp 333-344), 2007.
15 patients with chronic TTH and 7 controls, range of different interventions tested.
Link to Abstract

Yogic meditation in tension headache
Vasudevan, Anita; Kumaraiah, V; Mishra, H; Balodhi, J. P. NIMHANS Journal. Vol.12(1), Jan 1994, pp. 69-73.
Uncontrolled study, 7 patients with tension headache were taught and underwent 30 sessions of Yogic Meditation. No change in muscle tension, change in pain perception.
Link to Abstract