Headaches: Tension-Type

Description

Lifestyle Changes

Good health habits, including adequate sleep, healthy diet, regular exercise, and good stress management are important, along with the following specific measures for headache management. Quitting smoking is essential in reducing the risks for all headaches.

Pressure, Heat, and Cold

An ancient and potentially effective 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. In one 2000 study, 87% of headache sufferers experienced significant relief and the rest reported moderate relief while they were wearing special headbands that could be tightened. They applied packs that were frozen or microwaved. (Either heat or cold packs were useful, although people with tension headaches generally preferred cold packs.)

Dietary Factors

A healthy diet rich in fresh fruits and vegetables and whole grains and low in saturated fats (animal fats) is important to everyone. Fish (particularly oily fish such as salmon and tuna) and soy are protein sources that may be a good alternative to red meats.

Caffeine. In some people with headaches, caffeine appears to be an excellent companion to medications. One study found that the caffeine equivalent of two and a half of cups of coffee can help treat a tension-type headache by itself. Many medications contain combinations of pain or anxiety relievers and caffeine, which boosts pain-relieving potency and counters drowsiness. Taking ibuprofen along with caffeine is even more effective than either substance alone. (It should be noted that in some people with migraines, the tannin found in coffee or tea may be a trigger for the headache. In addition, withdrawal from caffeine is a major cause of headache.)

Treatment of Sleep Disorders

Headaches that occur during the night and early morning may be related to sleep disorders. One study reported that treating an underlying sleep disorder, such as sleep apnea or insomnia in patients who also had headaches resulted in headache cure or improvement in all patients except those who suffered from restless legs syndrome. [For more information, see the Well-Connected Reports #27, Insomnia and #65, Sleep Apnea.]

Relaxation and Other Stress Reduction Therapies

A number of stress-reduction methods are available that may help counteract the tendency for muscle contraction and uneven blood flow associated with some headaches. Such approaches may be especially helpful for children and pregnant women with chronic headaches.

In choosing specific strategies for treating stress, several factors should be considered.

• First, no single method is uniformly successful: a combination of approaches is generally most effective.
• Second, what works for one person does not necessarily work for someone else.
• Third, stress can be positive as well as negative. Appropriate and controllable stress provides interest and excitement and motivates the individual to greater achievement, while a lack of stress may lead to boredom and depression.

Among the stress reduction techniques that may be helpful are the following:

• Guided imagery. (This uses body awareness and visualization of pleasant or positive images.)
• Biofeedback. This technique works when patients develop awareness of their physical responses and learn to feed this information back to the brain for the purpose of replicating that response. It is often used to reduce muscle tension. One interesting and sometimes effective technique for headaches is called thermal biofeedback. It employs the idea that hand-warming reduces blood flow to the brain and so relieves headache. The patient learns techniques (such as using specific images) that can raise the temperatures of the hand during a headache. Studies suggest the approach has been helpful in children with tension and migraine headaches.
• Autogenic training. This approach combines elements of meditation, relaxation, and self-hypnosis. In one study, it reduced headache frequency and use of medications in patients with tension-type and migraine headaches. It was more successful for tension-type.
• Massage therapy. In a 2002 study, massage therapy of the neck and shoulder muscles reduced the frequency of chronic daily tension-type headaches within the first week of treatment. (It did not have any effect on the intensity of headaches, however.)
• Reflexology, an alternative massage method that manipulates the feet, was associated with improvement in 81% of patients with tension or migraine headaches. Patients reported an improvement in energy, well-being, and increased ability to understand the cause of the headaches. In the study, 19% went off medication.
• Muscle relaxation exercises.
• Self-Hypnosis.
• Breathing exercises. Studies have reported that correct and rhythmic breathing from the diaphragm can sometimes relieve tension-type headaches. Such breathing exercises may be particularly beneficial when performed with physical movements. (Yoga, in fact, is a practice that combines both and has been helpful in people with headaches.)

Any of these therapies may be used in conjunction with drug therapy. Of interest was a 2001 Swedish study that reported that relaxation techniques helped adolescents with migraines but not tension-type headaches. An Italian study the same year, however, reported that biofeedback techniques provided benefits for young patients with periodic tension-type headaches. [For more information, see the Well-Connected Report #31, Stress.]