When a tension headache strikes, most people head for their medicine cabinet or drugstore, looking for an over-the-counter painkiller such as acetaminophen or ibuprofen.
But if you get them often, that plan can backfire.
“Frequent use of these drugs can cause rebound headaches,” says Priyanka Chaudhry, MD, of the Baylor Neuroscience Center Headache Center.
There can also be side effects, as with any medicine. Taking too much acetaminophen is bad for your liver, and overdoing ibuprofen can upset your stomach.
You need a plan that goes beyond pills. Simple things -- like better sleep, stress management, and regular exercise -- are key. Basic home remedies, such as hot and cold compresses, also help.
If you’re looking into other methods, from acupuncture to supplements, you need to know what might help and what to skip.
It teaches you how to gain control over things your body normally handles automatically, such as your heartbeat.
To learn how, you wear sensors that track these bodily activities on a screen as your teacher guides you through relaxation exercises. You can see on the screen how your body responds.
There’s “pretty good” data supporting biofeedback for tension headaches, Chaudhry says. She points to a study that found that relaxation and a certain type of biofeedback, done either alone or together, lowered tension headaches by 50%.
In another report, researchers reviewed 53 studies and concluded that biofeedback helped, especially for making these headaches rarer.
“Biofeedback is extremely useful,” says Jennifer Kriegler, MD, director of the Headache Medicine Fellowship at Cleveland Clinic.
“It monitors tension in your neck, jaw, and temples, and you can learn how to make those areas relax,” she says. “But any type of relaxation technique will offer some benefit, even if it’s simple breathing exercises. And you can do those on your own, without seeing a practitioner.”
Peppermint Oil and Tiger Balm
Peppermint oil feels cool and may help with pain, Chaudhry says. Rubbing it along your hairline may also help relax the muscles in your face and neck.
One small study backs that up. The researchers focused on 41 people with tension headaches and found that applying peppermint oil to the forehead and temples was as effective as taking 1,000 milligrams of acetaminophen. (That’s equal to two extra-strength Tylenol.) More research would be needed to confirm that, though.
Tiger Balm has nothing to do with tigers. It’s an herbal ointment made with ingredients like camphor and menthol.
It may have similar benefits to peppermint oil when used the same way. Australian researchers found that it was as effective as acetaminophen in relieving tension headaches.
These were small studies, Chaudhry cautions, but she says treatments like these that go on your skin are generally harmless and are OK to try, as long as you’re not allergic to the ingredients.
Practitioners of this traditional Chinese medical technique use very thin needles at specific points on the body to redirect your energy to ease various problems.
“Acupuncture can promote muscle relaxation,” Kriegler says. “It’s worth trying for tension headaches.”
How well does it work? The research is mixed. This is because the exact placement of the needles depends on the person, so it’s hard to test a standard approach, Kriegler says.
One study of 270 people with tension headaches found that acupuncture was better than no treatment at all at making tension headaches rarer. But it wasn’t better than a fake acupuncture treatment.
When other researchers combed through several studies, they concluded that acupuncture has “limited” effectiveness in curbing headaches.
If you want to try it, give it several sessions, each of which takes about an hour. Your insurance may not cover it, so check on the prices first.
Ginger curbs inflammation. Some research shows it can be an effective treatment for migraines, but the herb’s ability to treat tension headaches has gotten less research.
“I’m assuming that part of the reason ginger tea could help with headache pain is that it’s warm and soothing, and when you have a cup, you stop what you’re doing and relax for a few minutes,” Kriegler says. “Taking a break and having anytea might work just as well. There’s no magic in ginger itself for headaches.”
A few small studies have found that butterbur and feverfew can help treat and prevent migraines, leading some people to speculate that these herbs may also be useful for tension headaches.
But “for tension-type headaches, these are not the therapies I would tell a patient to use. There’s no clear data that they help,” Chaudhry says.
There can be side effects. Feverfew can interact with certain medications, like blood thinners, and neither supplement is safe for pregnant women.
Chaudhry sometimes suggests melatonin to her patients, because it can help improve sleep -- and getting your ZZZs can lower your chances of coming down with a tension headache. Kriegler occasionally recommends coenzyme Q10 and magnesium oxide, which can encourage muscle relaxation. They both say you should check with your doctor before you try any type of supplement -- even if it’s “natural.”
It feels good. But does it help your headaches?
“There are short-term benefits to massage: Your levels of anxiety and the stress hormone cortisol decrease. It has a calming effect,” Chaudhry says.
In one study, researchers found that people got fewer headaches when they got neck and shoulder massages. But when headaches did strike, they were as intense as before.
So go ahead and book an occasional massage. Still, keep up with your other treatments, Chaudhry says.
Homeopathy is based on the idea that "like cures like." A small dose of a substance that causes symptoms similar to an illness is given to a person to stimulate the body’s healing process.
These remedies are usually made from plants. Popular choices for tension headaches include gelsemium and bryonia.
There aren’t strong studies to back that up.
A review of research published in Complementary Therapies in Medicine in 1999 concluded that “there is evidence that homeopathy is not effective for tension-type headache.” Since then, that hasn’t changed.
The research on whether this works for tension headaches is mixed.
One study found that this type of treatment made these headaches less frequent and less intense.
But another study, published in The Journal of the American Medical Association, found that after 4 weeks of chiropractic spinal adjustments, there wasn’t a “positive effect” on pain.
Without more evidence, Chaudhry says that “a clear recommendation can’t be made for or against” spinal manipulation for chronic tension headaches.
Keith Overland, a past president of the American Chiropractic Association, disagrees. People assume that chiropractic care always involves spinal manipulation, but that’s not true, he says.
“A treatment plan might include massage, physical therapy, and supplements. A doctor will only recommend manipulation if it’s indicated,” he says.
A chiropractic doctor with a degree has more than 4,000 hours of post-graduate doctoral education and is trained to examine and diagnose you, Overland says. If you want to make sure your chiropractor has a good safety rating, he suggests you check with your insurance company.