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National Institutes of Health • National Center for Complementary and Alternative Medicine

NCCAM Clinical Digest

Headaches and Complementary Health Practices :
What the Science Says

November 2011
A woman holds her head in pain.

Relaxation Training

Scientific Evidence

  • One review article noted that relaxation training significantly reduced headache activity compared to other forms of therapy.

Side Effects and Cautions

  • Relaxation techniques are generally considered safe for healthy people.
  • There have been rare reports that certain relaxation techniques might cause or worsen symptoms in people with epilepsy or certain mental illnesses, or with a history of abuse or trauma. People with heart disease should talk to their doctor before doing progressive muscle relaxation.


Scientific Evidence

  • A review article reported that adding biofeedback to a combination of an antidepressant and high blood pressure medication was more effective in treating tension-type headaches than medication alone.
  • Results from one study indicated that biofeedback provided no additional benefit over relaxation therapy in reducing headache frequency and severity.

Side Effects and Cautions

  • Biofeedback is generally thought to be safe; however, it may not be appropriate for certain people.


Scientific Evidence

  • In a review of two large trials in people with tension-type headaches, researchers found that adding acupuncture to the use of pain relievers was more effective than using pain relievers alone.
  • A review that analyzed results from two large and three small trials comparing true acupuncture with sham acupuncture (in which needles were either inserted at incorrect points or did not penetrate the skin) demonstrated a slightly better effect for true acupuncture in treating tension-type headaches.
  • Results of another review article determined that adding acupuncture to acute treatment or routine care may be beneficial in reducing migraine frequency and intensity.

Side Effects and Cautions

  • Acupuncture is considered safe when performed by a qualified and competent practitioner using sterile needles.
  • Few complications have been reported.
  • Serious adverse events related to acupuncture are rare, but include infections and punctured organs.

Tai Chi

Scientific Evidence

  • Results from a small clinical trial suggested that a 15-week program of tai chi was effective in reducing the impact of tension-type headaches when compared to a wait-list control group.

Side Effects and Cautions

  • Tai chi is a relatively safe practice; however, some health care providers may advise their patients to modify or avoid certain tai chi postures due to acute back pain, knee problems, bone fractures, sprains, and osteoporosis.

Cognitive-Behavioral Therapy

Scientific Evidence

  • It has been suggested that cognitive-behavioral therapy may offer additional relief when combined with medication used for preventing migraines.


Scientific Evidence

  • Only a few studies have rigorously examined the role of massage as a headache treatment.
  • A 2008 pilot study involving 16 participants suggested that massage may be beneficial in reducing the frequency of tension type headaches as well as the intensity and duration of pain.
  • In another small study, researchers observed that a specific type of massage called craniosacral therapy, which involves light touch and manipulation of the skull and spine to release restrictions in tissues, was more effective than no treatment in relieving pain from a tension-type headache but suggested that larger studies are needed to determine the efficacy of massage as a headache treatment.
  • Researchers are also investigating whether massage therapy may help prevent migraines. In a 2006 study, researchers randomly assigned 24 people with migraines to receive six 45-minute massages that focused on the muscles of the back, shoulders, head, and neck while 24 people without migraines acted as a control group. Although there was no change in the average intensity of migraines experienced, the researchers observed a significant reduction in migraine frequency among those who received massages.

Side Effects and Cautions

  • Massage therapy appears to have few serious risks—if it is performed by a properly trained therapist and if appropriate cautions are followed. The number of serious injuries reported is very small.
  • Side effects of massage therapy may include temporary pain or discomfort, bruising, swelling, and a sensitivity or allergy to massage oils.
  • Cautions about massage therapy include the following:
    • Vigorous massage should be avoided by people with bleeding disorders or low blood platelet counts, and by people taking blood-thinning medications such as warfarin.
    • Massage should not be done in any area of the body with blood clots, fractures, open or healing wounds, skin infections, or weakened bones (such as from osteoporosis or cancer), or where there has been a recent surgery.
    • Although massage therapy appears to be generally safe for cancer patients, they should consult their oncologist before having a massage that involves deep or intense pressure. Any direct pressure over a tumor usually is discouraged. Cancer patients should discuss any concerns about massage therapy with their oncologist.
    • Pregnant women should consult their health care provider before using massage therapy.

Spinal Manipulation

Scientific Evidence

  • Literature reviews suggest that spinal manipulation may offer some benefit for tension-type headaches and that it also may prevent migraines as well as the medication amitriptyline.

Side Effects and Cautions

  • Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the parts of the body that were treated.
  • Although there have been rare reports of serious complications such as stroke, a large 2009 study did not find a relationship between spinal manipulation and vertebrobasilar artery stroke, which involves the arteries that supply blood to the back of the brain. Safety remains an important part of ongoing research.

Riboflavin, Coenzyme Q10, and Magnesium

Scientific Evidence

  • Some research suggests that the supplements riboflavin and coenzyme Q10 may be helpful headache treatments.
  • Studies using magnesium to prevent migraines were inconclusive.

Side Effects and Cautions

  • Riboflavin and coenzyme Q10 are generally well tolerated, but magnesium supplements may cause diarrhea.
  • Riboflavin supplements are not recommended for pregnant women.

Feverfew and Butterbur

Scientific Evidence

  • The herbs feverfew (Tanacetum parthenium) and butterbur (Petasites hybridus) have been used historically for headache relief.
  • Study results have indicated that feverfew and butterbur may help reduce migraine frequency.

Side Effects and Cautions

  • In clinical trials, use of feverfew was associated with mild side effects such as open sores in the mouth and upset stomach.
  • Butterbur is generally well tolerated but may cause mild gastrointestinal upset.
  • Some butterbur products contain potentially harmful chemicals called pyrrolizidine alkaloids (PAs). If seeking a butterbur product, look for one labeled or certified as PA-free.
  • Feverfew and butterbur are not recommended for pregnant women.

NCCAM Clinical Digest is a service of the National Center for Complementary and Alternative Medicine, NIH, DHHS. NCCAM Clinical Digest, a monthly e-newsletter, offers evidence-based information on CAM, including scientific literature searches, summaries of NCCAM-funded research, fact sheets for patients, and more.

The National Center for Complementary and Alternative Medicine is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCAM Web site at NCCAM is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.



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