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

NCCAM Clinical Digest

Chronic Pain and Complementary Health Practices—Headache :
What the Science Says

July 2012

Complementary health practices that have been studied for headaches include relaxation training; biofeedback; acupuncture; tai chi; cognitive-behavioral therapy; massage; spinal manipulation; and dietary supplements, such as riboflavin (vitamin B2), magnesium, feverfew, and butterbur.

Relaxation Training for Headaches

Relaxation techniques include a number of practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to consciously produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of calm and well-being.

Scientific Evidence

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

Safety

  • 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.

Biofeedback for Headaches

Biofeedback is the use of simple electronic devices to teach people how to consciously regulate bodily functions, like breathing, heart rate, and blood pressure.

Scientific Evidence

  • A review 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.

Safety

  • Biofeedback is generally considered safe.

Acupuncture for Headaches

Reviews of research on acupuncture for reducing the frequency and intensity of migraine and tension-type headaches conclude that patients may benefit from acupuncture therapy.

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 Cochrane 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 Cochrane review determined that adding acupuncture to acute treatment or routine care may be beneficial in reducing migraine frequency and intensity.

Safety

  • 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.

Massage for Headaches

Only a few studies have rigorously examined the role of massage as a headache treatment.

Scientific Evidence

  • 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.

Safety

  • 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.

Spinal Manipulation for Headaches

There is some evidence that cervical spinal manipulative therapy may help patients suffering from chronic tension-type or cervicogenic (neck-related) headaches.

Scientific Evidence

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

Safety

  • Side effects from cervical spinal manipulative therapy 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 cervical 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.
  • For risks associated with thoracic/lumbar spinal manipulation, see NCCAM's fact sheet, Spinal Manipulation for Low-Back Pain.

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.nih.gov. 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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