ChiroACCESS Clinical Review

Episodic Tension-type Headache: Therapy

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.


How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)

Published on

January 22, 2010

Text Size:     
Information relating to the treatment of episodic tension-type headache (ETTH) is limited.  Most studies address chronic tension type-headache (CTTH) or do not differentiate between headache types.  For the purpose of this review and assigned ratings, studies on CTTH and non differentiated tension type headache (TTH) will be included when the author feels the information may be appropriate for ETTH.  Whenever CTTH or TTH references are used they will be duly noted.   

All interventions should be evaluated in light of a strong placebo effect in ETTH.  A recent trial comparing ketoprofen, acetaminophen and placebo found over 50% of patients rated the effect of the placebo as “good/excellent “ (1).

AttentionIn order to view the full content of this review, which includes information broken down by topic, you must be a registered user of ChiroACCESS. The primary mission of ChiroACCESS is to disseminate accurate user-friendly information to practicing chiropractors, faculty and students of chiropractic in order to ensure the best possible patient care.

Please click on the following link in order to register at ChiroACCESS and view the full detail of this clinical review.

If you already have an account, you may log in at this time.



Mehlisch DR, Weaver M, Fladung B. Ketoprofen, acetaminophen, and placebo in the treatment of tension headache. Headache 1998 Sep;38(8):579-89.

 [ Medline ID 11398300 ]


Sun-Edelstein C, Mauskop A. Complementary and alternative approaches to the treatment of tension-type headache. Curr Pain Headache Rep 2008 Dec;12(6):447-50.

 [ Medline ID 18973739 ]


Nestoriuc Y, Martin A, Rief W, Andrasik F. Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback 2008 Sep;33(3):125-40.

 [ Medline ID 18726688 ]


Nestoriuc Y, Rief W, Martin A. Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol 2008 Jun;76(3):379-96.

 [ Medline ID 18540732 ]


D'Souza PJ, Lumley MA, Kraft CA, Dooley JA. Relaxation training and written emotional disclosure for tension or migraine headaches: a randomized, controlled trial. Ann Behav Med 2008 Aug;36(1):21-32.

 [ Medline ID 18696172 ]


Gunreben-Stempfle B, Griessinger N, Lang E, Muehlhans B, Sittl R, Ulrich K. Effectiveness of an intensive multidisciplinary headache treatment program. Headache 2009 Jul;49(7):990-1000.

 [ Medline ID 19473281 ]


Matchar DB, Harpole L, Samsa GP, Jurgelski A, Lipton RB, Silberstein SD, et al. The headache management trial: a randomized study of coordinated care. Headache 2008 Oct;48(9):1294-310.

 [ Medline ID 18547268 ]


Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev 2009;(1):CD007587.

 [ Medline ID 19160338 ]


Xue CC, Dong L, Polus B, English RA, Zheng Z, Da CC, et al. Electroacupuncture for tension-type headache on distal acupoints only: a randomized, controlled, crossover trial. Headache 2004 Apr;44(4):333-41.

 [ Medline ID 15109358 ]


Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, et al. Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ 2005 Aug 13;331(7513):376-82.

 [ Medline ID 16055451 ]


Endres HG, Bowing G, Diener HC, Lange S, Maier C, Molsberger A, et al. Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial. J Headache Pain 2007 Oct;8(5):306-14.

 [ Medline ID 17955168 ]


Davis MA, Kononowech RW, Rolin SA, Spierings EL. Acupuncture for tension-type headache: a meta-analysis of randomized, controlled trials. J Pain 2008 Aug;9(8):667-77.

 [ Medline ID 18499526 ]


White AR, Resch KL, Chan JC, Norris CD, Modi SK, Patel JN, et al. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia 2000 Sep;20(7):632-7.

 [ Medline ID 11128820 ]


Gottschling S, Meyer S, Gribova I, Distler L, Berrang J, Gortner L, et al. Laser acupuncture in children with headache: a double-blind, randomized, bicenter, placebo-controlled trial. Pain 2008 Jul 15;137(2):405-12.

 [ Medline ID 18022318 ]


Biondi DM. Physical treatments for headache: a structured review. Headache 2005 Jun;45(6):738-46.

 [ Medline ID 15953306 ]


Torelli P, Jensen R, Olesen J. Physiotherapy for tension-type headache: a controlled study. Cephalalgia 2004 Jan;24(1):29-36.

 [ Medline ID 14687010 ]


van EH, Lucas C. Efficacy of physiotherapy including a craniocervical training programme for tension-type headache; a randomized clinical trial. Cephalalgia 2006 Aug;26(8):983-91.

 [ Medline ID 16886935 ]


Gobel H, Fresenius J, Heinze A, Dworschak M, Soyka D. [Effectiveness of Oleum menthae piperitae and paracetamol in therapy of headache of the tension type]. Nervenarzt 1996 Aug;67(8):672-81.

 [ Medline ID 8805113 ]


Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia 1994 Jun;14(3):228-34.

 [ Medline ID 7954745 ]


Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther 2001 Sep;24(7):457-66.

 [ Medline ID 15125860 ]


Bove G, Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. JAMA 1998 Nov 11;280(18):1576-9.

 [ Medline ID 9820258 ]


Vernon H, Jansz G, Goldsmith CH, McDermaid C. A randomized, placebo-controlled clinical trial of chiropractic and medical prophylactic treatment of adults with tension-type headache: results from a stopped trial. J Manipulative Physiol Ther 2009 Jun;32(5):344-51.

 [ Medline ID 19539116 ]


Anderson RE, Seniscal C. A comparison of selected osteopathic treatment and relaxation for tension-type headaches. Headache 2006 Sep;46(8):1273-80.

 [ Medline ID 16942472 ]


Grazzi L, Andrasik F, Usai S, Bussone G. Magnesium as a preventive treatment for paediatric episodic tension-type headache: results at 1-year follow-up. Neurol Sci 2007 Jun;28(3):148-50.

 [ Medline ID 17603767 ]


Grazzi L, Andrasik F, Usai S, Bussone G. Magnesium as a treatment for paediatric tension-type headache: a clinical replication series. Neurol Sci 2005 Feb;25(6):338-41.

 [ Medline ID 15729497 ]


Altura BM, Altura BT. Tension headaches and muscle tension: is there a role for magnesium? Med Hypotheses 2001 Dec;57(6):705-13.

 [ Medline ID 11918431 ]


Prousky J, Seely D. The treatment of migraines and tension-type headaches with intravenous and oral niacin (nicotinic acid): systematic review of the literature. Nutr J 2005;4:3.

 [ Medline ID 15673472 ]


Ribeiro CA. L-5-Hydroxytryptophan in the prophylaxis of chronic tension-type headache: a double-blind, randomized, placebo-controlled study. For the Portuguese Head Society. Headache 2000 Jun;40(6):451-6.

 [ Medline ID 10849040 ]


Prakash S, Shah ND. Chronic tension-type headache with vitamin D deficiency: casual or causal association? Headache 2009 Sep;49(8):1214-22.

 [ Medline ID 19619241 ]


Miano S, Parisi P, Pelliccia A, Luchetti A, Paolino MC, Villa MP. Melatonin to prevent migraine or tension-type headache in children. Neurol Sci 2008 Sep;29(4):285-7.

 [ Medline ID 18810607 ]


Vernon H, McDermaid CS, Hagino C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. Complement Ther Med 1999 Sep;7(3):142-55.

 [ Medline ID 10581824 ]


Owen JM, Green BN. Homeopathic treatment of headaches: a systematic review of the literature. J Chiropr Med 2004;3(2):45-52.

 [ Medline ID 19674623 ]


Walach H, Haeusler W, Lowes T, Mussbach D, Schamell U, Springer W, et al. Classical homeopathic treatment of chronic headaches. Cephalalgia 1997 Apr;17(2):119-26.

 [ Medline ID 9137850 ]


Fernandez-de-las-Penas C, onso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache 2006 Mar;46(3):454-60.

 [ Medline ID 16618263 ]


Fernandez-de-las-Penas C, onso-Blanco C, Cuadrado ML, Pareja JA. Myofascial trigger points in the suboccipital muscles in episodic tension-type headache. Man Ther 2006 Aug;11(3):225-30.

 [ MANTIS ID 16863699 ]


Fernandez-de-las-Penas C, Cuadrado ML, rendt-Nielsen L, Simons DG, Pareja JA. Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia 2007 May;27(5):383-93.

 [ Medline ID 17359516 ]


von SC, Reilich P, Straube A, Schafer J, Blaschek A, Lee SH, et al. Myofascial trigger points in children with tension-type headache: a new diagnostic and therapeutic option. J Child Neurol 2009 Apr;24(4):406-9.

 [ Medline ID 19339283 ]


Cooper BC, Kleinberg I. Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment. Cranio 2009 Apr;27(2):101-8.

 [ Medline ID 19455921 ]


Speciali JG, Eckeli AL, Dach F. Tension-type headache. Expert Rev Neurother 2008 May;8(5):839-53.

 [ Medline ID 18457540 ]


Cooper BC, Kleinberg I. Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment. Cranio 2009 Apr;27(2):101-8.

 [ Medline ID 19455921 ]


Kubitzek F, Ziegler G, Gold MS, Liu JM, Ionescu E. Low-dose diclofenac potassium in the treatment of episodic tension-type headache. Eur J Pain 2003;7(2):155-62.

 [ Medline ID 12600797 ]


Lange R, Lentz R. Comparison ketoprofen, ibuprofen and naproxen sodium in the treatment of tension-type headache. Drugs Exp Clin Res 1995;21(3):89-96.

 [ MANTIS ID 7555617 ]


Martinez-Martin P, Raffaelli E Jr, Titus F, Despuig J, Fragoso YD, ez-Tejedor E, et al. Efficacy and safety of metamizol vs. acetylsalicylic acid in patients with moderate episodic tension-type headache: a randomized, double-blind, placebo- and active-controlled, multicentre study. Cephalalgia 2001 Jun;21(5):604-10.

 [ Medline ID 11472387 ]


Pini LA, Del BE, Zanchin G, Sarchielli P, Di TG, Prudenzano MP, et al. Tolerability and efficacy of a combination of paracetamol and caffeine in the treatment of tension-type headache: a randomised, double-blind, double-dummy, cross-over study versus placebo and naproxen sodium. J Headache Pain 2008 Dec;9(6):367-73.

 [ Medline ID 18815727 ]


Prior MJ, Cooper KM, May LG, Bowen DL. Efficacy and safety of acetaminophen and naproxen in the treatment of tension-type headache. A randomized, double-blind, placebo-controlled trial. Cephalalgia 2002 Nov;22(9):740-8.

 [ Medline ID 12421160 ]


Migliardi JR, Armellino JJ, Friedman M, Gillings DB, Beaver WT. Caffeine as an analgesic adjuvant in tension headache. Clin Pharmacol Ther 1994 Nov;56(5):576-86.

 [ Medline ID 7955822 ]