Complementary and alternative approaches to the treatment of tension-type headache

While pharmacotherapy with nonsteroidal anti-inflammatories (NSAIDs) and tricyclic antidepressants comprises the traditional treatment of tension-type headaches (TTH), the use of other therapeutic approaches in combination with medications can increase the success of treatment. Patients with comorbid mood disorders and frequent headaches may particularly benefit from some nonpharmacologic approaches. This review focuses on complementary and alternative approaches to tension-type headache treatment, including psychological therapies, acupuncture, and physical treatments. The current evidence indicates that EMG biofeedback (BFB) is effective in the treatment of TTH, and cognitive behavioral therapy and relaxation training may also be beneficial. Physical therapy and acupuncture may be considered in patients with frequent TTH, but the scientific basis is limited.