What’s the Bottom Line?

What do we know about the usefulness of complementary approaches for headaches?

Psychological and Physical Approaches

• Acupuncture may provide relief for some people with headaches. However, research suggests that part of its benefit may be related to expectations, beliefs, and placebo responses rather than the specific effects of needle placement.

• Biofeedback techniques have shown potential for helping with tension-type headaches and migraines, though study findings are not entirely consistent.

• For massage therapy, relaxation practices, spinal manipulation, and tai chi, available evidence is limited or mixed, making it difficult to draw firm conclusions about effectiveness.

Dietary Supplements

• Butterbur has been shown to decrease migraine frequency in both adults and children. Although it was once recommended for migraine prevention, concerns about possible liver toxicity led to the withdrawal of that recommendation.

• Some research suggests that coenzyme Q10, feverfew, magnesium, and riboflavin (vitamin B2) might reduce how often migraines occur. Still, the overall amount of supporting evidence is relatively small. Diets rich in omega-3 fatty acids may lessen migraine frequency and severity, but omega-3 supplements have not consistently demonstrated the same benefits.

What do we know about the safety of complementary approaches for headaches?

Overall, the psychological and physical approaches discussed here have good safety records when performed appropriately. However, no therapy is completely risk-free. Factors such as age, underlying health conditions, pregnancy, and use of medications or supplements can influence safety.

Dietary supplements may cause side effects and can interact with prescription or over-the-counter medications. Anyone considering supplements for headache prevention or treatment should consult a qualified health care provider.

Some Basics About Headaches

Headaches are the most frequently reported form of pain and a common reason for missed work or school, as well as medical visits. This overview focuses on tension-type headaches and migraines, the two forms most often studied in complementary health research.

Tension Headaches and Migraines: What’s the Difference?

• Tension-type headaches are the most common variety. They are linked to tight muscles in the neck, shoulders, scalp, and jaw. Stress, anxiety, depression, lack of sleep, skipped meals, overwork, and alcohol use may contribute to their development.

• Migraines affect about 12 percent of people in the United States. They typically cause moderate to severe throbbing pain, often on one side of the head. Migraines are frequently accompanied by sensitivity to light and sound, nausea, and sometimes visual disturbances such as flashing lights or zigzag lines. Triggers may include stress, hormonal shifts, missed meals, sleep disruption, or bright light. Genetic factors influencing brain cell activity may also play a role.

What the Science Says About Complementary Health Approaches for Headache

Scientific studies have found encouraging results for certain complementary approaches to tension headaches and migraines. For others, findings remain limited or inconsistent.

Psychological and Physical Approaches

Approaches that have been evaluated include acupuncture, biofeedback, massage therapy, relaxation techniques, spinal manipulation, and tai chi.

Acupuncture

Acupuncture involves stimulating specific points on the body, usually by inserting very thin needles into the skin.

Numerous studies have examined acupuncture for headache relief. When results are combined, they suggest acupuncture can reduce headache frequency or intensity. However, some of the improvement may stem from nonspecific effects such as patient expectations rather than needling alone.

When provided by a trained practitioner using sterile equipment, acupuncture is generally safe. Improper technique can result in rare but serious complications.

Biofeedback

Biofeedback uses electronic devices to monitor bodily functions such as muscle tension. By observing these signals, individuals can learn to recognize and control physical responses, including tightening of muscles associated with headaches.

Several forms of biofeedback have been studied, including general relaxation training and headache-specific protocols.

• Tension headaches: Many studies suggest biofeedback may help, though high-quality reviews show mixed results.

• Migraines: Research indicates biofeedback may reduce migraine frequency, but it remains unclear whether it performs better than placebo treatments.

Biofeedback is generally considered safe and rarely causes side effects.

Massage

Massage therapy involves hands-on manipulation of muscles and other soft tissues.

A small number of studies suggest massage may offer benefit for migraines, but the evidence base is too limited to make definite conclusions.

Massage is typically safe when delivered by a trained professional. Individuals with certain medical conditions or who are pregnant should seek medical advice before receiving treatment.

Relaxation Techniques

Relaxation practices such as progressive muscle relaxation, guided imagery, and controlled breathing are intended to trigger the body’s relaxation response.

Although considered promising by some experts, the scientific evidence supporting relaxation techniques for tension headaches is inconsistent. Some findings indicate they may be less effective than biofeedback.

These techniques are generally safe, though rare adverse effects have been reported in individuals with serious physical or mental health disorders.

Spinal Manipulation

Spinal manipulation involves applying controlled force to joints of the spine, typically by chiropractors or other trained professionals.

It is commonly used for headache management, but research results are conflicting, leaving its effectiveness uncertain.

Possible side effects include temporary soreness, fatigue, or increased headache. Rare cases of stroke following manipulation of the upper spine have been reported, though a direct causal link has not been firmly established.

Tai Chi

Tai chi combines slow, deliberate movements with deep breathing and meditation.

One small study found that tai chi participants with tension headaches experienced improvements in headache symptoms and quality of life compared to those who did not participate. However, the evidence is too limited to draw strong conclusions.

Tai chi is generally regarded as a safe, low-impact activity.

Dietary Supplements

Butterbur

Butterbur may reduce migraine frequency in adults and children. However, concerns about liver toxicity have raised safety issues. Anyone considering butterbur should carefully weigh potential risks and benefits with a health care provider.

Coenzyme Q10

Research suggests coenzyme Q10 might reduce how often and how long migraines occur, though it may not affect severity. Because available studies are small, uncertainty remains about its overall usefulness.

No major side effects have been consistently reported, but coenzyme Q10 can interact with certain medications, including blood thinners and insulin.

Feverfew

Studies on feverfew for migraine prevention have produced mixed results.

Potential side effects include digestive upset, mouth irritation, and skin reactions. Feverfew may also interact with medications.

Magnesium

Magnesium supplementation may help decrease migraine frequency, with several studies suggesting benefit.

High doses can cause diarrhea, nausea, and abdominal cramping. Very large amounts may lead to serious toxicity. Magnesium may also interact with certain medications. Because migraine doses may exceed typical safe intake levels, supplementation should be supervised by a health professional.

Riboflavin

Riboflavin (vitamin B2) has been studied for migraine prevention, with some research showing benefit, particularly in adults. Evidence in children is less convincing.

No significant adverse effects have been reported, and riboflavin is not known to have major drug interactions.

Omega-3 Fatty Acids

Diets high in omega-3 fatty acids, especially from fatty fish, may help reduce migraine frequency and the number of headache days. Diets lower in certain omega-6 fats while higher in omega-3s may offer additional benefit.

In contrast, omega-3 supplements have generally not reduced migraine frequency or severity in large studies, though some evidence suggests they might shorten the duration of attacks.

Omega-3 supplements typically cause only mild side effects. People who take blood-thinning medications or who have fish or shellfish allergies should consult a health care provider before using them.

Research Supported by NCCIH

Ongoing research includes studies of mindfulness meditation for migraine, including brain imaging to evaluate changes, and comprehensive analyses of acupuncture trials for pain conditions such as headaches.

More To Consider

• Most dietary supplements have not been thoroughly studied in pregnant or breastfeeding women or in children. Medical guidance is recommended before use in these groups.

• Supplements can interact with conventional treatments.

• When seeking practitioner-based therapies such as acupuncture or biofeedback, choose professionals with appropriate training and credentials.

• Inform all of your health care providers about any complementary approaches you use to ensure safe and coordinated care.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information about complementary and integrative health approaches and related research. It does not offer medical advice or treatment referrals.

Toll-free in the United States: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1

Email: [email protected]

National Institute of Neurological Disorders and Stroke (NINDS)

NINDS supports and conducts research on disorders of the brain and nervous system, including headache conditions.

Toll-free in the United States: 1-800-352-9424

Know the Science

Educational resources are available to help consumers better understand scientific research, clinical trials, and health information so they can make informed decisions.

PubMed®

PubMed is a database of scientific and medical research articles, including abstracts and publication details.

MedlinePlus

MedlinePlus provides reliable health information from government agencies and other authoritative sources to help answer health-related questions.

Key References

• Selected systematic reviews and clinical trials evaluating acupuncture, biofeedback, spinal manipulation, tai chi, dietary interventions, and nutritional supplements for headache management.

Other References

• Additional reviews and research articles addressing complementary therapies, safety considerations, and nutritional approaches related to headache care.

This material is provided for informational purposes only and is not a substitute for professional medical advice. Always consult a qualified health care provider regarding diagnosis or treatment decisions.