Headaches: What You Need To Know

Some Basics About Headaches

Headaches are the most common form of pain. They’re a major reason why people miss work or school or visit a health care provider. This fact sheet focuses on two types of headache: tension headaches and migraines. Researchers have studied complementary health approaches for both.

Tension Headaches and Migraines: What’s the Difference?

• Tension headaches—the most common type of headache—are caused by tight muscles in the shoulders, neck, scalp, and jaw. They may be related to stress, depression, or anxiety and may occur more often in people who work too much, sleep too little, miss meals, or drink alcoholic beverages.
• Migraine headaches—which affect about 12 percent of Americans—involve moderate to severe throbbing pain, often on one side of the head. During a migraine, people are sensitive to light and sound and may feel nauseated. Some people have visual disturbances before a migraine—like seeing zigzag lines or flashing lights, or temporarily losing their vision. Anxiety, stress, lack of food or sleep, exposure to light, or hormonal changes (in women) can trigger migraines. Genes that control the activity of some brain cells may play a role in causing migraines.

For more information about headaches, visit the National Institute of Neurological Disorders and Stroke website.

What the Science Says About Complementary Health Approaches for Headache

Research has produced promising results for some complementary health approaches for tension headache or migraine. For other approaches, evidence of effectiveness is limited or conflicting.

Psychological and Physical Approaches

Psychological and physical approaches that have been studied for headache include acupuncture, biofeedback, massage, relaxation techniques, spinal manipulation, and tai chi.

Acupuncture

Acupuncture is a technique in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin.

There have been many studies of acupuncture for headache. The combined results from these studies indicate that acupuncture may help relieve headache pain, but that much of its benefit may be due to nonspecific effects including expectation, beliefs, and placebo responses rather than specific effects of needling.

Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

More information on acupuncture

Biofeedback

Biofeedback measures body functions and gives you information about them so that you can become more aware of those functions and learn to control them. For example, a biofeedback device may show you measurements of muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them.

Several types of biofeedback have been studied for headaches, including techniques that help people learn to relax and more specific techniques that focus on changes that occur during headaches.

• Tension headaches. Many studies have tested biofeedback for tension headaches, and several evaluations of this research have concluded that biofeedback may be helpful. However, an evaluation that included only the highest quality studies concluded that there is conflicting evidence about whether biofeedback is helpful for tension headaches.
• Migraines. Studies have shown decreases in the frequency of migraines in people who were using biofeedback. However, it’s unclear whether biofeedback is better than a placebo for migraines.

Biofeedback generally does not have harmful side effects.

Massage

Massage therapy includes a variety of techniques in which practitioners manipulate the soft tissues of the body.

Limited evidence from two small studies suggests massage therapy is possibly helpful for migraines, but clear conclusions cannot be drawn.

Massage therapy appears to have few risks when performed by a trained practitioner. However, people with health conditions and pregnant women may need to avoid some types of massage and should consult their health care providers before having massage therapy.

More information on massage therapy

Relaxation Techniques

Relaxation techniques—such as progressive muscle relaxation, guided imagery, and breathing exercises—are practices that can produce the body’s natural relaxation response. (Some types of biofeedback are also designed to help people learn relaxation; biofeedback is discussed in a separate section above.)

Although some experts consider relaxation techniques to be promising for tension headaches, there isn’t much evidence to support their effectiveness. An evaluation of high-quality studies on relaxation techniques found conflicting evidence on whether they’re better than no treatment or a placebo. Some studies suggest that relaxation techniques are less helpful than biofeedback.

Relaxation techniques generally don’t have side effects. However, rare harmful effects have been reported in people with serious physical or mental health conditions.

More information on relaxation techniques

Spinal Manipulation

Spinal manipulation is a technique in which practitioners use their hands or a device to apply a controlled force to a joint of the spine. Chiropractors or other health professionals may use this technique.

Spinal manipulation is frequently used for headaches. However, it’s uncertain whether manipulation is helpful because studies have had contradictory results.

Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the area that was manipulated. There have been rare reports of strokes occurring after manipulation of the upper (cervical) spine, but whether manipulation actually caused the strokes is unclear.

More information on spinal manipulation

Tai Chi

Tai chi, which originated in China, combines meditation with slow, graceful movements, deep breathing, and relaxation.

One small randomized study has evaluated tai chi for tension headaches. Some evidence of improvements in headache status and health-related quality of life was found among patients on the tai chi program compared to others on a wait list. These data are too limited to draw meaningful conclusions about whether this practice is helpful for tension headaches.

Tai chi is generally considered to be a safe practice.

More information on tai chi

Dietary Supplements

Butterbur

Butterbur appears to help reduce the frequency of migraines in adults and children. In 2012, the American Academy of Neurology recommended its use for preventing migraines. However, the Academy stopped recommending it in 2015 because of serious concerns about possible liver toxicity. If you are considering using butterbur, discuss its risks and benefits with your health care provider.

More information on butterbur

Coenzyme Q10

A 2021 review of 6 studies (371 total participants) in which coenzyme Q10 was compared with a placebo (an inactive substance) showed that coenzyme Q10 may help reduce the duration and frequency of migraines but not their severity. Because both the amount of evidence and the size of the effects observed in the studies were small, there are still uncertainties about whether coenzyme Q10 is helpful for migraines.

No serious side effects of coenzyme Q10 have been reported. Coenzyme Q10 may interact with some medications, including the anticoagulant (blood-thinning) medication warfarin and the diabetes drug insulin.

More information on coenzyme Q10

Feverfew

A 2020 review that included 7 studies (634 participants) of feverfew for migraine prevention found that the results of the studies were inconsistent.

Side effects of feverfew may include digestive disturbances, skin rash, and inflammation of the mouth. Feverfew may interact with medications.

More information on feverfew

Magnesium

A 2018 review of 5 studies (253 participants) found that magnesium was possibly effective in reducing the frequency of migraines. Three of the five studies showed evidence of benefits.

High doses of magnesium from dietary supplements or medicines can cause diarrhea, nausea, and stomach cramps, and very large doses can cause serious toxicity. Magnesium can interact with medicines, including some antibiotics, diuretics, and drugs used to treat osteoporosis. Because the amounts of magnesium people take for migraines are greater than the largest daily intake of magnesium from supplements and medicines that is considered safe, magnesium supplements for migraine should be used only under the supervision of a health care provider.

Riboflavin

A 2017 review looked at 9 studies (546 participants) of riboflavin supplementation to prevent migraine. Some of these studies used a rigorous design in which riboflavin was compared with a placebo; others didn’t. Some but not all of the studies indicated that riboflavin was helpful. Riboflavin supplementation seemed to be more useful in adults than in children.

No harmful effects from the use of riboflavin have been reported, and riboflavin is not known to interact with drugs.

Omega-3 Fatty Acids

The results of a recent study indicated that diets high in omega-3 fatty acids may be helpful for migraines. Omega-3s in supplement form have not been shown to reduce the frequency or severity of migraines, but a small amount of evidence suggests that they might reduce the duration of migraine attacks.

• In a 2021 study conducted by researchers from the National Institutes of Health in cooperation with other investigators, 182 adults with frequent migraines were assigned to one of these three test diets for 16 weeks:
  • A diet high in omega-3 fatty acids from high-fat fish and low in linoleic acid (an omega-6 fatty acid found in corn, soybean, and other vegetable oils, as well as some nuts and seeds)
  • A diet high in omega-3s but with as much linoleic acid as in the average U.S. diet
  • A control diet containing omega-3s and linoleic acid in the amounts found in the average U.S. diet

Compared to participants receiving the control diet, those in the two groups receiving higher amounts of omega-3s had fewer hours of headaches and fewer hours of moderate-to-severe headaches per day, as well as fewer days per month with headaches. The group that received a diet low in linoleic acid and high in omega-3s showed a greater decrease in headache days per month than the group who received the diet with average amounts of linoleic acid and high amounts of omega-3s. There were no significant differences among the groups in scores on a questionnaire that evaluates migraine-related quality of life, however.

• An analysis published in 2021 took advantage of data collected during a large study (the VITamin D and OmegA-3 TriaL [VITAL]), in which more than 25,000 middle-aged or older people were randomly assigned to receive omega-3 fatty acid (fish oil) supplements or placebos for 5 years to test the effects of omega-3s on the risk of developing heart disease and cancer. A total of 1,032 of the study participants reported a history of probable migraine and answered questions about changes in the frequency and severity of their migraines. The results showed that omega-3 supplementation did not affect migraine frequency or severity.
• A 2018 review of 5 smaller studies (382 total participants), 4 of which evaluated omega-3 supplements and 1 of which evaluated foods rich in omega-3s, found no effect of omega-3s on the frequency of migraines. The 3 studies (119 participants) that looked at severity of migraines also found no effect of omega-3s. However, the 2 studies (134 participants) that looked at the duration of migraines found evidence that migraines were significantly shorter in people taking omega-3s.

Omega-3 supplements usually produce only mild side effects, if any. There’s conflicting evidence on whether omega-3 supplements might influence the risk of prostate cancer. If you’re taking medicine that affects blood clotting or if you’re allergic to fish or shellfish, consult your health care provider before taking omega-3 supplements.

NCCIH-Funded Research

NCCIH is supporting several studies of complementary health approaches for headaches.

More Information

Current NCCIH-funded research includes

• A study of mindfulness meditation for migraine that includes measurement of brain changes with magnetic resonance imaging (MRI)
• A combined analysis of many studies of acupuncture for various types of pain, including headaches

More To Consider

• Most dietary supplements have not been tested in pregnant women, nursing mothers, or children. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, consult your (or your child’s) health care provider.
• Be aware that some dietary supplements may interact with conventional medical treatments.
• If you’re considering a practitioner-provided complementary health practice such as biofeedback or acupuncture, ask a trusted source (such as your health care provider or nearby hospital) to recommend a practitioner. Find out about the training and experience of any complementary health practitioner you’re considering. To learn more, see NCCIH’s resources on how to find a complementary health practitioner.
• Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.