Several types of nonpharmacologic treatment, including physical exercise, relaxation training, and acupuncture can provide long-lasting improvements for patients with chronic tension-type headaches, physical therapists in Sweden report.
Because the frequent use of pain medications can lead to chronic headaches, it is important that analgesics are discontinued as a first step in treating tension headaches, Dr. Elisabeth Soderberg and her associates report in the current issue of the journal Cephalalgia.
The research team, at Sahlgrenska Academy, Goteborg University, designed a study in which 90 patients, who had chronic tension-type headaches for an average of 7 years, were randomly assigned to physical training, relaxation training, or acupuncture. Chronic tension-type headache was defined as headache occurring at least 15 days per month for at least 6 months.
The trial began with a 4-week pretreatment period, during which time the subjects used diaries to document headache characteristics. They also kept diaries in the 4 weeks immediately after the training sessions and again 3 and 6 months after treatment.
Acupuncture was administered at recommended sites using 10 to 12 needles during 30-minute weekly sessions for 10 to 12 weeks.
Physical training included five exercises focused on the neck and shoulder muscles, repeated about 100 times each, along with ergometric cycling and stretching.
The patients who were taught relaxation also learned “breathing techniques, stress coping techniques, how to relax during activity and how to relax in everyday living.”
Immediately after the last treatment, the only significant between-group difference was a higher number of headache-free periods in the relaxation group compared with the acupuncture group. Otherwise, “there were no long-lasting differences between the interventions.”
Compared with initial measures, acupuncture significantly reduced headache intensity at 3 months and 6 months. Physical training was associated with reduced headache intensity and more headache-free periods immediately after the last treatment and after 6 months. Relaxation training led to significant improvements in headache intensity and frequency immediately after the training and at 3 and 6 months.
Soderberg and her associates suggest that a combination of all three techniques may provide the best outcome.