What Is Tension-Type Headache?
TTH is the most common kind of headache disorder. It is a primary headache disorder. This means the headache itself is the problem and is not being caused by something else. Many medical problems can cause headaches similar to TTHs, so people with new or worsening headaches should see a doctor to make sure there is not something else causing them. The doctor will ask about the headaches and any other symptoms and may recommend tests to look for other medical conditions.2
TTH is divided into 3 main types: infrequent episodic TTH (less than 1 day per month on average), frequent episodic TTH (1–14 days per month), and chronic TTH (15 or more days per month, for at least 3 months). About three-quarters of people have TTHs at some point during their life. At any given time, a little less than half of people report having had TTHs in the past year, and about 2 percent have chronic TTH. TTH can affect all ages, although it most commonly affects people in their 30s and 40s. Both men and women can get TTH.
What Are the Symptoms?
Each headache in episodic TTH usually lasts 30 minutes to 7 days. In chronic TTH, symptoms last hours to days. In some cases, they are always present and do not go away on their own. Most people with TTH describe the headache as a feeling of mild pressure or tightening on both sides of the head. Many people with TTH also have tenderness in the muscles of the head and neck. They may also be sensitive to light or sound, but not both at the same time. Mild nausea can also occur with chronic TTH, but it is not severe and does not cause vomiting.
What Are the Treatments?
Most people with occasional TTH treat their headaches as needed with over-the-counter medications such as acetaminophen or ibuprofen. If headaches occur more than a few days per week, or are causing difficulties with work or home life, other treatments may be needed. Treatment can include EMG biofeedback (monitoring muscle tension with a machine to help learn how to relax), cognitive behavioral therapy, relaxation training, acupuncture, physical therapy, or daily preventive medications.
In the study “Acupuncture for Patients With Chronic Tension-Type Headache: A Randomized Controlled Trial,” Zheng et al. looked at how well acupuncture worked for people with chronic tension-type headaches (TTHs).
How Was This Study Done?
All the study participants had reported having chronic TTH for at least a year. During the study, half of them got true acupuncture (TA) treatments, and half got superficial acupuncture (SA). Both groups had needles placed in the same spots, but for the TA group, the needles were placed deep enough to make each spot feel numb, sore, heavy, or painful. Both groups had 20 acupuncture sessions over 8 weeks. Patients kept track of their headaches starting 4 weeks before they received acupuncture and for 32 weeks after starting treatment. At monthly study visits, they told the researchers about the headaches they experienced. All patients received headache education at their visits.
Acupuncture points used: Fengchi (GB20), Taiyang (EX-HN5), Baihui (DU20), Hegu (LI4) and Taichong (LR3).
What Did the Study Show?
On average, after completing the acupuncture treatment course, patients in both groups had fewer headache days, did not need rescue medications such as ibuprofen as often, and had reduced pain intensity. More participants got better as the study went on, even after the acupuncture treatments had stopped. More patients got better in the TA group than in the SA group. By the end of the study, the headache days per month of more than two-thirds of the people in the TA group (68.2%) and half of those in the SA group (50%) were reduced by at least half. Patients receiving TA on average had 14 fewer headache days than they had at the beginning of the study, and patients in the SA group had 9.5 fewer headache days on average.
What Does This Mean for Patients With TTH?
This study showed that acupuncture may help treat chronic TTH. As with this study's participants, acupuncture could cut down the number of headache days by half or more for many people with chronic TTH. This improvement can last for months, even after stopping acupuncture treatments. Because of this, acupuncture is a promising treatment for people with chronic TTH to try.
Future Directions
This study took place in China, where acupuncture is more commonly used than in the United States and other Western countries. Many past medical studies have shown that treatments sometimes work better when people believe they will work. We do not know how well acupuncture works in people who are less familiar with it. This study involved acupuncture treatments that were performed multiple times a week. It can be hard to get that many acupuncture treatments because of availability and/or cost. Future studies could explore whether acupuncture with more time between sessions or fewer sessions still works.
Reference:
1. Acupuncture for Patients With Chronic Tension-Type Headache: A Randomized Controlled Trial.Neurology. 2022 Jun 22;10.1212/WNL.0000000000200670. doi: 10.1212/WNL.0000000000200670. https://pubmed.ncbi.nlm.nih.gov/35732505/
2. Emily J. Riddle. Acupuncture Treatment for Chronic Tension-Type Headache.