Stress Management and Tension Headaches
Melissa C. Stöppler, M.D., About.com

Stress therapy may help with symptom control.

Stress management therapy, particularly when combined with standard preventive medical therapy, has been shown to be effective in reducing symptoms of chronic tension-type headache (TTH).

TTHs are the most common type of headaches, comprising about 75% of all headaches. Likely caused by changes in blood circulation and muscle tension in the muscles of the scalp and face, these headaches can be triggered by various events including nervous tension and stress. When TTHs occur near-daily or very frequently (over 15 days per month) over at least a six-month period of time, they are termed chronic TTHs. One form of therapy that has been shown to help to prevent the development of chronic TTHs is treatment with antidepressant medications.

Psychologists at Ohio University examined the value of stress management therapy, antidepressant medication, stress therapy plus medication, or placebo treatment in over 200 adults who suffered from chronic TTHs.

The mean age of the persons examined was 37, and 76% were women. The participants reported a mean of 26 days of headache per month. After random assignment to one of the four treatment groups, the participants were evaluated by self-ratings of headache pain, analgesic medication use, and headache-related disability.

The results, published in the May 2, 2001 issue of the Journal of the American Medical Association, showed that both the medical therapy with tricyclic antidepressant medication and stress management therapy were more effective in reducing headache activity, headache-related disability, and pain medication usage than the placebo. However, combined medical and stress management therapy was more likely to lead to significant decreases in headache symptoms than medication or stress therapy alone. Combined therapy was effective for pain reduction in 64% of study participants, while stress therapy alone and medication alone led to significant symptom reduction in 35% and 38% of the participants, respectively.

These results show that stress management therapy alone is moderately effective in reducing symptoms of chronic TTHs and that stress therapy increases the effectiveness of standard medical therapy. The stress therapy used in this study included education in relaxation techniques and cognitive coping skills. Instruction in relaxation methods or the practice of yoga, martial arts, or other learned programs can lead to symptom improvement in a number of other medical conditions. If learning to relax is difficult, structured programs can help you develop the necessary skills for efficient relaxation.

Reference:
Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized clinical trial. JAMA 2001 May 2;285(17):2208-15.