Tension headache relief: what actually works

Regular sleep, meals and water come first. Mayo Clinic's self-care guidance for tension-type headache is specific: eat on a regular schedule and don't skip meals, especially breakfast; drink plenty of water; and keep the same bedtime and wake time 7 days a week, weekends included. If you can't fall asleep within 15 minutes, Mayo suggests getting up and doing something calming until you feel drowsy.

Both sources add detail on sleep. NINDS notes that too little or too much sleep can worsen headaches, and that daytime naps cut into deep sleep at night and can trigger headaches in some adults. Mayo flags sleep apnea: it can cause tension-type headaches, often noticed as waking up with one, and treating the apnea may ease them.

Exercise helps if you build up slowly. Mayo says it releases chemicals that block pain signals to the brain and suggests walking, swimming or cycling, but warns that exercising too intensely can bring on some headaches. Smoking works against you: nicotine reduces blood flow to the brain and triggers a reaction in the nerves at the back of the throat, and Mayo says either change can lead to a headache.

More than 400 milligrams a day, roughly 4 cups of coffee, can cause headaches and irritability, according to Mayo Clinic. In smaller amounts caffeine may help curb a headache, which is why some headache medicines contain it, but regular heavy use raises the risk of headaches over time.

Stopping causes trouble too. Mayo notes that quitting caffeine can bring on headaches whether you stop suddenly or taper, and NINDS lists both caffeine and caffeine withdrawal as triggers. If your weekend headaches start a few hours after you would normally have your second coffee, withdrawal may be the cause. A steady, moderate daily amount usually works better than heavy weekdays followed by caffeine-free weekends.

It may ease the muscle tension that comes with them, but trials have not shown that massage makes the headaches less frequent. Start with heat, which is Mayo Clinic's direct advice for tense neck and shoulder muscles. Mayo lists 5 ways to apply it: a heating pad on low, a hot water bottle, a hot shower or bath, a warm compress or a hot towel. Ice or a cool washcloth on the forehead is the alternative.

Mayo's claim for massage is modest: it "also can relieve muscle tension — and sometimes headache pain." Its suggestion is self-massage, gently working the temples, scalp, neck and shoulders with your fingertips, or gently stretching the neck.

The research supports that caution. NCCIH's summary of the massage research says only a small number of studies have looked at headache, with inconsistent results. The most relevant trial it cites, from 2015, split 56 people with tension headaches 3 ways: massage at myofascial trigger points, an inactive sham (detuned ultrasound), both twice a week for 6 weeks, or a waiting list. Headache frequency fell in both the massage and the sham groups, with no difference between them.

The evidence is better for the muscles around the headache. A 2013 review of 12 studies with 757 participants found massage more helpful for neck and shoulder pain than inactive therapies, though not better than other active treatments, and the shoulder benefit was short-term. A 2014 trial of 228 people with chronic neck pain tested dose: sessions of 60 minutes, several times a week, did better than fewer or shorter ones. NINDS includes massage, physical therapy and gentle exercise among the options a doctor may add to a treatment plan. Taken together, massage may loosen the tight neck and shoulders that feed a tension headache, but you should not count on it to stop the headache itself.

A head spa may help in the same limited way massage does, by easing tension in the scalp, neck and shoulders. It is not a headache treatment, and none of the studies above tested one. If you want to try it, the session at O2 Head & Beauty Spa in Arcadia that fits best is Package D, a Classic Scalp Treatment of 60 minutes ($156 regular, $78 at the member rate). Along with the scalp cleansing, waterfall hydrotherapy and nano steam, it includes an aromatherapy oil massage and a head, neck, shoulder and arms massage.

For more time on the upper body, Package B runs 90 minutes ($196 regular, $98 member). It adds a longer hand, arms, neck, shoulder and head massage and one add-on of your choice, and a neck treatment is one of the options. If you would rather skip the scalp care, the Targeted Treatment is a 60 minute pain relief session ($120 regular, $80 member); tell the front desk your neck and shoulders are the focus when you book, and ask there how the member rate works.

If a headache is new, sudden or severe, see a doctor before booking anything; the warning signs are listed below. Keep the pressure comfortable, too. NCCIH puts the risk of harm from massage as low but reports rare serious side effects, including blood clots, nerve injury and bone fracture, often involving vigorous techniques or people already at higher risk of injury.

Mayo Clinic's line is 9 days a month: taking over-the-counter pain medicine more often than that can make headaches harder to treat, and Mayo advises seeing a health care provider instead of continuing to medicate. NINDS states the general rule. Regular overuse of headache medications can worsen attacks or create new headache symptoms, and a doctor can help you plan safe use.

This is how a manageable problem can turn chronic. A headache comes back, you take more, and the medicine starts causing the next headache. The safeguard is to count. If you reach for painkillers on more than a couple of days most weeks, you are close to Mayo's limit, and that frequency is worth raising with a clinician in its own right.

When each headache starts, what you were doing, how long it lasted and what helped: that is Mayo Clinic's short version. Triggers are personal, and a written record shows patterns that memory misses, such as headaches that follow a short night or a skipped lunch.

Two weeks of notes usually shows a pattern. According to NINDS, the diary also helps a doctor identify the headache type and choose a treatment, and it keeps an honest count of your painkiller days.

NINDS asks for more detail than Mayo. After each headache, note these 6 things:

Right away if any of NINDS's 10 warning signs appear: a sudden, severe headache, possibly with a stiff neck; a severe headache with fever, nausea or vomiting not explained by another illness; a "first" or "worst" headache that comes with confusion, weakness, double vision or loss of consciousness; a headache that worsens over days or weeks or changes its pattern; a headache after a head injury; a headache with loss of sensation or weakness anywhere in the body, which can signal a stroke; a headache with convulsions or trouble breathing; two or more headaches a week; a constant headache in someone who never had headaches before, especially over age 50; or new headaches in someone with a history of cancer or HIV/AIDS.

NINDS also advises talking with a doctor any time headaches affect your daily life. For children, get care for headaches that keep coming back or follow a brain injury, check with a doctor before giving headache medicine, and seek care quickly for a headache that comes with a rash, fever or sleepiness.

Work through these 6 steps in order, and give them 2 weeks before deciding nothing helps: