From the Guidelines
Effective prophylactic measures for managing tension include cognitive behavioral therapy (CBT), behavioral activation (BA), structured physical activity and exercise, and psychosocial interventions with empirically supported components, such as relaxation and problem-solving, as recommended by the American Society of Clinical Oncology (ASCO) guideline update 1. These approaches have been shown to be beneficial in reducing symptoms of anxiety and depression, which are often associated with tension.
- CBT is a type of psychotherapy that helps individuals identify and change negative thought patterns and behaviors that contribute to their tension.
- BA is a type of therapy that focuses on helping individuals engage in activities that they enjoy and that give them a sense of purpose and fulfillment.
- Structured physical activity and exercise have been shown to reduce symptoms of anxiety and depression by releasing endorphins, which are natural mood-boosters.
- Psychosocial interventions, such as relaxation and problem-solving, can help individuals manage stress and tension by teaching them healthy coping mechanisms. It is essential to note that these recommendations are based on intermediate-quality evidence and have a strong strength of recommendation, indicating that the benefits of these interventions outweigh the harms 1. Additionally, other studies have suggested that aerobic exercise or progressive strength training, as well as physical therapy, may be beneficial in managing tension and headache disorders, including migraine and tension-type headache 1. However, the most recent and highest-quality study, the 2023 ASCO guideline update, prioritizes CBT, BA, structured physical activity and exercise, and psychosocial interventions as the most effective prophylactic measures for managing tension 1.
From the Research
Recommended Prophylactic Measures for Managing Tension
- The use of lifestyle interventions such as regular physical exercise, body weight management, and healthy dietary patterns can help prevent and manage hypertension, which is often associated with muscle tension and anxiety 2.
- Stress management and promotion of adequate sleep patterns coupled with circadian entrainment are also recommended as prophylactic measures for managing tension 2.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been evaluated for the prevention of tension-type headache, but the evidence suggests that they are no more effective than placebo or amitriptyline in reducing headache frequency in patients with chronic tension-type headache 3.
- Amitriptyline is recommended as a first-line drug for prophylaxis of chronic tension-type headache, and physical and integrative therapies such as electromyography biofeedback, cognitive behavioral therapy, exercise, massage, and trigger point injection can also be effective 4.
- Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, and can be an excellent lifestyle behavior treatment option for patients with mild-moderate-risk blood pressure and cholesterol 5.
- Identifying and managing environmental, dietary, and behavioral triggers, as well as using preventive medication therapy, can help reduce migraine frequency, severity, and headache-related distress, and may also improve quality of life and prevent the progression to chronic migraines 6.
Prophylactic Medications for Tension-Type Headache
- Amitriptyline is recommended as a first-line drug for prophylaxis of chronic tension-type headache 4.
- SSRIs and SNRIs have been evaluated for the prevention of tension-type headache, but the evidence suggests that they are no more effective than placebo or amitriptyline in reducing headache frequency in patients with chronic tension-type headache 3.
- Other medications such as divalproex, topiramate, metoprolol, propranolol, and timolol may be effective for migraine prophylaxis, but their use for tension-type headache is not well established 6.
Non-Pharmacologic Therapies for Tension Management
- Electromyography biofeedback, cognitive behavioral therapy, exercise, massage, and trigger point injection can be effective for managing tension-type headache 4.
- Relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy have good evidence to support their use in migraine prevention, and may also be beneficial for managing tension 6.
- Increasing physical activity can help improve both blood pressure and blood cholesterol, and can be an excellent lifestyle behavior treatment option for patients with mild-moderate-risk blood pressure and cholesterol 5.