Open Source Apothecary At Home / Muscles, joints and nerves

Tension-type headache

The commonest headache and the least pharmacological: sleep, hydration, and not taking painkillers too often.

remedy

Tension-type headache is a band-like pressure, usually bilateral, without the nausea, photophobia or throbbing of migraine. Ordinary and frequent, and the main treatment is non-pharmacological.

The intervention that matters most is avoiding medication overuse. Taking a simple analgesic or a triptan on more than about 10-15 days a month causes medication-overuse headache — a chronic daily headache maintained by the treatment for it. It is common, it is under-recognised, and the treatment is stopping the analgesic, which makes the headache worse for one to two weeks before it gets better. This is the single most useful fact on the page.

What helps. Sleep regularity, hydration, treating neck and jaw problems (which cause referred headache and are worth a physiotherapy assessment), regular meals, aerobic exercise, and stress management — including relaxation training and cognitive behavioural approaches, which have trial evidence.

What is reasonable from the kitchen. Peppermint oil diluted and dabbed on the temples has small trial evidence in tension headache; the mechanism is the cooling TRPM8 effect. Ginger tea is a sensible adjunct. Willow bark contains salicin, which is the ancestor of aspirin and carries the same cautions — stomach irritation, bleeding risk, and never in children with a viral illness.

What not to do. Do not use willow bark or aspirin in a child or teenager with a fever or a viral illness, because of Reye's syndrome. Do not use a herb with antiplatelet activity alongside an anticoagulant without checking.

What the studies found

Preparation

Peppermint oil on the temples

• Dilute to 2-10% in a carrier oil and dab on the temples and forehead, avoiding the eyes
• Small trials support it in tension headache
• Keep it away from the eyes. It stings badly and can cause a chemical burn.

Ginger tea

• 1-2 g dried ginger or 2-3 cm fresh, simmered covered 10 minutes
• Pleasant and safe

Willow bark

• Contains salicin, the ancestor of aspirin. Standardised extracts in trials used 120-240 mg of salicin.
• Never in children or teenagers with a fever or a viral illness — Reye's syndrome
• Same cautions as aspirin: stomach irritation, bleeding, not with anticoagulants, not in aspirin-sensitive asthma
• Do not use it as a substitute for aspirin in a cardiac context — the doses are not equivalent

A cold or warm compress

• Either, whichever helps. 15-20 minutes.

The intervention with the most evidence

• Limit simple analgesics to under 10 days a month. More than that maintains the headache.
• Sleep and wake times consistent, including weekends
• Hydration, regular meals, aerobic exercise
• Neck and jaw assessment if the headaches follow neck pain or clenching
• Relaxation training or CBT

Stopping an overused analgesic

• Expect one to two weeks of a worse headache after stopping, then improvement
• Do it with a clinician's support; some people need a bridge and some need to come off a triptan specifically

Cautions and interactions

• Medication-overuse headache is the commonest reason a chronic daily headache does not improve.
• Do not use willow bark or aspirin in children or teenagers with a fever or viral illness.
• Willow bark has the aspirin interaction profile — anticoagulants, NSAIDs, aspirin-sensitive asthma, and stomach bleeding.
• Peppermint oil on the skin is a sensitiser with repeated neat use. Dilute it, and keep it out of the eyes.

When this is not a self-care problem — get help

• A sudden severe headache at maximum intensity in seconds, a headache with fever and a stiff neck, a headache with new weakness, confusion, or visual loss, or a headache after a head injury — emergency care.
• New headache over 50, a changing pattern, a headache waking you from sleep, or one worse on lying down or coughing — assessment.

Related

• Migraine: the herbs with real prophylaxis trials
• Insomnia: what works before the herbs
• Herb-drug interactions: the ones with numbers behind them
• Dose, and why more is sometimes worse

Sources

1. Efficacy of psychological treatment for tension-type headache: a systematic review and meta-analysis. The journal of headache and pain 2025; doi:10.1097/j.pain.0000000000002731 PubMed 41315905
2. Effects of sleep hygiene education for insomnia: A systematic review and meta-analysis. Sleep medicine reviews 2025; doi:10.1016/j.smrv.2025.102109 PubMed 40449065
3. Network meta-analysis examining efficacy of components of cognitive behavioural therapy for insomnia. Clinical psychology review 2024; doi:10.1016/j.cpr.2024.102507 PubMed 39504928
4. Cognitive behavioral therapy for insomnia to treat major depressive disorder with comorbid insomnia: A systematic review and meta-analysis. Journal of affective disorders 2024; doi:10.1016/j.jad.2024.09.017 PubMed 39242039