What’s the Bottom Line?

What do we know about the usefulness of complementary approaches for headaches?

Psychological and Physical Approaches

• Acupuncture can be helpful for headaches. Much of its benefit may be due to nonspecific factors including expectation, beliefs, and placebo responses rather than specific effects of needling.
• Some studies indicate that biofeedback-based techniques may be helpful for tension headaches and migraines, but not all research results agree.
• For massage, relaxation techniques, spinal manipulation, and tai chi, the evidence is too limited or inconsistent to allow conclusions to be reached.

Dietary Supplements

• Butterbur appears to help reduce the frequency of migraines in adults and children. In 2012, the American Academy of Neurology recommended its use for preventing migraines. However, the Academy stopped recommending it in 2015 because of serious concerns about possible liver toxicity.
• There is some evidence that coenzyme Q10, feverfew, magnesium, and the B vitamin riboflavin might be helpful for reducing the frequency of migraines. However, for all of these supplements, the amount of evidence is small. A recent study of foods rich in omega-3 fatty acids found that they may reduce the frequency and severity of migraines, but studies of omega-3 fatty acid supplementation have not shown the same effects.

What do we know about the safety of complementary approaches for headaches?

In general, the psychological and physical approaches discussed in this fact sheet have good safety records. However, that doesn’t mean that they’re risk-free for everyone. Your age, health, special circumstances (such as pregnancy), and medicines or supplements that you take may affect the safety of complementary approaches.

Dietary supplements may have side effects, and some may have undesirable interactions with medicines. Talk with your health care provider if you are considering a dietary supplement for headaches.

Some Basics About Headaches

Headaches are the most common form of pain. They’re a major reason why people miss work or school or visit a health care provider. This fact sheet focuses on two types of headache: tension headaches and migraines. Researchers have studied complementary health approaches for both.

Tension Headaches and Migraines: What’s the Difference?

• Tension headaches—the most common type of headache—are caused by tight muscles in the shoulders, neck, scalp, and jaw. They may be related to stress, depression, or anxiety and may occur more often in people who work too much, sleep too little, miss meals, or drink alcoholic beverages.
• Migraine headaches—which affect about 12 percent of Americans—involve moderate to severe throbbing pain, often on one side of the head. During a migraine, people are sensitive to light and sound and may feel nauseated. Some people have visual disturbances before a migraine—like seeing zigzag lines or flashing lights, or temporarily losing their vision. Anxiety, stress, lack of food or sleep, exposure to light, or hormonal changes (in women) can trigger migraines. Genes that control the activity of some brain cells may play a role in causing migraines.

What the Science Says About Complementary Health Approaches for Headache

Research has produced promising results for some complementary health approaches for tension headache or migraine. For other approaches, evidence of effectiveness is limited or conflicting.

Psychological and Physical Approaches

Psychological and physical approaches that have been studied for headache include acupuncture, biofeedback, massage, relaxation techniques, spinal manipulation, and tai chi.

Acupuncture

Acupuncture is a technique in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin.

There have been many studies of acupuncture for headache. The combined results from these studies indicate that acupuncture may help relieve headache pain, but that much of its benefit may be due to nonspecific effects including expectation, beliefs, and placebo responses rather than specific effects of needling.

Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

Biofeedback

Biofeedback measures body functions and gives you information about them so that you can become more aware of those functions and learn to control them. For example, a biofeedback device may show you measurements of muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them.

Several types of biofeedback have been studied for headaches, including techniques that help people learn to relax and more specific techniques that focus on changes that occur during headaches.

• Tension headaches. Many studies have tested biofeedback for tension headaches, and several evaluations of this research have concluded that biofeedback may be helpful. However, an evaluation that included only the highest quality studies concluded that there is conflicting evidence about whether biofeedback is helpful for tension headaches.
• Migraines. Studies have shown decreases in the frequency of migraines in people who were using biofeedback. However, it’s unclear whether biofeedback is better than a placebo for migraines.

Biofeedback generally does not have harmful side effects.

Massage

Massage therapy includes a variety of techniques in which practitioners manipulate the soft tissues of the body.

Limited evidence from two small studies suggests massage therapy is possibly helpful for migraines, but clear conclusions cannot be drawn.

Massage therapy appears to have few risks when performed by a trained practitioner. However, people with health conditions and pregnant women may need to avoid some types of massage and should consult their health care providers before having massage therapy.

Relaxation Techniques

Relaxation techniques—such as progressive muscle relaxation, guided imagery, and breathing exercises—are practices that can produce the body’s natural relaxation response. (Some types of biofeedback are also designed to help people learn relaxation; biofeedback is discussed in a separate section above.)

Although some experts consider relaxation techniques to be promising for tension headaches, there isn’t much evidence to support their effectiveness. An evaluation of high-quality studies on relaxation techniques found conflicting evidence on whether they’re better than no treatment or a placebo. Some studies suggest that relaxation techniques are less helpful than biofeedback.

Relaxation techniques generally don’t have side effects. However, rare harmful effects have been reported in people with serious physical or mental health conditions.

Spinal Manipulation

Spinal manipulation is a technique in which practitioners use their hands or a device to apply a controlled force to a joint of the spine. Chiropractors or other health professionals may use this technique.

Spinal manipulation is frequently used for headaches. However, it’s uncertain whether manipulation is helpful because studies have had contradictory results.

Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the area that was manipulated. There have been rare reports of strokes occurring after manipulation of the upper (cervical) spine, but whether manipulation actually caused the strokes is unclear.

Tai Chi

Tai chi, which originated in China, combines meditation with slow, graceful movements, deep breathing, and relaxation.

One small randomized study has evaluated tai chi for tension headaches. Some evidence of improvements in headache status and health-related quality of life was found among patients on the tai chi program compared to others on a wait list. These data are too limited to draw meaningful conclusions about whether this practice is helpful for tension headaches.

Tai chi is generally considered to be a safe practice.

Dietary Supplements

Butterbur

Butterbur appears to help reduce the frequency of migraines in adults and children. In 2012, the American Academy of Neurology recommended its use for preventing migraines. However, the Academy stopped recommending it in 2015 because of serious concerns about possible liver toxicity. If you are considering using butterbur, discuss its risks and benefits with your health care provider.

Coenzyme Q10

A 2021 review of 6 studies (371 total participants) in which coenzyme Q10 was compared with a placebo (an inactive substance) showed that coenzyme Q10 may help reduce the duration and frequency of migraines but not their severity. Because both the amount of evidence and the size of the effects observed in the studies were small, there are still uncertainties about whether coenzyme Q10 is helpful for migraines.

No serious side effects of coenzyme Q10 have been reported. Coenzyme Q10 may interact with some medications, including the anticoagulant (blood-thinning) medication warfarin and the diabetes drug insulin.

Feverfew

A 2020 review that included 7 studies (634 participants) of feverfew for migraine prevention found that the results of the studies were inconsistent.

Side effects of feverfew may include digestive disturbances, skin rash, and inflammation of the mouth. Feverfew may interact with medications.

Magnesium

A 2018 review of 5 studies (253 participants) found that magnesium was possibly effective in reducing the frequency of migraines. Three of the five studies showed evidence of benefits.

High doses of magnesium from dietary supplements or medicines can cause diarrhea, nausea, and stomach cramps, and very large doses can cause serious toxicity. Magnesium can interact with medicines, including some antibiotics, diuretics, and drugs used to treat osteoporosis. Because the amounts of magnesium people take for migraines are greater than the largest daily intake of magnesium from supplements and medicines that is considered safe, magnesium supplements for migraine should be used only under the supervision of a health care provider.

Riboflavin

A 2017 review looked at 9 studies (546 participants) of riboflavin supplementation to prevent migraine. Some of these studies used a rigorous design in which riboflavin was compared with a placebo; others didn’t. Some but not all of the studies indicated that riboflavin was helpful. Riboflavin supplementation seemed to be more useful in adults than in children.

No harmful effects from the use of riboflavin have been reported, and riboflavin is not known to interact with drugs.

Omega-3 Fatty Acids

The results of a recent study indicated that diets high in omega-3 fatty acids may be helpful for migraines. Omega-3s in supplement form have not been shown to reduce the frequency or severity of migraines, but a small amount of evidence suggests that they might reduce the duration of migraine attacks.

• In a 2021 study conducted by researchers from the National Institutes of Health in cooperation with other investigators, 182 adults with frequent migraines were assigned to one of these three test diets for 16 weeks:
  • A diet high in omega-3 fatty acids from high-fat fish and low in linoleic acid (an omega-6 fatty acid found in corn, soybean, and other vegetable oils, as well as some nuts and seeds)
  • A diet high in omega-3s but with as much linoleic acid as in the average U.S. diet
  • A control diet containing omega-3s and linoleic acid in the amounts found in the average U.S. diet

Compared to participants receiving the control diet, those in the two groups receiving higher amounts of omega-3s had fewer hours of headaches and fewer hours of moderate-to-severe headaches per day, as well as fewer days per month with headaches. The group that received a diet low in linoleic acid and high in omega-3s showed a greater decrease in headache days per month than the group who received the diet with average amounts of linoleic acid and high amounts of omega-3s. There were no significant differences among the groups in scores on a questionnaire that evaluates migraine-related quality of life, however.

• An analysis published in 2021 took advantage of data collected during a large study (the VITamin D and OmegA-3 TriaL [VITAL]), in which more than 25,000 middle-aged or older people were randomly assigned to receive omega-3 fatty acid (fish oil) supplements or placebos for 5 years to test the effects of omega-3s on the risk of developing heart disease and cancer. A total of 1,032 of the study participants reported a history of probable migraine and answered questions about changes in the frequency and severity of their migraines. The results showed that omega-3 supplementation did not affect migraine frequency or severity.
• A 2018 review of 5 smaller studies (382 total participants), 4 of which evaluated omega-3 supplements and 1 of which evaluated foods rich in omega-3s, found no effect of omega-3s on the frequency of migraines. The 3 studies (119 participants) that looked at severity of migraines also found no effect of omega-3s. However, the 2 studies (134 participants) that looked at the duration of migraines found evidence that migraines were significantly shorter in people taking omega-3s.

Omega-3 supplements usually produce only mild side effects, if any. There’s conflicting evidence on whether omega-3 supplements might influence the risk of prostate cancer. If you’re taking medicine that affects blood clotting or if you’re allergic to fish or shellfish, consult your health care provider before taking omega-3 supplements.

More To Consider

• Most dietary supplements have not been tested in pregnant women, nursing mothers, or children. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, consult your (or your child’s) health care provider.
• Be aware that some dietary supplements may interact with conventional medical treatments.
• If you’re considering a practitioner-provided complementary health practice such as biofeedback or acupuncture, ask a trusted source (such as your health care provider or nearby hospital) to recommend a practitioner. Find out about the training and experience of any complementary health practitioner you’re considering.
• Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Results from studies indicate that acupuncture may help relieve headache pain, but that much of its benefit may be due to nonspecific effects including expectation, beliefs, and placebo responses rather than specific effects of needling.

What Does the Research Show?

• A 2018 update to a 2012 meta-analysis (of 39 studies involving a total of 20,827 participants) concluded that acupuncture is effective for the treatment of 4 chronic pain conditions, including migraine, with treatment effects lasting over time. 
• A 2016 Cochrane review of 22 randomized trials found that acupuncture was more effective than no acupuncture, was slightly more effective than sham, and may be similarly effective as preventative drug treatment for chronic pain. 
• A 2021 systematic review of 8 studies involving 3,846 participants found evidence that acupuncture and manual therapy can be valuable nonpharmacologic treatment options for tension-type headaches. 
• A 2022 systemic review of 15 randomized controlled trials compared acupuncture to sham acupuncture, and acupuncture to medical treatment. In 7 out of 10 trials comparing acupuncture to sham, reviewers found acupuncture showed a more significant reduction in the frequency of migraine attacks and headache intensity. 

Safety

• Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

Many studies have tested biofeedback for tension headaches, and several evaluations of this research have concluded that biofeedback may be helpful. Studies have shown decreases in the frequency of migraines in people who were using biofeedback. However, it’s unclear whether biofeedback is better than a placebo for migraines.

What Does the Research Show?

• A 2009 review of 44 randomized trials with 2,618 participants concluded that there is conflicting evidence about whether biofeedback is helpful for tension headaches. 
• A 2016 review of 5 studies involving 137 children and adolescents found that biofeedback seemed to be helpful with migraines, especially with reducing their frequency. The number of participants in the studies, however, was small.
• A 2007 meta-analysis of 55 studies found medium effect sizes for the short- and long-term outcome of biofeedback for migraine in adults. The meta-analysis concluded that biofeedback significantly and substantially reduced the pain and psychological symptoms of patients with chronic migraines within the scope of only 11 sessions.

Safety

• Biofeedback generally does not have harmful side effects.

Butterbur appears to help reduce the frequency of migraines in adults and children. However, butterbur contains pyrrolizidine alkaloids (PA), which are hepatotoxic. The American Academy of Neurology stopped recommending butterbur in 2015 because of serious concerns about possible liver toxicity. Some butterbur preparations have had PA toxins removed to ensure safety. Only butterbur products that have been processed to remove PAs and are labeled or certified as PA-free should be considered for use.

What Does the Research Show?

• A 2022 narrative review of the literature examined the safety and clinical efficacy of the butterbur root extract Petadolex. The review of randomized, double-blinded and placebo-controlled trials with Petadolex found that migraine attack frequency was reduced significantly at 150 mg/day, and no relevant abnormal liver function was reported. The reviewers concluded that butterbur is effective in the prevention of migraine attacks by blocking calcitonin gene-related peptide signaling.
• A 2012 study analyzed 21 commercial butterbur products in the United States for petasins (the active ingredient in butterbur) and PAs, and found only 7 products to be safe and effective, with petasin present and no detectable PAs. The study also found that six products had no detectable amounts of petasin and seven had toxic levels of PAs.

Safety

• Some butterbur products contain chemicals called pyrrolizidine alkaloids (PAs). PAs can damage the liver, lungs, and blood circulation, and possibly cause cancer. Only butterbur products that have been processed to remove PAs and are labeled or certified as PA-free should be considered for use.
• Not enough is known about whether it’s safe to apply butterbur products to the skin.
• Several studies, including a few studies of children and adolescents, have reported that PA-free butterbur products seem to be safe when taken by mouth in recommended doses for up to 16 weeks. However, some products claiming to be PA-free may not in fact be. For example, Petadolex is marketed as a PA-free butterbur product, but it has been associated with liver damage in some people, suggesting that it may have had PAs. Also, the safety of longer-term use of butterbur has not been established.
• Butterbur products with PAs should not be used during pregnancy or while breastfeeding because they may cause birth defects or liver damage. Little is known about whether it’s safe to use PA-free butterbur during pregnancy or while breastfeeding.
• PA-free butterbur is generally well tolerated but can cause side effects such as belching, headache, itchy eyes, diarrhea, breathing difficulties, fatigue, upset stomach, and drowsiness.
• Butterbur may cause allergic reactions in people who are sensitive to plants such as ragweed, chrysanthemums, marigolds, and daisies.

There is some limited evidence that coenzyme Q10 may help reduce the duration and frequency of migraines but not their severity.

What Does the Research Show?

• A 2021 systematic review and meta-analysis of 6 studies (371 total participants), which compared coenzyme Q10 with a placebo, showed that coenzyme Q10 may help reduce the duration and frequency of migraines but not their severity. Because both the amount of evidence and the size of the effects observed in the studies were small, there are still uncertainties about whether coenzyme Q10 is helpful for migraines.

Safety

• No serious side effects of coenzyme Q10 have been reported. Coenzyme Q10 may interact with some medications, including the anticoagulant (blood-thinning) medication warfarin and the diabetes drug insulin.

Some research suggests that feverfew may help prevent migraine headaches, but results have been mixed. Some research suggests it may reduce migraine headache frequency, as well as some symptoms, such as pain, nausea/vomiting, and light sensitivity.

What Does the Research Show?

• A 2020 Cochrane review (an update to a previous Cochrane review, which added one larger rigorous study) of 6 studies involving 561 participants found a difference in effect between feverfew and placebo of 0.6 migraine attacks per month. However, the reviewers noted that this constitutes low quality evidence, which needs to be confirmed in larger rigorous trials with stable feverfew extracts and clearly defined migraine populations before firm conclusions can be drawn.

• Based on the evidence, the Canadian Headache Society (CHS), American Academy of Neurology/American Headache Society (AAN/AHS), and European Federation of Neurological Societies (EFNS) have different recommendations. The CHS made a strong recommendation based on moderate quality evidence to not offer feverfew for migraine, citing the evidence is no better than placebo for the prophylaxis of migraine. The AAN/AHS recommended that feverfew is probably effective and should be offered for prevention. The EFNS stated that feverfew is possibly beneficial for migraine prevention.

Safety

• Side effects of feverfew can include nausea, digestive problems, and bloating; if the fresh leaves are chewed, sores and irritation of the mouth may occur. In addition, there is some evidence that parthenolide (a substance found in feverfew) may cause glutathione depletion. 
• People who are sensitive to ragweed and related plants may experience allergic reactions to feverfew.
• Do not take feverfew while pregnant because it may affect uterine contractions. Little is known about whether it’s safe to use feverfew while breastfeeding.

Research on the use of magnesium supplements to prevent or reduce symptoms of migraine headaches is limited.

What Does the Research Show?

• A 2018 systematic review of five studies found Grade C (possibly effective) evidence for prevention of migraine with magnesium. However, a 2021 review concluded that even if the preliminary results are very promising, more rigorous studies have to be designed to confirm the efficacy of magnesium for headache.
• A 2009 review found that three of four small, short-term, placebo-controlled trials showed modest reductions in the frequency of migraines in patients given up to 600 mg/day magnesium. Because the typical dose of magnesium used for migraine prevention exceeds the Tolerable Upper Intake Level (UL), this treatment should be used only under the direction and supervision of a health care provider.

• According to a 2016 summary of existing guidelines on nutraceuticals for migraines, based on research from the CHS, there is low quality evidence that supports the use of magnesium in the prophylaxis of migraine, suggesting a daily dose of 24 mmol (600 mg) or elemental magnesium as magnesium citrate. The AAN/AHS gave magnesium a Level B recommendation, and the EFNS gave magnesium a Level C. The EFNS recommended use of the same dose of magnesium as the Canadian guidelines.

Safety

• High doses of magnesium from dietary supplements or medicines can cause diarrhea, nausea, and stomach cramps, and very large doses can cause serious toxicity. Magnesium can interact with medicines, including some antibiotics, diuretics, and drugs used to treat osteoporosis. Because the amounts of magnesium people take for migraines are greater than the largest daily intake of magnesium from supplements and medicines that is considered safe, magnesium supplements for migraine should be used only under the supervision of a health care provider.

Only a small number of studies of massage for headache have been completed, and their results are not consistent.

What Does the Research Show?

• A 2021 systematic review of 8 studies involving 3,846 participants found evidence that acupuncture and manual therapy, including massage therapy, can be valuable nonpharmacologic treatment options for tension-type headaches. 
• A 2016 study with 64 participants evaluated lymphatic drainage and traditional massage (once a week for 8 weeks) in patients with migraine and found that the frequency of migraines decreased in both groups, compared with people on a waiting list. 
• A 2011 study of 83 participants evaluated the effect of adding hand massage to multimodal behavior treatment of migraine and found that hand massage had no effect on migraine frequency.

Safety

• Massage therapy appears to have few risks when performed by a trained practitioner. However, people with health conditions and pregnant women may need to avoid some types of massage and should consult their health care providers before having massage therapy.

Diets high in omega-3 fatty acids may be helpful for migraines; however, omega-3s in supplement form have not been shown to reduce the frequency or severity of migraines. There is a small amount of evidence that suggests that omega-3 supplements might reduce the duration of migraine attacks. 

What Does the Research Show?

• In a 2021 study of 182 adults with frequent migraines, researchers from the National Institutes of Health, in cooperation with other investigators, assigned participants to one of three groups for 16 weeks comparing a diet high in omega-3 fatty acids from high-fat fish and low in linoleic acid, a diet high in omega-3s but with as much linoleic acid as in the average U.S. diet, and a control diet containing omega-3s and linoleic acid in the amounts found in the average U.S. diet. Participants in the two groups receiving higher amounts of omega-3s had fewer hours of headaches and fewer hours of moderate-to-severe headaches per day, as well as fewer days per month with headaches compared to the control group. The greatest decrease in headache days per month was seen in the group that received a diet high in omega-3s and low in linoleic acid. 
• A 2021 analysis of the VITamin D and OmegA-3 TriaL (VITAL) showed that omega-3 supplementation did not affect migraine frequency or severity among the 1,032 study participants with a reported a history of probable migraine. 
• A 2018 review of 5 small studies involving a total of 382 participants found that while omega-3s did not affect the frequency of migraines, there was a reduction in duration of migraine attacks.

Safety

• Omega-3 fatty acid supplements usually do not have negative side effects. When side effects do occur, they typically consist of minor gastrointestinal symptoms. 

Some studies have found that relaxation techniques such as autogenic training or biofeedback-assisted autogenic training, hypnotherapy (and self-hypnosis paired with guided imagery) may help to reduce headache pain; however, the findings should be viewed cautiously because many of the studies have not been of high quality. 

What Does the Research Show?

• A 2019 review of 7 studies involving 571 children looked at the effects of relaxation training on migraine headaches, tension-type headache, or both. Although some studies reported decreased headache frequency, duration, and intensity after relaxation training, other studies did not. Overall, the results were inconsistent, and the research was of very low quality.
• In a 2018 review of 6 studies involving a total of 274 participants, 5 of the studies found that autogenic training or biofeedback-assisted autogenic training helped to reduce headache pain; however, because of the small sample size and study limitations, the review authors noted that the findings should be viewed cautiously. 
• In a 2018 review, five of eight studies found that hypnosis—usually self-hypnosis and often paired with guided imagery—resulted in less headache activity in people diagnosed with migraine or chronic headache disorder; however, none of the studies in this review were rated high quality. 

Safety

• Relaxation techniques generally don’t have side effects. However, rare harmful effects have been reported in people with serious physical or mental health conditions.

Some, but not all, of the few small studies conducted to date have found evidence of a beneficial effect of riboflavin supplements on migraine headaches in adults and children.

What Does the Research Show?

• A 1998 randomized controlled trial of 55 participants with migraines compared treatment with 400 mg riboflavin daily with placebo for 12 weeks. The results, 4 months after the trial, showed that the reduction in migraine attacks per month was greater for patients treated with riboflavin (56 percent) compared to the placebo group (19 percent).
• A 2020 review concluded that overall, studies to date report that riboflavin has similar efficacy to valproate for migraine prophylaxis, but has a more tolerable side effect profile.

• According to a 2016 summary of existing guidelines on nutraceuticals for migraines, the CHS gave riboflavin a strong recommendation based on low quality evidence for benefit and minimal side effects. The CHS guidelines recommend 400 mg daily to eligible patients for migraine prophylaxis. The AAN/AHS guidelines state that riboflavin is “probably effective” and should be considered for migraine prevention (with a Level B recommendation). The EFNS guidelines state that riboflavin is possibly helpful (with a Level C recommendation). 

Safety

• Adverse effects from high riboflavin intakes from foods or supplements (400 mg/day for at least 3 months) have not been reported. A 2021 review found that in all of the studies included in the review, riboflavin was well tolerated without major side effects or safety concerns.

Spinal manipulation may be one of several complementary health approaches (including massage therapy) that’s as helpful as medications used for migraine prevention, but the research isn’t conclusive.

What Does the Research Show?

• A 2020 AHRQ systematic review of noninvasive, nonpharmacologic treatment for chronic pain reported spinal manipulation therapy was associated with slight-to-moderate improvements in function compared to usual care on the Headache Impact Test and the Headache Disability Inventory (scale 0–100) and in pain over the short term (i.e., 1–6 months) in one trial. The standard of evidence was rated as low.
• A 2022 systematic review and meta-analysis of 20 studies involving 1,439 participants found evidence suggesting that manual and exercise therapy may reduce headache intensity, frequency, and disability over the short and long term in people with cervicogenic headaches; however, the overall risk of bias in many of the trials included in the analysis was high. A sensitivity meta-analysis on studies with low risk of bias showed moderate-quality evidence supporting the use of spinal manipulation compared to sham interventions. 

Safety

• Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the area that was manipulated. There have been rare reports of strokes occurring after manipulation of the upper (cervical) spine, but whether manipulation actually caused the strokes is unclear.

Data are too limited to draw meaningful conclusions about whether tai chi is useful for tension headaches. 

What Does the Research Show?

• One small, randomized study has evaluated tai chi for tension headaches and found some evidence of improvements in headache status and health-related quality of life among patients in the tai chi program compared to others on a wait list. However, these data are too limited to draw meaningful conclusions about whether this practice is helpful for tension headaches.

Safety

• Tai chi is generally considered to be a safe practice.