Acupuncture for Tension Headaches: What the Research Shows
Updated: 6 days ago
A tight band around your head that won't let go. A dull ache that builds through the afternoon, with your neck and shoulders locked up to match. If that sounds familiar, you're far from alone: tension-type headache affects an estimated 26% of people worldwide, according to a 2022 analysis by Lars Jacob Stovner and colleagues in The Journal of Headache and Pain.
The research on acupuncture for tension headaches is encouraging. In a 2016 Cochrane review, two large trials found that 48% and 45% of people who added acupuncture to routine care had their headache frequency at least halved, compared with 19% and 4% on routine care alone.
Below I'll go through what that review found, where the evidence is stronger and thinner, and how I approach tension headaches in clinic.
What is a tension headache?
A tension headache, or tension-type headache, is usually a dull, pressing ache on both sides of the head, often described as a tight band. It tends to be milder than a migraine and usually doesn't come with the nausea or light sensitivity many people with migraine have. In my experience the two sit on the same continuum, with migraines involving more intense pain and more neurological symptoms.
Tension headaches often travel with a stiff neck and shoulders. Long hours at a screen, a forward head posture and a busy stress load are common contributors. Certain muscles can also refer pain into the head when they hold trigger points, which I cover in a separate post.
What does the research say about acupuncture for tension headaches?
The best evidence is a Cochrane review that pooled 12 randomised trials and 2,349 adults and found acupuncture can reduce how often tension-type headaches happen. Cochrane is an international organisation that systematically reviews health research. The Cochrane review of acupuncture for the prevention of tension-type headache, led by Klaus Linde, was published in 2016.
The authors concluded that a course of at least six acupuncture sessions may be a valuable option for people with frequent tension-type headache. They also concluded that acupuncture appears effective for frequent episodic or chronic tension-type headaches, while noting that more trials are needed, particularly comparing it with other treatments.
How does acupuncture compare with routine care, sham acupuncture and other treatments?
Acupuncture clearly beat routine care, had a modest edge over sham acupuncture, and hasn't yet been shown better or worse than other treatments. Sham acupuncture means needles placed at non-acupuncture points, or needles that don't penetrate the skin. It's used in trials as the "placebo" comparison. The table shows the percentage of people whose headache frequency at least halved.
Compared with | Acupuncture | Comparison group | What it suggests |
Routine care or acute treatment only (trial 1) | 48% | 19% | A clear benefit when added to routine care |
Routine care or acute treatment only (trial 2) | 45% | 4% | A clear benefit when added to routine care |
Sham acupuncture (pooled trials) | 51% | 43% | A modest edge, similar at six months |
Physiotherapy, massage, exercise, relaxation | Not shown superior | - | Trials too limited to draw a conclusion |
The trials comparing acupuncture with physiotherapy, massage, exercise and relaxation were low to moderate quality, with inadequate reporting. The reviewers considered them uninformative, so the review can't tell us whether acupuncture is better or worse than those options.
How strong is the evidence for acupuncture and tension headaches?
Cochrane rated the evidence as moderate to low, which means the findings are useful but not settled. A few limits are worth knowing.
The two routine-care trials weren't blinded. People knew whether they were getting acupuncture, and effects beyond four months weren't studied. Blinding is difficult with acupuncture in general, because the practitioner always knows what they're doing and it's hard to design a convincing placebo for needling.
The sham result leans on one large trial. About 400 people in a single good-quality trial drove much of the sham-controlled effect. In my view, a true sham is also difficult to create, and people improving with sham acupuncture is promising, because it suggests even inaccurate acupuncture can have beneficial effects.
Side effects were similar to sham. Adverse events were reported by 17% of people having acupuncture and 12% having sham, which wasn't a significant difference. Only 1 of 420 acupuncture participants dropped out because of an adverse effect.
What does this mean if you have tension headaches?
It means acupuncture is a reasonable option to try for frequent tension headaches, and a block of sessions gives a fairer picture than one visit. The trials used courses of at least six sessions, and treatment tends to be cumulative. That's why I look at your response across a run of sessions, then plan from there.
Research tells us what happens on average. In clinic, I'm looking at you. I assess the muscles of your neck and shoulders, your posture and screen habits, and how well your body winds down from stress. The acupuncture mainly works on releasing tight muscles, promoting healthy blood flow and helping your nervous system shift into a rest-and-digest state.
If you'd like to read more, start with the four contributing factors behind many headaches and the muscle trigger points that refer pain to the head, or see what the research says about acupuncture for migraines. For what to expect from treatment, read about how long acupuncture takes to work and how often to come.
FAQs: Acupuncture for Tension Headaches
Does acupuncture work for tension headaches?
The research suggests it can reduce how often they occur. In a 2016 Cochrane review, two large trials found 48% and 45% of people who added acupuncture to routine care had their headache frequency at least halved, versus 19% and 4% with routine care alone.
How many acupuncture sessions are needed for tension headaches?
The Cochrane review concluded that a course of at least six sessions may be a valuable option. Treatment is cumulative, so I assess your response across a block of sessions and adjust the plan as you improve.
Is acupuncture better than physiotherapy or massage for tension headaches?
The review couldn't say. Trials comparing acupuncture with physiotherapy, massage, exercise and relaxation were too limited to show that either was better. These approaches can also work well alongside each other.
Does acupuncture for tension headaches have side effects?
In the Cochrane review, adverse events were reported by 17% of people having acupuncture and 12% having sham acupuncture, which wasn't a significant difference.
Ready to see how your tension headaches respond?
If you'd like a whole-body approach to your headaches, you're welcome to come and see me. I'll work out what's keeping your headaches going and put together a plan with you.
If you'd like to try acupuncture for headaches in Sydney's eastern suburbs, come and see me at Acupuncture Grove in Bondi Junction. You can book online here or reach out with a question.
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Gavin Martin-Rentz is an AHPRA-registered acupuncturist and Chinese medicine practitioner at Acupuncture Grove, Bondi Junction, Sydney, with over 10 years in practice.
Acupuncture Grove services Bondi Junction, Bondi Beach, Coogee, Clovelly, Bronte, Waverley, Randwick, Maroubra, Double Bay, Watsons Bay, Vaucluse and surrounding Sydney suburbs.
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