How can relaxation and alternative techniques help manage headache pain?

It’s common for people to attribute headaches to stress, but there’s no official headache classification of "stress headaches." However, stress certainly plays a role in causing a headache or making any headache worse. During stressful events, certain chemicals in the brain are released to combat the situation (know as the "flight or fight" response). The release of these chemicals can provoke vascular changes that can trigger headaches or make them worse.

Learning relaxation techniques can help manage your headache by modifying the pain and/or frequency of the headaches and prevent them from getting worse.

It is important for the family and the patient not to over look the value of non-medication based headache management strategies. In many cases, the efficacy of these techniques is well documented and surpasses that of many standard medication regimens. It is also important to note that many of the non-medication based headache management strategies can be--and often are--combined with standard medication therapies.

Methods to relax or reduce stress

There are several methods that can be tried to relax or reduce stress, including:

  • Breathing exercises
  • Progressive muscle relaxation
  • Mental imagery relaxation (also called guided imagery)
  • Biofeedback
  • Relaxation to music
  • Counseling/cognitive therapy (to help patients recognize and relieve stress)
  • Alternative therapies, including physical therapy, massage, hypnosis, chiropractic manipulation, acupuncture/acupressure, aromatherapy, and herbal therapy

Each of the above strategies -- which should be started at the first sign of headache (and in some cases, before the headache starts) -- will be described in greater detail below.

Breathing exercises

In order to learn how to relax, you need to become familiar with your own breathing patterns and change them in ways that will help you relax, which in turn, will reduce pain and anxiety. Your breathing pattern is often disrupted by changes in emotion. If you are anxious, you tend to hold your breath and speak in a high–pitched voice as you exhale. On the other hand, if you are depressed, you tend to sigh and speak in a low–pitched voice as you exhale. Below are a few breathing exercises. Before beginning them, be sure that you have:

  1. A quiet location that is free of distractions.
  2. A comfortable body position. Sit or recline on a chair or sofa.
  3. A good state of mind. Try to block out worries and distracting thoughts.

Rhythmic breathing

If your breathing is short and hurried, slow it down by taking long, slow breaths. Inhale slowly, then exhale slowly. Count slowly to five as you inhale, and then count slowly to five as you exhale. As you exhale slowly, pay attention to how your body naturally relaxes. Recognizing this change will help you to relax even more.

Deep breathing

Imagine a spot just below your navel. Imagine breathing in through that spot, filling your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon. With every long, slow exhalation, you should feel more relaxed. Breathing deeply and slowly floods the body with oxygen and other chemicals that work on the central nervous system and improve your comfort.

Visualized breathing

Find a comfortable place where you can close your eyes, and combine slowed breathing with your imagination. Picture relaxation entering your body and tension leaving your body. Breathe deeply but in a natural rhythm. Visualize the air coming into your nostrils, going into your lungs and expanding your chest and abdomen. Then, visualize your breath going out the same way. Continue breathing, but each time you inhale imagine that you are breathing in more relaxation. Each time you exhale, imagine that you are getting rid of a little more tension.

Progressive muscle relaxation

Progressive muscle relaxation is a technique that teaches you to consciously concentrate on relaxing every muscle in your body beginning at your toes and working all the way up to your head. Reducing muscular tension helps reduce pain.

Progressive muscle relaxation is a two-step process. First, you deliberately apply tension to certain muscle groups and then you stop the tension and turn your attention to noticing how the muscles relax as the tension flows away.

Here’s a quick tutorial on how the procedure works:

  • Step 1, tension -- First, focus your mind on a muscle group, for instance, the muscles in your hand. As you inhale, squeeze the muscles in your hand (by making a tight fist) as hard as you can for about 8 seconds.
  • Step 2, releasing the tension -- Now, as you exhale, quickly open your hand and let the pain and tightness go. Feel the muscles relax and become loose and limp as the tension flows away. You would repeat this tension-relaxation process for all the major muscle groups in your body, beginning with the muscles in your feet and moving upward all the way to your face.

Guided imagery

Mental imagery relaxation, or guided imagery, is a proven form of focused relaxation that helps create harmony between the mind and body. Guided imagery coaches you in creating calm, peaceful images in your mind — a "mental escape."

Guided imagery provides a powerful psychological strategy that enhances a person’s coping skills. Many people dealing with stress feel a loss of control, fear, panic, anxiety, helplessness and uncertainty. Research has shown that guided imagery can dramatically counteract these effects. It can help people overcome stress, anger, pain, depression, insomnia and other problems. Guided imagery also has been shown to dramatically decrease pain and the need for pain medication, enhance sleep, and strengthen the immune system and enhance the ability to heal.

With guided imagery, a person imagines a pleasant experience or a particularly soothing environment. By concentrating on creating as much detail as possible, the mind becomes absorbed in this task, which in turn, lessens the stressful or painful event.

Patients must understand that guided imagery is not an alternative to medical or surgical treatment, nor is it a cure. Rather, it is an inexpensive, yet powerful way in which patients can actively participate in their health care.


Biofeedback is a technique that involves learning how to relax and better cope with pain and stress by altering your behavior, thoughts, and feelings. More specifically, biofeedback uses electronic devices to measure physiologic processes such as breathing rate, heart rate, skin temperature, skin conductance (which varies with perspiration) and muscle tension (which is measured with a device called an electromyography). A biofeedback unit processes the electronic signals and "feeds back" the information to the user in the form of sounds or graphs on a computer screen.

Biofeedback allows you to learn how your body responds in stressful situations, how to gain control over certain physiologic functions that cause tension and physical pain, and how to create a state of total body relaxation. If a headache, such as a migraine, begins slowly, many people can use biofeedback to stop the attack before it becomes full blown.

Biofeedback equipment is expensive and professionals who use it must receive considerable technical training. Biofeedback training usually requires several sessions with a skilled biofeedback therapist. Some companies, however, make some simple biofeedback devices for self treatment at home. These devices can be helpful for people who have difficulty with the more imaginable relaxation techniques.

Relaxation exercises can be combined with your favorite music in the background. Select the type of music that lifts your mood or that you find soothing or calming. Some people find it easier to relax while listening to specially designed relaxation audio, which provide music and relaxation instructions. Ask your healthcare provider about the availability of audio sources.

Cognitive therapy

Cognitive therapy gives you insight into sources of your stress and other triggers and the development of headache. Common sources of stress in children and adolescents include:

  • Problems at home/family conflict
  • Having overly permissive or overly strict parents
  • Not getting enough sleep
  • Rejection or harassment by peers at school
  • Having no close friends
  • Academic challenges
  • Joining too many extra-curricular activities
  • Sexual, physical or emotional abuse

Cognitive therapy involves three main steps. In the first step, counselors help patients recognize any negative thoughts associated with the stressors. Examples of negative thoughts could include: "That rotten teacher made the exam too hard," or "My headache is never going to go away."

The second step involves gaining insight into the negative thoughts and challenging the belief about the thought. For instance, the counselor will help patients realize that all past headaches have gone away so the next one will go away too.

The third and final step is to substitute positive thoughts for the negative ones and/or to teach patients to distract themselves so that they think about more pleasant thoughts. An example of a self-confidence-building statement might be, "I’ve had this type of headache before and I know how to handle it. I will beat this headache." Cognitive therapy teaches patients how to maintain a positive mood.

Beyond stress and relaxation strategies: Alternative approaches for managing headaches

The remainder of this document focuses briefly on other headache management and pain reduction approaches. With the exception of physical therapy, many of the approaches discussed below represent nontraditional therapies being used to manage head pain in the United States.

It’s important to note that some of the therapies mentioned are not completely harmless -- especially in the hands of unqualified practitioners. Also, it’s important to know that many therapies require multiple sessions and may take longer to work than traditional drug-based therapy.

Because some of these approaches are largely unproven, it’s important to find a trustworthy, certified, practitioner. Since most physicians today are open to consideration of alternative treatments, don’t hesitate to ask your doctor about referring you to a qualified alternative health practitioner. In fact, ask your doctor to help coordinate your program of care.

Physical therapy

Physical therapy is a medical discipline that deals with the muscles, joints, ligaments, tendons, and nerves of the body. Physical therapy can be very helpful for headaches that originate in the muscles or joints of the neck (also called cervicogenic headaches). Patients who have migraines or tension-type headaches may have their headache pain brought on by neck strain and therefore may benefit from physical therapy.

Massage therapy

Massage has become a popular approach for relieving chronic pain, easing muscle tension, and for promoting relaxation. People with headaches triggered by muscle tension, poor posture, or emotional stress or anxiety might benefit from massage therapy.


Hypnosis uses a blend of relaxation, imagery, and the power of suggestion to achieve a heightened sense of relaxation. Headache relief is achieved through deep relaxation and posthypnotic suggestion.

Chiropractic manipulation

Chiropractics is a form of treatment involving spinal manipulation. It has been claimed that migraine, tension-type headache, and post-traumatic headache may benefit from this technique based on the theory that pain arises from abnormal motion and irritation to the neck muscles and nerves and other tissues and that manipulation can alleviate the pain by restoring normal mobility and function. It’s important to note that there is not as much scientific evidence supporting chiropractic manipulation as a headache approach as there is for other more "mainstream" treatment approaches. Furthermore, excessive manipulation may actually cause additional problems. Ask your primary care physician if this therapeutic approach is suitable for you.

Acupuncture and acupressure

Acupuncture -- is a traditional form of Chinese medicine and controls pain by the skilled placement of small, sharp needles along select points on the body. It is thought that stimulation of the acupuncture points results in the release of endorphins -- the body’s natural pain reliever. If you choose this form of therapy, make sure your practitioner is certified and that clean, sterile needles are used.

Acupressure-- follows the same principles as acupuncture but replaces needles with the application of physical pressure.


Aromatherapy involves the distillation of essential oils from plants. These oils are inhaled or absorbed through the skin in the form of ointments, compresses or aromatic baths. Some aromatherapy products may benefit some headache sufferers. (On the other hand, some odors may increase or provoke nausea if used during migraine attacks.) In particular, oil from lavender flower has been used to relieve muscle spasm and a small amount can be massaged over tense muscles of the forehead, neck or shoulders. In addition, a combination of peppermint and eucalyptus oils, when massaged into the forehead, has been found effective in relieving tension-type headache.


Yoga, a Hindu-based practice for achieving mental and physical relaxation through stretching, breathing and meditation exercises, can be a stress-reducing outlet that enhances your health and well-being. Increased flexibility, chronic disease management, weight loss and improved balance and coordination are among yoga’s many health benefits.

Vitamin, mineral, and herbal products

Of the products listed below, only five have been studied in clinical trials and showed to have some effectiveness in migraine. These products are magnesium, riboflavin, feverfew, butterbur, and coenzyme Q10. The other products listed below have been mentioned for use in migraine but have not been formally, scientifically studied.

Magnesium and riboflavin

There is some scientific evidence showing that the mineral magnesium given daily either alone or with a daily dose of riboflavin (also known as vitamin B2) can reduce migraine frequency. Ask your doctor about this treatment option.

Coenzyme Q10

Coenzyme Q10 is a naturally occurring substance found in the body’s tissues, in many foods, and can also be made into a supplement. It is used by the body to produce energy for cells (and most extensively studies for diseases involving the body’s energy cells -- ie, mitochondrial disorders), and as an antioxidant. Coenzyme Q10 is also being studied in cancer treatment, in the relief of side effects caused by some cancer treatments, and has been shown in trials to be an effective preventive treatment for migraine. Very few side effects have been reported with use of this product.

Herbal therapy

The following herbal products have been used to treat headache or for pain relief:

  • Feverfew -- best studied herbal for headache; has shown value in preventing and treating migraine headache and may also be helpful in cluster and menstrually related headaches.
  • Butterbur -- is an herbal product that has been shown to be an effective preventive treatment for migraine.
  • Cayenne (capsaicin) -- is the "hot" in hot peppers. Has been used topically to provide pain relief. Some evidence of effectiveness in cluster headache.
  • Chamomile tea -- has sedative effects and relaxes the body. Has been used to ease the nausea of migraine.
  • Dandelion -- contain magnesium and vitamin B, which is helpful for headache prevention.
  • Ginger -- is an anti-inflammatory that might offer some benefit in migraine.
  • Gingko -- has been shown to increase blood flow to the brain and reduce platelet clumping. Is used to treat headache.
  • Stinging nettle -- is an anti-inflammatory. Has been used to relieve chronic headache.
  • Willow bark -- relieves pain.

Unlike medications, herbal products do not undergo vigorous clinical study and review by the Food and Drug Administration, therefore a very cautious approach to their use should be the norm. Not all herb products are safe and more research -- especially in children -- is needed to define who benefits, the proper dosing to exert a benefit, and to identify any side effects. Other tips regarding use of herbal products include:

  • Be an informed consumer, read more about any herbal product you may consider using
  • Be wary of products that claim to cure everything
  • Be skeptical if the person or company recommending herbal products is the one that will profit from selling them
  • Be particularly cautious if you are pregnant or have serious health issues
  • Tell your medical doctor what you are trying. Some herbal products interfere with the actions of both prescription and over-the-counter medications and should not be taken together

2-Minute relaxation exercise

Turn your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped, such as your shoulders or neck. Rotate your head in a smooth, circular motion once or twice. (Stop any movements that cause pain.) Roll your shoulders forward and backward several times. Let all of your muscles completely relax. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly. You should feel more relaxed now.

10 Ways to Ease Stress

By Michael G. McKee, PhD, Section of Health Psychology, Department of Psychiatry and Psychology, The Cleveland Clinic

  • Eat and drink sensibly. Alcohol and food abuse may seem to reduce stress, but they actually add to it. Eat well-balanced meals. Also get plenty of rest and sleep.
  • Assert yourself. You do not have to meet others’ expectations or demands. It’s okay to say "No." Remember, being assertive allows you to stand up for your rights and beliefs while respecting those of others. Be assertive instead of becoming angry, aggressive, combative or passive.
  • Stop smoking or other bad habits. Aside from the obvious health risks of cigarettes, nicotine acts as a stimulant and brings on more stress symptoms. Give yourself the gift of dropping unhealthy habits.
  • Exercise regularly. Choose non-competitive exercise and set reasonable goals. Aerobic exercise has been shown to release endorphins (natural substances that help you feel better and maintain a positive attitude). Alternative mind-body techniques -- such as Tai Chi, yoga, and meditation -- can also be considered.
  • Study and practice relaxation techniques. Relax every day — choose from a variety of different techniques. Combine opposites - a time for deep relaxation and a time for aerobic exercise is a sure way to protect your body from the effects of stress.
  • Take responsibility. Control what you can and accept that there are events that you cannot control.
  • Reduce stressors (causes of stress). Many people find life synonymous with too many demands and too little time. For the most part, these demands are ones we have chosen. Effective time-management skills involve delegating when appropriate, setting priorities, pacing yourself and taking time out for yourself.
  • Examine your values and live by them. The more your actions are in accordance with your beliefs, the better you will feel, no matter how busy your life is. Use your values when choosing your activities.
  • Set realistic goals and expectations. It’s okay, and healthy, to realize you cannot be 100% successful at everything at once.
  • Sell yourself to yourself. When you are feeling overwhelmed, remind yourself of what you do well. Have a healthy sense of self-esteem.

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