Nonpharmacological Treatment

Physical treatment modalities, such as hot and cold packs, ultrasound and electrical stimulation, improvement of posture, relaxation, and exercise programs, have all been used. However, the majority of these treatments have not been properly evaluated, and most of the reported studies are not controlled. In one open-label study, the beneficial long-term effect of physical therapy was excellent,114[IV] whereas a controlled study reported only a minor effect on headache frequency after eight weeks of standardized treatment.115,116[II] A recent controlled study concluded that there was no significant effect of spinal manipulation on patients with episodic tension-type headache.98[II] Likewise botulinum toxin plays no role in the treatment of tension-type headache or migraine.117,118[II]

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