Integrative Treatments for Headache Disorders: Preventive and Acute

Preventing headaches

There are many ways to prevent headaches without medicine. These methods can be used alone or with medicine for better results. Combining medicine with non-medicine treatments creates an integrative plan, which is the best way to manage your pain, avoid emergency visits, do fun activities, and achieve your goals despite headaches. Choose one or more of these techniques daily to prevent headaches.
Follow the SMART (Sleep, Meals, Activity, Relax, Triggers) guide:

• Sleep well.

• Eat small, healthy meals often.

• Stay active.

• Manage stress with relaxation skills.

• Be aware of your headache triggers.

Exercise: Aerobic exercise like biking, walking fast, or running can reduce headaches. Try to do this at least twice a week. Some patients report that high-impact sports, jerking movements, and heavy lifting trigger headaches. Find an activity you enjoy, don’t be afraid to try something new!

Acupuncture: Weekly or twice-weekly acupuncture for 3-4 months can prevent headaches. Researchers believe that tiny needles help the body produce chemicals that fight pain and calm the nervous system.

Acupressure and acupressure bands and seeds: Acupressure is a technique where pressure is applied to specific points (acupoints) on the body. This technique uses tools such as acupressure bands, seeds, or fingers. Acupuncture needles are not used. Acupressure does not break the skin.  

Cognitive behavioral therapy (CBT): CBT is a proven therapy to prevent headaches. It teaches ways to change your thoughts so that they are more positive and helpful to your mood and pain.  Medicine plus CBT works better than medicine alone. It's usually taught by psychologists or licensed therapists.

Biofeedback and relaxation exercises: Headaches are less likely when your nervous system is relaxed. Biofeedback uses sensors to measure your body's stress levels. Learning relaxation techniques like deep breathing can help prevent headaches.

Mindfulness: Mindfulness is the practice of choosing to focus on a specific anchor such as your breath, sound or sensation. When you notice your attention wanders, (which it will!) you bring your attention back to your anchor without judging or criticizing and being curious and compassionate toward yourself.  If you practice mindfulness regularly, you may notice that your perception of stress decreases. Mindfulness is an important part of other practices, like meditation and yoga. There are courses offered at the Penn Program for Mindfulness.

Dietary changes: A healthy weight can reduce headaches. Eating a balanced diet like the Mediterranean diet may be best for reducing inflammation and general wellness. It includes whole grains, good fats, lean proteins, legumes, and colorful fruits and vegetables. For most patients it’s more important to focus on eating healthy foods rather than restricting their diet.

Talk to your healthcare provider about CHOP’s Integrative Nutrition Program or the Healthy Weight Program if you are interested in learning more.

Supplements: We recommend eating foods rich in magnesium, B vitamins, and coenzyme Q10, but your healthcare provider may also recommend one or more of these in a supplement. Supplements are not regulated in the same way as medications, so their quality and the amount of active ingredients vary depending on the brand. Please ask us if you would like to learn more about supplements or vitamin and mineral rich foods.

Massage: Massage is believed to promote healing and relaxation. It works by increasing circulation, relaxing muscle tissues and nerves, and can reduce pain, tension and anxiety. We recommend locating a Licensed Massage Therapist, (LMT) a physical therapist, osteopathic physician, or other medical provider licensed to use massage therapy. See our videos on CHOP You Tube or make an appointment with our massage therapy clinic by calling 215-590-5043 to schedule.

Yoga: Yoga involves physical postures, mindful breathing, inward concentrations, and creating a deep sense of connection to self. Yoga provides a variety of health benefits and can help with headaches. Ask a certified instructor about helpful poses and those to avoid.

Osteopathic and chiropractic manipulation: Gentle spinal manipulation can help with headaches and neck pain. Neurologists worry that some chiropractic treatments can damage blood vessels and lead to a dangerous condition called “arterial dissection.” Please look for a doctor of osteopathic medicine or chiropractor who practices gentler forms of manipulation.

Goal or intention setting: Set daily intentions, like “I will not let my pain control my day.”

Spend time outside: Being in nature can reduce anxiety and pain. Morning sunshine helps regulate your body clock.

Laughter: Laughing trains your nervous system to handle stress better. It releases pain-killing, mood-lifting chemicals.

Groups: Spend time with positive people. Join groups or clubs that make you feel supported.

Treating acute headaches

You can treat headaches without medicine. These methods can also make your medicine work better. Try these in-the-moment techniques:

Breathing exercises: Learn breathing exercises like ratio breathing, belly breathing, and heart-focused breathing to help with pain.

Mindful movement: Move mindfully with yoga, Tai Chi, or Qigong to distract your brain from pain.

Stretching and relaxation: Stretch and relax tight neck and shoulder muscles.

Lotions and oils: Use lotions like Topricin®, arnica, or oils like peppermint and lavender to relieve pain. Essential oils like lavender, peppermint or eucalyptus must ALWAYS be properly diluted before applying to the skin. Apply to painful areas or use a personal “sniffer.”

Imagery: Imagine yourself in a peaceful place where you feel calm and comfortable such as a favorite vacation place or your bedroom.

Hypnosis: Clinical hypnosis is an intervention used to help create a relaxed state in coping with pain, anxiety, and other medical conditions. A trained healthcare provider guides you to “pay attention on purpose” to parts of your day-to-day functioning. It involves helping you use your own problem-solving skills to develop a sense of control and confidence in response to specific concerns like a headache. We recommend contacting your insurance company to find out if there are licensed providers in your area covered under your current plan

Art projects: Doing creative activities such as coloring or drawing can you help focus your attention on the pleasure of creating something beautiful and distract your brain from pain.

Music: Listen to relaxing music or nature sounds to decrease pain and improve mood.

Positive thoughts or self-talk: Think positive thoughts to help you cope with pain. Remind yourself that you are strong, and the pain will not last forever.

Gratitude list: List things you are thankful for. Focus on these when in pain.

Learn something new: Distract yourself by learning new things. Watch educational videos or listen to podcasts.

Letting go and letting in: Letting go of fear and pain takes courage. Pain is a natural defense mechanism. Our nervous system can get stuck in the pain pathway. Ask about cognitive behavioral therapy (CBT) to learn to live fully, even with pain.

Reviewed July 2024 by Christina Szperka MD, MSCE and Lisa Squires RN, BSN, CCRN-K, HNB-BC