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Deep Dive

Almost always effective: PMR for tension headaches

 

Developed by American doctor and psychologist Edmund Jacobson, progressive muscle relaxation (PMR) is a valuable tool for headache sufferers. As described previously in this article, numerous studies have shown that this dedicated relaxation technique is a great way to help prevent migraine attacks. And as it turns out, PMR is extremely effective for tension headaches too.

 

Autonomy through headache prevention

Headaches are some of the most disabling conditions of all. Nearly everyone gets a headache at some point, but some people get them all the time and their quality of life suffers as a result. Migraine and tension-type headaches alone account for about 92% of primary headache disorders. Preventive measures can significantly reduce or even eliminate both types of headache, while significantly reducing the need for medication.

Feeling helpless against headaches adds to the pain and worsens the burden for many people. Conversely, knowing that there are things you can do to control your headaches gives back a sense of autonomy. For sustained, effective headache prevention, managing your personal stress levels is crucial. Stress is a major trigger for both migraines and tension headaches, and a major factor in determining whether headaches become chronic.

 

Beating stress with PMR

Progressive muscle relaxation (PMR) is all about learning to relax your entire body and enter a state of deep relaxation, making you significantly better at coping with stress. The deliberate tensing and relaxing of different muscle groups also improves your body awareness, which can lead to greater mindfulness toward your body. Headache Hurts has a slimmed-down ten-minute version of the exercise that’s easy to fit in during a break at uni or after you get home. (Find it on the app and website).

 

Effective and easy to use: studies prove it

Progressive muscle relaxation was primarily used in the 1970s as a preventive measure to manage migraines. Then, a meta-analysis published in 1980 showed that the method is effective against tension headaches, too – particularly so, in fact. A review of nine different studies revealed that PMR led to an almost 60% improvement in headache symptoms compared to the control group.

Another study in 1982 confirmed that progressive muscle relaxation is effective in preventing tension headaches, again concluding that a reduction in symptoms of more than 50% was achievable. When a method achieves this level of effectiveness and meets certain statistical criteria, the result is termed "clinically significant.” This means the level of effectiveness is so high that patients typically experience a dramatic improvement.

Later in the 1980s, a team led by scientist Ruth Hyman reviewed 48 studies on the effects of relaxation techniques on various health issues in a number of areas. Hyman’s research found that the most successful techniques were meditation and progressive muscle relaxation, with PMR being particularly effective for headaches and high blood pressure. PMR was highlighted as being suitable for treatment and prevention across a wide age range, benefiting everyone from students to the elderly.

 

New insights: PMR for better sleep

A 2021 study examined the effects of progressive muscle relaxation and breathing exercises on chronic tension headaches over a 12-week period. At the start of the study, all the patients said their headaches were severely interfering with their lives. Since the subjects also reported significant sleep problems because of their headaches, the study also measured the impact of the techniques on sleep quality. Headaches and sleep issues often occur together and worsen each other, a well-known phenomenon with a devastating impact. Poor sleep is a classic headache trigger. In turn, severe headaches cause sleep problems, creating a vicious cycle.

This is what the study showed: at each assessment during the PMR program (at 4, 8 and 12 weeks), participants experienced a significant reduction in both the severity and frequency of their headaches. At the start, all participants reported poor sleep quality, which the control group still experienced at 97% after 12 weeks. However, among those practicing progressive muscle relaxation, this figure was halved – a significant improvement.

 

A relaxed brain performs better

Beyond the effects we’ve already looked at, PMR has other astounding effects likely to benefit practitioners of the method. An experimental study at the University of St. Augustine in Florida demonstrated that medical students who used this technique were not only calmer during a battery of tasks but also performed better than subjects in the control group. The authors speculate that the relaxed participants benefited from improved recall. Beyond the collected data, the researchers suggest numerous positive impacts of relaxation techniques on various quality of life aspects, whether precisely measurable or not.

  • Álvarez-Melcón AC, Valero-Alcaide R, Atín-Arratibel MA, Melcón-Álvarez A, Beneit-Montesinos JV. Effects of physical therapy and relaxation techniques on the parameters of pain in university students with tension-type headache: A randomised controlled clinical trial. Neurologia (Engl Ed). 2018 May;33(4):233-243. English, Spanish. doi: 10.1016/j.nrl.2016.06.008. Epub 2016 Aug 1. PMID: 27491303.

    Anderson RE, Seniscal C. A comparison of selected osteopathic treatment and relaxation for tension-type headaches. Headache. 2006 Sep;46(8):1273-80. doi: 10.1111/j.1526-4610.2006.00535.x. PMID: 16942472.

    Arena JG, Hightower NE, Chong GC. Relaxation therapy for tension headache in the elderly: a prospective study. Psychol Aging. 1988 Mar;3(1):96-8. doi: 10.1037//0882-7974.3.1.96. PMID: 3077319.

    Blanchard EB, Andrasik F, Neff DF, Arena JG, Ahles TA, Jurish SE, Pallmeyer TP, Saunders NL, Teders SJ, Barron KD, Rodichok LD. Biofeedback and relaxation training with three kinds of headache: treatment effects and their prediction. J Consult Clin Psychol. 1982 Aug;50(4):562-75. doi: 10.1037//0022-006x.50.4.562. PMID: 6749918.

    Blanchard EB, Appelbaum KA, Radnitz CL, Michultka D, Morrill B, Kirsch C, Hillhouse J, Evans DD, Guarnieri P, Attanasio V, et al. Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache. J Consult Clin Psychol. 1990 Apr;58(2):210-5. doi: 10.1037//0022-006x.58.2.210. PMID: 2186066.

    Gopichandran L, Srivastsava AK, Vanamail P, Kanniammal C, Valli G, Mahendra J, Dhandapani M. Effectiveness of Progressive Muscle Relaxation and Deep Breathing Exercise on Pain, Disability, and Sleep Among Patients With Chronic Tension-Type Headache: A Randomized Controlled Trial. Holist Nurs Pract. 2021 May 28. doi: 10.1097/HNP.0000000000000460. Epub ahead of print. PMID: 34054116.

    Hubbard KK, Blyler D. Improving Academic Performance and Working Memory in Health Science Graduate Students Using Progressive Muscle Relaxation Training. Am J Occup Ther. 2016 Nov/Dec;70(6):7006230010p1-7006230010p8. doi: 10.5014/ajot.2016.020644. PMID: 27767946.

    King HH. Recognizing the Value of Manual Therapy Interventions for Head Pain. J Am Osteopath Assoc. 2017 Jan 1;117(1):60-62. doi: 10.7556/jaoa.2017.013. PMID: 28055094.

    Lardon A, Girard MP, Zaïm C, Lemeunier N, Descarreaux M, Marchand AA. Effectiveness of preventive and treatment interventions for primary headaches in the workplace: A systematic review of the literature. Cephalalgia. 2017 Jan;37(1):64-73. doi: 10.1177/0333102416636096. Epub 2016 Sep 29. PMID: 26935099.

    Mongini F, Ciccone G, Rota E, Ferrero L, Ugolini A, Evangelista A, Ceccarelli M, Galassi C. Effectiveness of an educational and physical programme in reducing headache, neck and shoulder pain: a workplace controlled trial. Cephalalgia. 2008 May;28(5):541-52. doi: 10.1111/j.1468-2982.2008.01551.x. Epub 2008 Mar 3. PMID: 18318746.

    Mongini F, Evangelista A, Milani C, Ferrero L, Ciccone G, Ugolini A, Piedimonte A, Sigaudo M, Carlino E, Banzatti E, Galassi C. An educational and physical program to reduce headache, neck/shoulder pain in a working community: a cluster-randomized controlled trial. PLoS One. 2012;7(1):e29637. doi: 10.1371/journal.pone.0029637. Epub 2012 Jan 9. PMID: 22253751; PMCID: PMC3253792.

    Mongini F, Evangelista A, Rota E, Ferrero L, Ugolini A, Milani C, Ceccarelli M, Joffrain L, Ciccone G, Galassi C. Further evidence of the positive effects of an educational and physical program on headache, neck and shoulder pain in a working community. J Headache Pain. 2010 Oct;11(5):409-15. doi: 10.1007/s10194-010-0231-2. Epub 2010 Jun 20. PMID: 20563879; PMCID: PMC3452277.

    Regehr, C. et al.: Interventions to reduce stress in university students: A review and meta-analysis, Journal of Affective Disorders 148, 1–11, 2013

    Robb, S. et al.: Music Assisted Progressive Muscle Relaxation, Progressive Muscle Relaxation, Music Listening, and Silence: A Comparison of Relaxation Techniques, Journal of Music Therapy, XXXVII (1), 2-21, 2000, https://doi.org/10.1093/jmt/37.1.2

    Rota E, Evangelista A, Ceccarelli M, Ferrero L, Milani C, Ugolini A, Mongini F. Efficacy of a workplace relaxation exercise program on muscle tenderness in a working community with headache and neck pain: a longitudinal, controlled study. Eur J Phys Rehabil Med. 2016 Aug;52(4):457-65. Epub 2016 Jan 8. PMID: 26745361.

    Turkistani A, Shah A, Jose AM, Melo JP, Luenam K, Ananias P, Yaqub S, Mohammed L. Effectiveness of Manual Therapy and Acupuncture in Tension-Type Headache: A Systematic Review. Cureus. 2021 Aug 31;13(8):e17601. doi: 10.7759/cureus.17601. PMID: 34646653; PMCID: PMC8483450.

    Victoria Espí-López G, Arnal-Gómez A, Arbós-Berenguer T, González ÁAL, Vicente-Herrero T. Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review. J Jpn Phys Ther Assoc. 2014;17(1):31-38. doi: 10.1298/jjpta.Vol17_005. PMID: 25792906; PMCID: PMC4316547.

     

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