Tension-type headache (ICD-10: R51) is one of the most prevalent primary headache disorders globally, primarily induced by persistent psychological stress and emotional dysregulation. This condition arises from prolonged involuntary contraction of the skeletal muscles and vascular smooth muscles in the craniofacial, cervical, and shoulder regions, resulting in chronic, persistent cranial pressure pain and soft tissue tension.
Chronic psychological stressors, including long-term worry, persistent nervous tension, and chronic anxiety, trigger sustained tonic spasm of the cervical, cranial, and shoulder musculature. Continuous muscle contraction stimulates the release of endogenous pain mediators, such as lactic acid, bradykinin, serotonin, potassium, and phosphorus, which accumulate in local soft tissues. Meanwhile, persistent muscular spasms compress superficial blood vessels, impair peripheral microcirculation, and hinder metabolic waste excretion. The progressive buildup of pain-causing metabolites irritates cutaneous and muscular nerve endings, ultimately leading to recurrent and chronic tension-type headache.
Clinical Diagnostic Criteria
Clinically, tension-type headache has a higher incidence in female patients aged 30 years and older. Pain symptoms typically initiate in the cervical and temporal regions, presenting as stable mild-to-moderate dull pain with classic manifestations of cranial pressure, heaviness, distension, and band-like tightness around the head. Unlike migraine, this headache is continuous rather than paroxysmal, with symptomatic duration ranging from several days and weeks to months, easily developing into chronic persistent headache.
In chronic progressive cases, patients frequently develop obvious tenderness and soreness at the exit of the greater occipital nerve in the cervical, shoulder, and occipital regions. The subcutaneous soft tissues of the neck become tense and sclerotic, with palpable hard nodules and localized tenderness upon gentle pinching. Neck flexion and extension movements may induce or aggravate headache symptoms in partial patients, which is commonly associated with underlying cervical muscle strain and cervical spondylosis.
Standard Acupuncture Therapy for Tension Headache
Acupuncture for tension-type headache is a safe, non-invasive, and clinically verified TCM therapeutic approach. Standardized WHO acupoint stimulation effectively relieves cervicocranial muscle spasm, improves local blood microcirculation, accelerates the metabolism and excretion of pain mediators, alleviates nerve tension, and treats stress-induced chronic headache at the source with stable and lasting efficacy.
Standard Acupoints and Needling Protocol (WHO Standard)
1. Taiyang (EX-HN5, Bilateral)
Location: A depression approximately 25 mm posterior to the midpoint between the lateral eyebrow tip and the outer canthus.
Needling Method: Adopt two 30-gauge, 2-inch filiform needles. After standard aseptic skin disinfection, perform oblique insertion at a depth of 45 millimeters toward the Shuaigu (GB8) acupoint.
Needling Sensation: Local temporal distension and soreness.
2. Shuaigu (GB8, Bilateral)
Location: Approximately 40 mm vertically above the ear apex, within the hairline.
Needling Method: Adopt two 30-gauge, 1.5-inch filiform needles. After local aseptic disinfection, implement horizontal subcutaneous needling at a depth of 33 millimeters toward the occipital region.
Needling Sensation: Local distending soreness.
3. Fengchi (GB20, Bilateral)
Location: Bilateral depressions between the upper attachments of the sternocleidomastoid and trapezius muscles, level with Fengfu (GV16).
Needling Method: Use two 30-gauge, 2-inch filiform needles. After standard disinfection, insert obliquely 40 mm toward the spinal column.
Needling Sensation: Local cervical distension and soreness, with possible radiating tingling sensation extending to the ipsilateral occipital and temporal regions.
4. Neiguan (PC6, Bilateral)
Location: Located approximately 40 millimeters proximal to the palmar wrist crease, between the palmaris longus tendon and flexor carpi radialis tendon.
Needling Method: Adopt two 30-gauge, 1.5-inch filiform needles. After routine aseptic disinfection, perform perpendicular insertion at a depth of 33 millimeters toward the Waiguan (SJ5) acupoint.
Needling Sensation: Local forearm distension and soreness, with radiating numbness extending toward the dorsum of the hand and middle finger.
Standard Clinical Treatment Protocol
Patients are required to maintain a seated position during the entire treatment process. All selected acupoints are needled in accordance with standardized aseptic operating specifications. Needles are retained for 40 minutes per session, with one manual reinforcing and reducing manipulation performed during the retention period to enhance therapeutic stimulation.
Treatment is administered once daily. A complete therapeutic course consists of 6 consecutive sessions, with a 3-day rest interval before commencing the next treatment course.
Clinical Effect Analysis & Medical Notes
Acupuncture therapy delivers prominent curative effects on tension-type headache. The majority of patients with early-stage tension headache achieve significant symptomatic relief or complete pain resolution within 3 to 5 standardized acupuncture sessions.
For chronic patients with persistent tension headache lasting for several years, obvious tender points and muscular pain nodules can be detected in the cervical and shoulder soft tissues. Combining the above core acupoints with targeted local tender point needling can optimize therapeutic effects. Although chronic intractable cases require longer treatment cycles, standardized TCM acupuncture treatment can effectively relax stiff muscles, eliminate pathological nodules, unblock microcirculation, and achieve favorable long-term recovery outcomes.