An analysis of 119 randomized controlled clinical trials showed that more than a third of subjects who received placebo or no treatment recovered from their headaches, although the recovery rate varied between types of intervention and patients.

Pharmacologic treatment of headaches typically starts when lifestyle changes, relaxation therapy, cognitive therapy and other nondrug approaches fail. Many of the prescribed or OTC drugs can lead to adverse events and even medication-overuse headaches.

“The prescription of medication needs to be carefully considered and evaluated with each individual patient,” investigators noted in the Journal of Manipulative and Physiological Therapeutics. “The question rises whether or not this way of prescription is always preferable over no treatment (wait and see), especially in the [tension-type headache] population.”

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The trials centered on tension-type headaches and migraines, and involved 7,119 participants. The mean recovery rate in all control groups was 35.7%. More control subjects recovered in pharmacological vs. nonpharmacologic (behavioral) trials (38.5% vs. 15.0%, respectively), but adults were more likely to recover in nonpharmacologic studies and children in pharmacologic studies.

de Groot FM et al. J Manipulative Physiol Ther. 2011;34:297-305