Sauna for chronic tension-type headache
Evidence review
Overview
In a New Zealand randomized trial, adults with chronic tension-type headache who used a sauna regularly for 8 weeks in addition to advice and education had a greater reduction in headache intensity than those receiving advice alone. Headache duration, sleep, depression and headache disability did not differ between groups. The trial has not been replicated.
Key findings
- Headache intensity (NPRS) change differed by 1.27 points (95% CI 0.48-2.07; p=0.002) favoring sauna (Kanji 2015)
- No significant difference in headache duration, sleep, depression or Headache Disability Index (Kanji 2015)
Every study we reviewed
1 mixed results
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 2 studies on headache, across all heat and cold therapies, including case reports and older work not graded here.
Efficacy of regular sauna bathing for chronic tension-type headache: a randomized controlled study.
Kanji G et al. J Altern Complement Med. 2015. PubMed 25636135 · DOI
- Who
- Adults meeting International Headache Society criteria for chronic tension-type headache (New Zealand)
- What
- Regular sauna attendance plus advice/education (n=17) vs advice/education alone (n=20)
- Protocol
- 8 wk
- Measured
- Headache intensity (numerical pain rating scale); duration, sleep, depression, Headache Disability Index
- Result
- Mean change in headache intensity differed by 1.27 (95% CI 0.48-2.07; p=0.002) favoring sauna; no significant differences in duration, sleep, depression or HDI
- Limitations
- Small single trial; unblinded; secondary outcomes null; protocol details not in abstract
Protocols used in the studies
Regular sauna bathing over 8 weeks added to advice and education; temperature, session length and frequency are not reported in the abstract.
What is still unknown
Unreplicated; optimal protocol, durability after stopping, and mechanism are unknown; no data in migraine.
Safety
Cautions for sauna in this condition
- General contraindications include unstable angina, recent myocardial infarction and severe aortic stenosis; alcohol during sauna use increases risk of hypotension, arrhythmia and sudden death (PMID 11165553).
- Evidence applies to tension-type headache only; it should not be extrapolated to migraine, for which no sauna trial was found.
For clinicians
Suggested rationale
A randomized trial found that regular sauna bathing for 8 weeks reduced headache intensity by about 1.3 points on a 0-10 scale in chronic tension-type headache compared with advice alone (Kanji 2015), without change in headache duration or disability.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: G44.229, G44.221. Examples only; the clinician assigns the code.
What a letter of medical necessity should containWho can write it: physicians, NPs, PAs and others