Treatment of tension-type headache remains very challenging. In addition to conventional therapies, alternative methods such as physical therapy, acupuncture, and botulinum toxin have been studied. In this article, recent literature is reviewed and discussed and challenges for the evaluation of these approaches are considered. Although the clinical evidence is still incomplete, certain treatments are promising and the active ongoing research hopefully will soon yield more answers. Of note, the specific issue of psychologic therapy is dealt with elsewhere in this issue.