Paeoniflorin is a major bioactive compound found in the root of Paeonia lactiflora, commonly used in Traditional Chinese Medicine (TCM). Historically, formulations containing peony root have been used for ailments including headache, particularly those attributed to "Qi stagnation" and "blood deficiency," which may align with Western concepts of tension-type headaches. These uses are documented in classical TCM texts, where peony-based formulas such as Shaoyao Gancao Tang (Peony and Licorice Decoction) are recommended for alleviating various pain syndromes, including headache and muscle tension.

Modern scientific studies on paeoniflorin’s effect specifically on tension-type headaches are limited. There is some preclinical evidence suggesting that paeoniflorin possesses anti-inflammatory, antispasmodic, and analgesic properties, which could theoretically benefit headache sufferers. However, clinical trials directly evaluating paeoniflorin or peony root extracts in the treatment of tension headaches are lacking. The available evidence is therefore primarily traditional, supported by long-standing empirical use in East Asian medicine rather than robust clinical validation.

In summary, paeoniflorin’s use for tension-type headache is justified mainly by traditional practice, with a low-to-moderate level of supporting evidence due to a lack of targeted scientific studies.