Tension headache

Diagnosis

If you have regular headaches, your health care professional may give you a physical and a neurological exam. Your care professional works to pinpoint the type and cause of your headaches using these approaches.

Your pain description

Your doctor can learn a lot about your headaches from the information you provide about the pain. Be sure to include these details:

• Pain description. Is the pain throbbing? Is it constant and dull? Is it sharp or stabbing?
• Pain intensity. A good indicator of pain intensity is how much you're able to do during the headache. Are you able to work? Do headaches wake you or prevent you from sleeping?
• Pain location. Do you feel pain all over your head? Is the pain on one side of your head? Or is the pain only on your forehead or behind your eyes?

Imaging tests

Your doctor may order tests to rule out serious causes of head pain, such as a tumor. Two common imaging tests include:

• Magnetic resonance imaging (MRI). An MRI scan is done using a powerful magnet and computer-generated radio waves to create images of your brain.
• Computerized tomography (CT). A CT scan combines a series of X-ray images taken from different angles. It creates cross-sectional images to provide a detailed view of your brain.

Treatment

Some people with tension-type headaches don't see a health care professional and try to treat the pain on their own. But repeated use of pain relievers available without a prescription can cause another type of headache known as medication overuse headache. Your health care professional can work with you to find the right treatment for your headaches.

Medicines to take during a tension-type headache

Several medicines can help reduce the pain of a headache. They include medicines you can buy at the store without a prescription and medicines available with a prescription.

• Pain relievers. Pain relievers available without a prescription are usually the first line of treatment for reducing headache pain. These include aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
• Combination medicines. Aspirin, acetaminophen (Tylenol, others) or both are often combined with caffeine or a sedative in a single medicine. Combination medicines may be more effective than single-ingredient pain relievers. Many combination medicines are available without a prescription.
• Triptans. For people who experience both migraines and episodic tension-type headaches, a triptan can effectively relieve the pain of both headaches.

Prescription opioids are rarely used because of their side effects and potential for dependency.

Preventive medicines

Your health care professional may prescribe medicines that help you have fewer headaches or headaches that are less painful. Preventive medicines may help if you have regular headaches that aren't relieved by pain medicine and other therapies.

Preventive medicines may include:

• Tricyclic antidepressants. Tricyclic antidepressants are the most commonly used medicines to prevent tension-type headaches. They include amitriptyline, nortriptyline (Pamelor) and protriptyline. These medicines can cause side effects such as constipation, drowsiness and dry mouth.
• Other antidepressants. The antidepressants venlafaxine (Effexor XR) and mirtazapine (Remeron) also can help prevent tension-type headaches.
• Anti-seizure medicines and muscle relaxants. The anti-seizure medicines gabapentin (Gralise, Horizant, Neurontin) and topiramate (Topamax, Qsymia, others) may help prevent headache pain. But more study is needed to understand how well they work to prevent tension-type headaches. The muscle relaxant tizanidine (Zanaflex) also can be used for prevention.

It can take several weeks or more for preventive medicines to build up in your system and take effect.

Your health care professional monitors your treatment to see how the preventive medicine is working. In the meantime, overusing pain relievers may interfere with the effects of the preventive medicines. Ask your health care professional about how often to use pain relievers while you're taking preventive medicine.

Alternative medicine

These nontraditional therapies may help if you have tension-type headache pain:

• Acupuncture. Acupuncture may provide temporary relief from chronic headache pain. Acupuncture involves using very thin, disposable needles that generally cause little pain or discomfort. Acupuncture is typically safe when performed by an experienced acupuncturist who follows safety guidelines and uses sterile needles.
• Massage. Massage can help reduce stress and relieve tension. It's especially effective for relieving tight, tender muscles in the back of the head, neck and shoulders. For some people, it may also provide relief from headache pain.
• Deep breathing, biofeedback and behavior therapies. These techniques and therapies can be useful for coping with tension-type headaches.

Lifestyle and home remedies

Rest, ice packs or a long, hot shower may be all you need to relieve a tension-type headache. If you experience chronic tension-type headaches, these strategies can help you reduce how many you have or how painful they are:

• Manage your stress level. One way to help reduce stress is by planning ahead and organizing your day. Another way is to allow more time to relax.
• Go hot or cold. Applying heat or ice — whichever you prefer — to sore muscles may ease a tension-type headache. For heat, use a heating pad set on low, a hot-water bottle, a warm compress or a hot towel. A hot bath or shower also may help. For cold, wrap ice, an ice pack or frozen vegetables in a cloth to protect your skin.
• Perfect your posture. Good posture can help keep your muscles from tensing. When standing, hold your shoulders back and your head level. Pull in your abdomen and buttocks. When sitting, make sure your thighs are parallel to the ground and your head isn't slumped forward.

Coping and support

Chronic pain can cause anxiety and depression. It also can affect your relationships, your productivity and the quality of your life.

Here are some suggestions:

• Talk to a counselor or therapist. Talk therapy may help you cope with the effects of chronic pain.
• Join a support group. Support groups can be good sources of information and a source of comfort. Group members often know about the latest treatments. Your health care provider may be able to recommend a group in your area.

Preparing for your appointment

You may start by seeing your health care professional. Or you may be referred to a specialist with expertise in the nervous system, known as a neurologist.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins or other supplements you take, including the doses.
• Questions to ask your health care professional.

Take a family member or friend along, if possible, to help you remember the information you're given.

For tension-type headaches, some basic questions to ask your health care professional include:

• What's likely causing my symptoms?
• Other than the most likely cause, what are other possible causes for my symptoms?
• What tests do I need?
• Is my condition likely temporary or chronic?
• What's the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care professional may ask you several questions, such as:

• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Avoid doing anything that seems to worsen your symptoms.