If you have chronic or recurrent headaches, your doctor may conduct physical and neurological exams, then try 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 a description of your pain. Be sure to include these details:
- Pain characteristics. Does your pain pulsate? Or is it constant and dull or sharp or stabbing?
- Pain intensity. A good indicator of the severity of your headache is how much you're able to function while you have it. Are you able to work? Do your headaches wake you or prevent you from sleeping?
- Pain location. Do you feel pain all over your head, on only one side of your head, or just on your forehead or behind your eyes?
If you have unusual or complicated headaches, your doctor may order tests to rule out serious causes of head pain, such as a tumor. Two common tests that can be used to image your brain include:
- Magnetic resonance imaging (MRI). An MRI scan combines a magnetic field, radio waves and computer technology to produce clear images.
- Computerized tomography (CT). A CT scan is a diagnostic imaging procedure that uses a series of computer-directed X-rays to provide a comprehensive view of your brain.
Some people with tension-type headaches don't seek medical attention and try to treat the pain on their own. Unfortunately, repeated use of pain relievers that are available without a prescription can actually cause another type of headache, medication overuse headache.
A variety of medications, both nonprescription and prescription, are available to reduce the pain of a headache, including:
- Pain relievers. Simple pain relievers available without a prescription are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
- Combination medications. Aspirin or acetaminophen (Tylenol, others) or both are often combined with caffeine or a sedative drug in a single medication. Combination drugs may be more effective than single-ingredient pain relievers. Many combination drugs are available without a prescription.
- Triptans and narcotics. For people who experience both migraines and episodic tension-type headaches, a triptan can effectively relieve the pain of both headaches. Opioids, or narcotics, are rarely used because of their side effects and potential for dependency.
Your doctor may prescribe medications to reduce the frequency and severity of attacks, especially if you have frequent or chronic headaches that aren't relieved by pain medication and other therapies.
Preventive medications may include:
- Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and protriptyline, are the most commonly used medications to prevent tension-type headaches. Side effects of these medications may include constipation, drowsiness and dry mouth.
- Other antidepressants. Evidence also supports the use of the antidepressants venlafaxine (Effexor XR) and mirtazapine (Remeron).
- Anticonvulsants and muscle relaxants. Other medications that may prevent tension-type headaches include anticonvulsants, such as gabapentin and topiramate (Topamax, Qsymia, others). More study is needed.
Preventive medications may require several weeks or more to build up in your system before they take effect. So don't get frustrated if you haven't seen improvements shortly after you begin taking a drug.
Your doctor will monitor your treatment to see how the preventive medication is working. In the meantime, overuse of pain relievers for your headaches may interfere with the effects of the preventive drugs. Ask your doctor about how often to use pain relievers while you’re taking preventive medication.
Lifestyle and home remedies
Rest, ice packs or a long, hot shower may be all you need to relieve a tension-type headache. A variety of strategies can help you reduce the severity and frequency of chronic tension-type headaches without using medicine. Try some of the following:
- 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. And if you're caught in a stressful situation, consider stepping back.
- 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.
The following nontraditional therapies may help if you have tension-type headache pain:
- Acupuncture. Acupuncture may provide temporary relief from chronic headache pain. Acupuncture practitioners treat you using extremely 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 your head, neck and shoulders. For some people, it may also provide relief from headache pain.
- Deep breathing, biofeedback and behavior therapies. A variety of relaxation therapies are useful in coping with tension-type headaches, including deep breathing and biofeedback.
Coping and support
Living with chronic pain can be difficult. Chronic pain can make you anxious or depressed and 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. Group members often know about the latest treatments. Your doctor may be able to recommend a group in your area.