Tension-Type Headaches

What Are Tension Headaches?

Tension-type headaches (TTH) are the most common type of headache, affecting up to 80% of people at some point. They cause a dull, aching pain often described as a band tightening around the head. While usually mild to moderate, they can become chronic and significantly impact quality of life.¹

Types²

Episodic

Less than 15 days per month
Can be infrequent or frequent
More easily treated

Chronic

15+ days per month for 3+ months
More difficult to treat
May evolve from episodic

Symptoms³

Dull, aching head pain
Sensation of tightness or pressure
Both sides of head affected
Mild to moderate intensity
Not worsened by routine activity
May have mild light or sound sensitivity
No nausea or vomiting (unlike migraine)

Triggers

Stress and anxiety
Poor posture
Eye strain
Jaw clenching
Lack of sleep
Skipped meals
Dehydration
Muscle tension

Treatment

Acute

OTC pain relievers (acetaminophen, ibuprofen)
Limit to 2 days per week (prevent medication overuse)
Rest in quiet, dark room
Hot or cold compress

Preventive

Tricyclic antidepressants (amitriptyline)
Other antidepressants
Muscle relaxants (sometimes)

Non-Drug Approaches

Stress management
Physical therapy
Biofeedback
Relaxation techniques
Acupuncture
Massage

Prevention

Manage stress
Regular sleep schedule
Good posture
Regular meals
Stay hydrated
Regular exercise
Take breaks from screens

Medication Overuse Warning

Frequent pain reliever use can worsen headaches
Can lead to "rebound" or medication overuse headache
Limit acute medications to 2 days/week
Preventive treatment better for frequent headaches

References

Bendtsen L, Jensen R. Tension-type headache: the most common, but also the most neglected, headache disorder. Curr Opin Neurol. 2006;19(3):305-309.
Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008;7(1):70-83.