Tension-Type Headaches

What Are Tension-Type Headaches?

Tension-type headaches (TTH) are the most common primary headache disorder, affecting up to 80% of people at some point. They cause a pressing or tightening sensation, often described as a "band around the head."¹

Types

• Episodic - Less than 15 days per month
• Chronic - 15 or more days per month for 3+ months

Symptoms²

• Pressing or tightening quality (not throbbing)
• Mild to moderate intensity
• Both sides of head affected
• Not worsened by physical activity
• No nausea or vomiting
• May have sensitivity to light OR sound (not both)
• Can last 30 minutes to 7 days

Triggers and Contributing Factors

• Stress and anxiety
• Poor posture
• Eye strain
• Jaw clenching
• Skipped meals
• Dehydration
• Poor sleep
• Depression

Treatment³

Acute Treatment

• Simple analgesics (acetaminophen, NSAIDs)
• Limit to 2-3 days per week to avoid medication overuse
• Caffeine combinations (use cautiously)

Preventive Treatment (for chronic)

• Amitriptyline (first-line)
• Other antidepressants
• Physical therapy
• Stress management

Non-Drug Approaches

• Regular exercise
• Stress management
• Improve posture
• Regular sleep schedule
• Relaxation techniques
• Massage
• Acupuncture

When to See a Doctor

• Sudden severe headache
• Headache pattern changes
• Frequent headaches
• Headaches not responding to treatment
• Need pain medication most days

References

1. Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache. Cephalalgia. 2007;27(3):193-210.
2. Headache Classification Committee. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
3. Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headache. Eur J Neurol. 2010;17(11):1318-1325.