Tension Headaches

In many ways tension headaches (or tension-type headaches) are the most ignored of all the headache types. Tension headaches are usually dull (not sharp or throbbing) or they may feel achy or pressure-like. They usually involve the whole head, or at least both sides of the head. They aren't typically severe (like migraine or cluster headaches) and as a result, unless they occur on a daily or near-daily basis, they rarely cause a person to seek medical help. Almost everyone has had a tension headache in his/her life. To be sure you shouldn't be worried about your headaches, click the worrisome symptoms link on the left side of this page.

Treatment of Tension Headaches

Many medications that are used to treat other sources of pain in the body are helpful in treating tension headaches. This includes non-steroidal antinflammatory drugs (NSAIDS) such as ibuprofen (Motrin,Advil), naproxen (Naprosyn, Aleve). Acetaminophen(Tylenol) may also be effective. If these are not effective enough, combination medications like Fioricet and Fiorinal (which also contain caffeine) can be used. You need to be careful with these medications, not only to avoid exceeding their recommended dosages, but also to prevent the development of rebound headaches.

Prevention Using Medications

If headaches are frequent or even daily, then you should focus on prevention. Some medications, taken daily, may be helpful. I typically start a person on a tricyclic antidepressant such as amitriptyline, starting out at a low dose (10mg at bedtime)and gradually increasing the dose until significant headache relief occurs. Headaches may improve in two ways. First they may become much less frequent or go away completely. Second, they may become less severe or be much easier to treat with over-the-countermedications. Other options for treatment include muscle relaxants (such as tizanidine)or SSRI medications (also used for depression, such as Prozac or Zoloft).

Prevention without medications

I generally advise patients to avoid bad habits which may make headaches more likely. This includes smoking, skipping meals, and drinking an excessive amount of alcohol.

Things to emphasize in your life are getting regular and sufficient sleep, regular exercise, and avoiding stress to the degree possible.

Anxiety and depression make headaches more likely to occur and treating these is also a good idea. This includes psychological counseling, relaxation therapy, stress management, and taking medications to help treat these conditions. Biofeedbackwith an emphasis on muscle relaxation may also be helpful.

Special Topics

Tension Headaches in Adolescents

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