Tension Headaches

Remember the most common type of headache is a tension headache. Tension headaches are due to tight muscles in your shoulders, neck, scalp and jaw. They are often related to stress, depression, anxiety, lock of sleep, missed meals or use of alcohol. Other common types of headaches include migraines, cluster headaches and sinus headaches.

Tension Type Headaches

 This is the most common type of headache with the clinical features as: 

  • Constant pain spreading all over the skull  
  • Pain radiating forward from the occipital region 
  • Feeling ‘dull’, ‘tight’ or like pressure. 
  • Sometimes, continuous pain for weeks without interruption 
  • The severity of pain varies individually. 
  • There is no photophobia. 
  • No complaint of vomiting 
  • Pain increases as the day goes on. 


Diagnosis of tension headache is mainly clinical.  Your doctor can diagnose your headache from a description of your pain. Therefore, never forget to include all the details,  such as pain characteristics, pain intensity, pain site, etc. In most cases, your physician will diagnose tension headache based upon the above clinical feature. However, he may run some imaging tests in certain cases to rule out an underlying serious problem. Following are the most important imaging tests in this regards: 

  1. MRI (Magnetic Resonance Imaging) Brain 
  2. CT (Computed Tomography) Scan Brain 


Management of this type of pain is mainly based on discussion with patients about the causes of this type of disease and the explanation that this is not a serious disease. Many medications both OTC and prescription, are available to reduce the cluster headache, including:

  • Pain relievers: Simple over-the-counter (OTC)  pain relievers are the first line of treatment for tension headache. These OTC medications include aspirin, naproxen, and ibuprofen. 
  • Prescribed drugs for tension headaches include naproxen, ketorolac and indomethacin. 
  • Combination drugs: Aspirin or acetaminophen or both can be combined with caffeine or a sedative drug to form a single medication. These drugs can be more effective. Some of these combinations are available over the counter.  
  • Triptans can be used in persons suffering from both migraines and episodic tension headaches because they are effective against the pain of both headaches. 

Preventive medications:

Your doctor may advise you on some medications to minimize the frequency and intensity of tension headache. This is especially important when you suffer from frequent or chronic headaches that aren’t easy to go away. Preventive medicines include:  

  • Tricyclic antidepressants such as amitriptyline and protriptyline, are widely used drugs to prevent tension headaches. Beware of the side effects of the drugs. 
  • Anticonvulsants and muscle relaxant such as Topiramate may prevent tension headaches.

Preventive medications can take several weeks or more to build up in your body before they take effect. So, you have to wait before seeing their effects. 


  • Rest
  • Ice packs 
  • Adopt coping strategies to manage your stress
  • Maintain a good posture.

Alternative treatments:

The following alternative treatment options may help:

  • Acupuncture
  • Gentle massage 
  • Deep breathing
  • Biofeedback
  • Behavioral therapies