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Young woman with tension headache

6 Top Symptoms of Tension Headaches and How to Treat Them

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Tension-type headache is the most common headache and the most prevalent neurological disorder. The cause of this type of headache remains uncertain.

The name is a misnomer due to the original attribution of tension headaches to tension and stress. Stress can trigger these headaches but is not the underlying cause.

Symptoms of a tension headache

  1. Symptoms are usually mild to moderate
  2. Symptoms affect both sides of the head, either in the front, top or back of the head and can radiate to the neck
  3. Pain is usually not throbbing
  4. Pain may be band-like, squeezing, dull, pressure-like, like a tight cap, head pressure, head fullness or simply the head does not feel right
  5. Symptoms usually don’t include nausea, vomiting, light sensitivity or noise sensitivity
  6. Symptoms aren’t aggravated by activity or head movement

Patients can have both migraine headaches and tension headaches.

Tension-type headache diagnosis is purely clinical and relies upon the patient’s description. There are no diagnostic tests for tension-type headaches.


Management of this type of headache is difficult and should be individualized. A combination of methods can be used to make living with this type of headaches more manageable.

Nonpharmacologic (with no medications) management is typically the first line and includes avoiding triggers, regulation of sleep, exercise, hydration and meals, cognitive behavioral therapy, biofeedback, self-hypnosis, relaxation, yoga, deep breathing and physical and occupational therapy.

As-needed over-the-counter medications can be used but must be limited to no more than two times a week to avoid rebound, medication-overuse headaches and the vicious cycle of chronic daily headaches.

The use of sedative medications like antihistamines, barbiturates (butabital) and opiates (narcotics) are not recommended. Such medications worsen tension-type headaches and cause ongoing daily headaches.

Preventive medications need to be considered when tension-type headache attacks occur more than two days a week. The goal of preventative treatment is 50% reduction in severity and frequency of these attacks. Complete elimination of tension-type headaches is currently not possible, unfortunately. The most effective medications are antidepressants. First-, second- and third-line preventive medications are amitriptyline, mirtazapine and venlafaxine, respectively. Please note that antidepressants are not addictive and, as many other medications, have different clinical uses and are used in several related and unrelated conditions.


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