Tension Headache

Diagnosis

Diagnosing tension-type headaches often begins with a detailed medical history, a physical exam and a neurological exam. Your health care professional uses this information to identify the cause and type of headaches you experience.

A key part of diagnosis is your description of the pain. Sharing clear details helps guide the evaluation. You may be asked about whether the pain feels throbbing, dull, sharp or stabbing. You also may be asked to describe how intense the pain is and whether it affects your daily activities, sleep or ability to work. Noting where the pain is located on your head also offers important clues.

Imaging tests may be recommended to rule out serious causes of head pain such as a tumor. Common tests include MRI, which uses magnets and radio waves to create brain images, and CT scans, which combine multiple X-ray images to provide cross-sectional views of the brain.

Treatment

Treatment for tension-type headaches focuses on relieving pain and preventing headaches from happening as frequently. Some people manage symptoms on their own, but frequent use of over-the-counter pain relievers can lead to medication overuse headaches. Working with a health care professional can help you find the right approach.

Medicines used during a headache can include:

• Pain relievers such as aspirin, ibuprofen or naproxen sodium, often used as the first option for symptom relief
• Combination medicines that mix aspirin, acetaminophen or both with caffeine or a sedative, which may be more effective for some people
• Triptans, which may help people who experience both migraines and episodic tension-type headaches
• Prescription opioids, which are rarely used because of dependency risks and side effects

Preventive medicines may be recommended when headaches occur regularly or do not respond to other treatments. Options may include tricyclic antidepressants such as amitriptyline, nortriptyline or protriptyline, which are commonly used for prevention but may cause drowsiness, dry mouth or constipation. Other antidepressants such as venlafaxine and mirtazapine can also be helpful. Anti-seizure medicines like gabapentin or topiramate and the muscle relaxant tizanidine may be considered, though more research is needed to confirm their effectiveness for tension-type headache prevention.

Preventive medicines may take several weeks or longer to work. During this time, using too many pain relievers may interfere with the benefits of preventive treatment. Your health care professional can guide you on safe use to ensure the best results.