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Headache: A Merck Manual of Patient Symptoms podcast

Tension-type headache causes mild generalized pain without the incapacity, nausea, or photophobia associated with migraine.

Tension-type headaches may be episodic or chronic. Episodic tension-type headaches occur < 15 days/mo. Episodic tension-type headache is very common; most patients obtain relief with OTC analgesics and do not seek medical attention. Tension-type headaches that occur ≥ 15 days/mo are considered chronic.

Symptoms and Signs

The pain is usually mild to moderate and often described as viselike. These headaches originate in the occipital or frontal region bilaterally and spread over the entire head. Unlike migraine headaches, tension-type headaches are not accompanied by nausea and vomiting and are not made worse by physical activity, light, sounds, or smells. Potential triggers for chronic tension-type headache include sleep disturbances, stress, temporomandibular joint dysfunction, neck pain, and eyestrain.

Many patients with frequent tension-type headache often have mild headaches with some but not all features of migraine; these headaches resemble tension-type headaches but are a forme fruste of migraine and respond to migraine specific drugs.

Episodic headaches may last 30 min to several days. They typically start several hours after waking and worsen as the day progresses. They rarely awaken patients from sleep.

Chronic headaches may vary in intensity throughout the day but are almost always present.

Diagnosis

• Clinical evaluation

Diagnosis is based on characteristic symptoms and a normal physical examination, which includes a neurologic examination. Potential triggers for chronic tension-type headache should be identified and treated.

Treatment

• Analgesics
• Sometimes behavioral and psychologic interventions

Some drugs used to prevent migraine, particularly amitriptylineSome Trade Names
ELAVIL
ENDEP
Click for Drug Monograph
, can help prevent chronic tension-type headache.

For most mild to moderate tension-type headaches, OTC analgesics (eg, aspirinSome Trade Names
BUFFERIN
ECOTRIN
GENACOTE
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, acetaminophenSome Trade Names
GENAPAP
TYLENOL
VALORIN
Click for Drug Monograph
) can provide relief. Massaging the affected area may help.

For severe headaches, prescription analgesics (eg, those that contain opioids) may be used.

Behavioral and psychologic interventions (eg, relaxation and stress management techniques) are often used and are effective, especially when combined with drug treatment.

Last full review/revision April 2008 by Stephen D. Silberstein, MD

Content last modified April 2008