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Tension-Type Headache

(Tension Headache)


Stephen D. Silberstein

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Reviewed/Revised Apr 2023

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

Tension-type headaches may be episodic or chronic:

  • Episodic tension-type headaches occur < 15 days/month. Episodic tension-type headache is very common; most patients obtain relief with over-the-counter (OTC) analgesics and do not seek medical attention.

  • Chronic tension-type headaches occur ≥ 15 days/month.

Symptoms and Signs of Tension-Type Headache

The pain of a tension-type headache 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.

Potential triggers for chronic tension-type headache include

Episodic headaches may last 30 minutes 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 of Tension-Type Headache

  • Clinical evaluation

Diagnosis of tension-type headache is based on characteristic symptoms and a normal physical examination, which includes a neurologic examination Introduction to the Neurologic Examination The purpose of the neurologic examination is to establish whether the patient’s brain, special senses, spinal cord, peripheral nerves, and muscle and skin receptors are functioning normally... read more . Potential triggers for chronic tension-type headache should be identified and treated.

Tension-type headache should be distinguished from a forme fruste of migraine Symptoms and Signs , which many patients with migraine have; these headaches have only some features of migraine and resemble tension-type headache, but they are mild and respond to migraine-specific medications.

If severe headaches are thought to be tension-type headaches, the diagnosis should be reconsidered because severe tension-type headaches are often migraines.

Pearls & Pitfalls

  • Reconsider the diagnosis of tension-type headache if headache is severe, particularly in a patient who has concomitant migraine or a history of prior migraine headaches.

Treatment of Tension-Type Headache

  • Analgesics

  • Sometimes behavioral and psychologic interventions

  • For chronic tension-type headaches, amitriptyline

For most mild to moderate tension-type headaches, OTC analgesics (eg, aspirin, acetaminophen) can provide relief. Massaging the affected area may help.

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

Drugs Mentioned In This Article

Drug Name Select Trade
Elavil, Tryptanol, Vanatrip
Anacin Adult Low Strength, Aspergum, Aspir-Low, Aspirtab , Aspir-Trin , Bayer Advanced Aspirin, Bayer Aspirin, Bayer Aspirin Extra Strength, Bayer Aspirin Plus, Bayer Aspirin Regimen, Bayer Children's Aspirin, Bayer Extra Strength, Bayer Extra Strength Plus, Bayer Genuine Aspirin, Bayer Low Dose Aspirin Regimen, Bayer Womens Aspirin , BeneHealth Aspirin, Bufferin, Bufferin Extra Strength, Bufferin Low Dose, DURLAZA, Easprin , Ecotrin, Ecotrin Low Strength, Genacote, Halfprin, MiniPrin, St. Joseph Adult Low Strength, St. Joseph Aspirin, VAZALORE, Zero Order Release Aspirin, ZORprin
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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