Medical Care

Various modalities are used in the treatment of tension headaches. These include hot or cold packs, ultrasound, electrical stimulation, improvement of posture, trigger point injections, occipital nerve blocks, stretching, and relaxation techniques.

Regular exercise, stretching, balanced meals, and adequate sleep may be part of a headache treatment program.^[12]

Alternative Medicine

Non-pharmacological treatments for headache include behavioral treatments such as cognitive-behavioral therapy, relaxation, and biofeedback, as well as acupuncture and massage. These treatments are options for patients who prefer non-pharmacological treatments or cannot take medications such as pregnant patients.^[13]Relaxation techniques such as meditation are effective for chronic headaches as measured by headache parameters. Patients with chronic headaches have been showed to have low levels of cortisol that normalized with the practice of meditation over time.

Acupuncture may be helpful for patients experiencing frequent or chronic TTH. A review of eleven studies involving 2,317 patients found evidence to support acupuncture as a valuable, nonpharmacologic tool for episodic or chronic TTH. Two of the studies reviewed compared acupuncture to treatment of acute headaches or routine care only and found statistically significant and clinically relevant short-term (up to 3 months) benefits of acupuncture over control for response, number of headache days, and pain intensity.^[14]According to several studies, massage may also be an effective therapy for individuals suffering from TTH. Massage can relieve tight muscles in the back of the head, neck, and shoulders, which may in turn relieve headache pain.^{[15, 16]} A combination of therapy with stress re-education and biofeedback may be best for patients.

Medication

The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan. 38(1):[QxMD MEDLINE Link].
Kiran U, Behari M, et al. The effect of autogenic relaxation on chronic tension headache and in modulating cortisol. Indian J Anaesth. 2005. 49(6):474-8.
Bendtsen L, Fumal A, Schoenen J. Tension-type headache: mechanisms. Handb Clin Neurol. 2010. 97:359-66. [QxMD MEDLINE Link].
Bezov D, Ashina S, Jensen R, Bendtsen L. Pain perception studies in tension-type headache. Headache. 2011 Feb. 51 (2):262-71. [QxMD MEDLINE Link].
Anderson, P. Tension-Type Headaches Linked to Neck Weakness. Medscape Medical News. Available at http://www.medscape.com/viewarticle/844414#vp_1. May 8, 2015; Accessed: September 4, 2015.
Madsen BK, Søgaard K, Andersen LL, Skotte JH, Jensen RH. Neck and shoulder muscle strength in patients with tension-type headache: A case-control study. Cephalalgia. 2015 Apr 1. [QxMD MEDLINE Link].
Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton RB, Scher AI, et al. (2007) The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 27:193-210.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15. 380(9859):2163-96. [QxMD MEDLINE Link].
Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache. 2015 Jan. 55 (1):21-34. [QxMD MEDLINE Link].
Russell MB. Tension-type headache in 40-year-olds: a Danish population-based sample of 4000. J Headache Pain. 2005 Dec. 6 (6):441-7. [QxMD MEDLINE Link].
[Guideline] Martin V, Elkind A. Diagnosis and classification of primary headache disorders. In: Standards of care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation; 2004. [Full Text].
[Guideline] Ruoff G, Urban G. Treatment of primary headache: episodic tension-type headache. In: Standards of care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation; 2004. [Full Text].
Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: history, review of the empirical literature, and methodological critique. Headache. 2005 May. 45 Suppl 2:S92-109. [QxMD MEDLINE Link].
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009 Jan 21. CD007587. [QxMD MEDLINE Link]. [Full Text].
Moraska A, Chandler C. Changes in Psychological Parameters in Patients with Tension-type Headache Following Massage Therapy: A Pilot Study. J Man Manip Ther. 2009. 17(2):86-94. [QxMD MEDLINE Link]. [Full Text].
Toro-Velasco C, Arroyo-Morales M, Fernández-de-Las-Peñas C, Cleland JA, Barrero-Hernández FJ. Short-term effects of manual therapy on heart rate variability, mood state, and pressure pain sensitivity in patients with chronic tension-type headache: a pilot study. J Manipulative Physiol Ther. 2009 Sep. 32(7):527-35. [QxMD MEDLINE Link].
Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J, et al. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010 Nov. 17 (11):1318-25. [QxMD MEDLINE Link].
Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008 Jan. 7(1):70-83. [QxMD MEDLINE Link].
Merikangas KR, Cui L, Richardson AK, Isler H, Khoromi S, Nakamura E, et al. Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study. BMJ. 2011 Aug 25. 343:d5076. [QxMD MEDLINE Link]. [Full Text].
Silver N. Headache (chronic tension-type). Am Fam Physician. 2007 Jul 1. 76(1):114-6. [QxMD MEDLINE Link]. [Full Text].
Ozkurt B, Cinar O, Cevik E, Acar AY, Arslan D, Eyi EY, et al. Efficacy of high-flow oxygen therapy in all types of headache: a prospective, randomized, placebo-controlled trial. Am J Emerg Med. 2012 May 2. [QxMD MEDLINE Link].
Caamaño-Barrios LH, Galán-Del-Río F, Fernández-de-Las-Peñas C, Plaza-Manzano G, Arendt-Nielsen L, Ortega-Santiago R. Widespread Pressure Pain Sensitivity over Nerve Trunk Areas in Women with Frequent Episodic Tension-Type Headache as a Sign of Central Sensitization. Pain Med. 2020 Nov 7. 21 (7):1408-1414. [QxMD MEDLINE Link].
Garza I, Robertson CE, Smith JH, Whealy MA. Headache and other craniofacial pain. Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022.
Rozental JM. Tension-type headache, chronic tension-type headache, and other chronic headache types. Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018.

Media Gallery

of 0

Author

Michelle Blanda, MD Chair Emeritus, Department of Emergency Medicine, Summa Health System Hospital; Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

Michelle Blanda, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Edward A Michelson, MD Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

J Stephen Huff, MD, FACEP Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD, FACEP is a member of the following medical societies: American Academy of Neurology, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Lori K Sargeant, MD Consulting Staff, Summa Emergency Associates Inc

Lori K Sargeant, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Ohio State Medical Association

Disclosure: Nothing to disclose.

Tension Headache Treatment & Management

Medical Care

Alternative Medicine

References

Tables

Contributor Information and Disclosures

What would you like to print?