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Tension-type headache is the most common headache condition.  Tension headaches are experienced by majority of men and women in their lifetimes.  A study in the United States showed that in one year, 38.3% of patients experience an episode of  tension-type headache.  Typically, the severity of an episodicof  tension type headaches is mild to moderate and patients do not seek medical treatment for these headaches.  This distinguishes tension-type headaches for migraines, which are associated with more severe pain and more likely to prompt patients to seek medical care.

What causes tension-type headaches?

It is not clear what causes tension-type headaches, but one theory is that the headaches result from temporary changes in the pain-perception mechanisms in the nerves of the head and neck region.  As a result, the pain sensations of the head and neck are amplified and a headache ensues.  Despite the name "H tension-type" headache, there is little scientific evidence that muscle tension or psychological tension is the cause of tension-type headaches, although psychological stresses and physical stresses may trigger, precipitate, or aggravate these types of headaches.

Tension plus migraine headaches
A substantial number of patients with tension-type headaches will also have migraine headaches.  One school of thought is that tension type headaches are simply a milder version of migraine headaches in this particular group of patients.  In this group of patients who clearly have migraines and also have tension-type headaches, treating the tension-type headaches as one would treat the migraine headaches is often quite effective.   In patients with migraines, a tension-type headache attack should be treated as a migraine, before symptoms worsen and develop into a full-blown migraine attack.

Patients who have tension-type headaches and migraines that occur frequently (three or more times a week) and require medication to control symptoms, preventative medication should be considered as well, in order to prevent rebound headaches from occurring.  Tricyclic antidepressants, Tizanidine, and anti--epileptic drugs are some of the more commonly prescribed medications for these patients with tension-type headaches and migraines that experience frequent tension headaches. 

Tension headaches without migraine headaches

In patients with tension-type headaches who never have migraines, abortive medications are typically taken by the patient without consultation with physicians.  Common abortive medications include NSAIDs, combinations of aspirin (or Tylenol ) with  caffeine, and occasionally muscle relaxants.  NSAIDs, Tylenol, or aspirin/Tylenol combined with caffeine are preferable to muscle relaxants.

Because episodic tension-type headaches can occur frequently for some patients, there is substantial risk of rebound headaches developing if a patient takes a medication more than two days per week.  The risk of rebound headaches can be minimized by limiting these medications for acute episodes to two days per week.  .  If medication use routinely exceeds two days per week, prophylactic or preventative therapy should be considered (in addition to other lifestyle modifications, noted below).  Common preventative medications used to treat tension-type headache include tricyclic antidepressants, muscle relaxants (baclofen and tizanidine) and SSRIs (anti-depressants). 

Are there alternative treatments for tension-type headache?
Patients with episodic or those with chronic tension headaches (defined as tension-type headaches that occur more than 15 days a month) may benefit from cognitive behavioral therapies, including pain-coping strategies,  biofeedback-assisted relaxation, physical therapy, and perhaps acupuncture.  Musculoskeletal pain arising from poor ergonomic situations can predispose or perhaps trigger tension-type headaches.  This is particularly true for office workers with poor workstation setups who may have improper shoulder, neck, back, or head posture for extended lengths of time, thereby triggering painful spasms of cervical nerve rootlets.  Any worker who perforce repetitive actions involving the upper extremities, head or neck may be predisposed to developing upper back in cervical pain as well. Ergonomic corrections, posture breaks, job rotation, and daily exercise is likely to be beneficial in this group of patients in particular.  Many manufacturing companies have recognized the benefit of the strategies and incorporate them into their daily work routines.