From the Guidelines
Tension-type headaches are commonly triggered by stress, poor posture, eye strain, inadequate sleep, dehydration, skipped meals, and muscle tension in the neck and shoulders, and the most effective treatment involves a combination of lifestyle modifications and over-the-counter pain relievers such as ibuprofen (400 mg) or acetaminophen (1000 mg) for acute relief, as recommended by the 2023 VA/DoD headache guidelines 1.
Triggers for Tension-Type Headaches
- Stress
- Poor posture
- Eye strain
- Inadequate sleep
- Dehydration
- Skipped meals
- Muscle tension in the neck and shoulders
Treatment for Tension-Type Headaches
- Over-the-counter pain relievers such as ibuprofen (400 mg) or acetaminophen (1000 mg) for acute relief, as recommended by the 2023 VA/DoD headache guidelines 1
- Lifestyle modifications, including:
- Practicing stress reduction techniques like deep breathing or meditation
- Maintaining good posture
- Taking regular breaks from screens
- Ensuring adequate hydration (at least 8 glasses of water daily)
- Establishing consistent sleep patterns
- Performing gentle neck stretches
- Physical therapy, massage, hot or cold compresses, and relaxation exercises to reduce muscle tension
- Preventive medications like amitriptyline (50 mg or 100 mg) for chronic tension-type headaches, as recommended by the 2023 VA/DoD headache guidelines 1
Prevention and Management
- Identifying personal triggers through a headache diary
- Avoiding caffeine overuse
- Regular exercise, such as aerobic exercise or progressive strength training, which received a "weak for" recommendation for the prevention of both migraine and TTH 1
- Rehabilitation approaches, including physical therapy, which received a "weak for" recommendation for the management of migraine and TTH 1
From the Research
Triggers for Tension-Type Headache
- Menstruation has a prominent unfavorable role in migraine and possibly in TTH 2
- Environmental factors such as weather, lights, noise and odors may play a role in triggering TTH 2
- Stress and other psychological factors can trigger TTH 2
- Sleeping problems, fatigue and tiredness may trigger TTH 2
- Intake of alcohol, caffeine withdrawal, skipping meals, and possibly dehydration may trigger TTH in some patients 2
Treatment for Tension-Type Headache
- Nonprescription analgesics are indicated for management of episodic TTH 3
- Prophylaxis should be considered for patients with chronic TTH, with very frequent episodic TTH, at risk of medication overuse headache, and who are unable to tolerate effective doses of first-line drugs 3
- Amitriptyline is recommended as a first-line drug for prophylaxis 3, 4
- Physical and integrative therapies for TTH management include electromyography biofeedback, cognitive behavioral therapy, exercise, massage, and trigger point injection 3
- Simple analgesics have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of TTH 4
- Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and if simple analgesics are ineffective, poorly tolerated or contraindicated 4
Management of Tension-Type Headache
- Tricyclic antidepressant medication and stress management therapy each produced larger reductions in headache activity, analgesic medication use, and headache-related disability than placebo 5
- Combined therapy of antidepressant medication and stress management therapy may improve outcome relative to monotherapy 5
- Topical heat or cold packs, exercise and other stress-reduction techniques, mild analgesics, muscle relaxants and trigger-point injections may be used to treat episodic tension-type headaches 6