There are a number of treatment options available for tension headaches. Although tension headaches cannot be cured, treatments aim to control the symptoms and prevent future episodes.

Although they do not cure headaches, prescription and over-the-counter medications may also be used to prevent tension headaches, stop the progression of tension headaches and relieve symptoms.

In what is known as acute therapy, a number of headache medications are used to stop or reduce the pain of an existing tension headache. These include:

• Analgesics (e.g., acetaminophen). These pain relievers are often effective in relieving headache pain.
  
  
• Nonsteroidal anti-inflammatory drugs (NSAIDs, including aspirin, ibuprofen and naproxen). These drugs are often used to relieve headache pain.
  
  
• Combination medications. Certain medications (e.g., aspirin, acetaminophen) may be combined with caffeine or a sedative into a single drug. Available over the counter and by prescription, these combination drugs are sometimes more effective at relieving pain than pure analgesics.
  
  
• Triptans (serotonin receptor agonists). These drugs may be recommended for patients who experience migraines as well as episodic tension headaches.
  
  
• Opiates. In rare cases, opiates may be prescribed to relieve pain associated with tension headaches. They are not commonly used because they carry a risk for dependence. They also cause a number of negative side effects, such as sedation, nausea and constipation.

Medications used to reduce the frequency and severity of tension headaches include:

• Antidepressants. Normally prescribed to relieve depression, these drugs can prevent tension headaches by stabilizing the levels of serotonin and other brain chemicals. Commonly prescribed antidepressants include:
  
  
  • Tricyclic antidepressants. These are commonly used to prevent chronic and episodic tension headaches.
    
    
  • Selective serotonin reuptake inhibitors (SSRIs). This type of antidepressant is favorable because it often causes fewer side effects than tricyclic antidepressants. However, SSRIs are usually less effective in preventing tension headaches.

Antidepressants may increase the risk of suicidal thinking and behavior in children and adolescents. The U.S. Food and Drug Administration (FDA) has issued an advisory that people being treated with these drugs should be closely monitored for unusual changes in behavior.

• NSAIDs. In addition to their role as acute therapy, daily use of NSAIDs may manage chronic tension headaches in many people.
  
  
• Anticonvulsants. Usually used to control seizures, these medications may be prescribed to prevent tension headaches.
  
  
• Muscle relaxants. In some cases, muscle relaxants are recommended for the prevention of tension headaches, even though the research has shown that muscle relaxants work centrally and cause sedation.  

Patients experiencing tension headaches with the features of a migraine may benefit from taking antihypertensives such as beta blockers or calcium channel blockers. These drugs, commonly used to treat migraines, may be used alone or in combination with antidepressants to reduce the frequency of tension headaches. A recent analysis of 94 clinical trials involving more than 24,000 patients found that four leading classes of antihypertensives (thiazide diuretics, beta blockers, ACE inhibitors, angiotensin II receptor antagonists) can significantly reduce the risk of headaches.

In order to be effective, drugs used to reduce the frequency and severity of tension headaches need to be taken at regular intervals. They are frequently recommended for patients wh

• Experience three or more headaches a week
• Do not find relief from acute or nondrug therapy
• Have headaches lasting longer than three to four hours
• Have severe pain that becomes disabling 
• Have severe pain that causes overuse of acute medication
• Cannot take acute medication because of unrelated medical conditions

Because preventive medication may take several weeks to build up in the nervous system and take effect, patients taking preventive medications may not notice improvement for a couple of months or more. Some patients may require a combination of medications to achieve the greatest effectiveness.

Physicians will closely monitor a patient’s treatment to determine its effectiveness. Once the headaches are under control, physicians may begin gradually reducing the medication dose.

Medications can provide temporary relief from head pain. However, they may also lose their effectiveness over time. In addition, medications used to treat tension headaches have a number of negative side effects. Patients are encouraged to discuss with their physician the risks of all over-the-counter and prescription drugs taken regularly for the treatment of headache pain.

Overuse of prescription and over-the-counter pain medications can lead to rebound headaches and the development of chronic daily headaches. To prevent these conditions, patients should take over-the-counter pain medication only when it is necessary. When the medication is used, patients should take the smallest dose needed to provide relief. Ideally, patients should not take over-the-counter pain medication more than two times a week. Patients taking prescription pain medication should not exceed the physician-recommended dosage.

Men may be undertreated for tension headaches. A recently completed nine-year British study involving more than 400,000 patients found that women are more likely to seek medical attention for headaches and to receive prescriptions. Other recent research indicates many adolescents with chronic headaches are not being treated. Anyone suffering from tension headaches or other headaches is advised to take the initiative in seeking help.

Additional treatment methods include:

• Acupuncture. During this procedure, fine needles are inserted into specific points in the body to control pain.
  
  
• Essential oils. A salve (an oil-based herbal solution) made from ginger, peppermint and wintergreen oils may be used to relieve tension headaches. Patients may benefit from smelling the salve or rubbing it on their temples and the nape of their neck.

In addition to taking medications, patients may reduce the frequency of tension headaches by avoiding factors that trigger the headaches. Patients may identify these triggers by keeping a headache diary for at least two months. To compile this journal, patients should record certain information after each headache occurs, including:

• When the headache occurred
• Severity of the headache
• Where the headache was located
• How long the headache lasted
• Medications taken
• Events prior to the headache
• What was eaten 24 hours before the headache occurred
• Sleep patterns and amount of sleep
• Level of stress

Patients may benefit most from using lifestyle changes to prevent and relieve tension headaches. Such treatment methods include:

• Exercising regularly. Patients can reduce the frequency and severity of tension headaches by participating in regular aerobic exercise (e.g., walking, swimming, bicycling). Such activity helps to relax the muscles and increase the levels of the body’s natural stress relievers. Exercise can also relieve the pain of an existing headache. Patients should discuss physical activity with their physician before starting an exercise routine.
  
  
• Managing stress. Patients may use a number of relaxation techniques, including deep breathing, yoga, and meditation to relieve stress, a common trigger of tension headaches. Organizing daily activities ahead of time can also reduce stress. Biofeedback may also be recommended. During this procedure, electronic monitoring devices are used to teach people how to consciously regulate their bodily functions through relaxation or imagery. Cognitive behavioral therapy may also be used to reduce stress in patients with depression or anxiety.
  
  
• Muscle relaxation. Some tension headaches patients may benefit from relaxing the muscles. Methods used to relieve muscle tension include thermotherapy (e.g., heating pad, hot-water bottle, warm compress, hot towel, hot bath or shower) and cryotherapy (e.g., ice pack, cold shower or bath). Massage therapy for the head, neck and shoulders can reduce stress and relieve tension. 
  
  
• Improving posture. Good posture and ergonomics can prevent muscle tension. There are a number of techniques a person can use to perfect their posture, including:
  
  
  • Hold the shoulders back and the head high when standing. Also pull the abdomen and buttocks in and tuck in the chin.
    
    
  • When in a sitting position, the thighs should be parallel to the ground and the head should not be slumped forward.
    
    
  • Avoid sitting, standing or working in one position for an extended period of time.
    
    
  • Avoid wearing high heels or shoes that do not fit properly.
    
    
  • Regularly perform stretching and strengthening exercises for the neck and shoulders.
    
    
  • Place weight on both feet when standing. When standing in place for an extended period of time, elevate one foot on a stool. Change to the other foot periodically.
    
    
  • When sitting for an extended period of time, use a footstool to elevate the feet. Get up and move around every 30 minutes.
    
    
  • Sit in straight-back chairs and keep the head supported.
    
    
  • Avoid carrying shoulder bags or purses weighing more than 2 pounds (1 kilogram).

Other common prevention methods include:

• Avoiding cigarette smoking
• Avoiding excess caffeine
• Avoiding alcohol
• Maintaining a regular, healthy diet
• Maintaining a regular sleep pattern and getting plenty of sleep and rest
• Keeping warm if the headache is triggered by the cold
• Using a different pillow
• Using a new sleeping position