Tension-type headache is a nonspecific headache, which is not vascular or migrainous, and is not related to organic disease. The most common form of headache, it may be related to muscle tightening in the back of the neck and/or scalp. There are two general classifications of tension-type headache: episodic and chronic, differentiated by frequency and severity of symptoms. Both are characterized as dull, aching and non-pulsating pain and affect both sides of the head.

Symptoms for both types are similar and may include:

  • Muscles between head and neck contract
  • A tightening band-like sensation around the neck and/or head which is a “vice-like” ache
  • Pain primarily occurs in the forehead, temples or the back on head and/or neck Episodic


Tension-type headache occurs randomly and is usually triggered by temporary stress, anxiety, fatigue or anger. They are what most of us consider “stress headaches.” It may disappear with the use of over-the-counter analgesics, withdrawal from the source of stress or a relatively brief period of relaxation.

For this type of headache, over-the-counter drugs of choice are aspirin, acetaminophen, ibuprofen or naproxen sodium. Combination products with caffeine can enhance the action of the analgesics.


Chronic tension-type headache is a daily or continuous headache, which may have some variability in the intensity of the pain during a 24-hour cycle. It is always present. If a sufferer is taking medication daily or almost daily and is receiving little or no relief from the pain, then a physician should be seen for diagnosis and treatment.

The primary drug of choice for chronic tension-type headache is amitriptyline or some of the other antidepressants. Antidepressant drugs have analgesic actions, which can provide relief for headache sufferers. Although a patient may not be depressed, these drugs may be beneficial. Selecting an antidepressant is based on the presence of a sleep disturbance. For the patient with chronic tension-type headaches, habituating analgesics must be strictly avoided. Biofeedback techniques can also be helpful in treating tension-type headaches.

Chronic tension-type headache can also be the result of either anxiety or depression. Changes in sleep patterns or insomnia, early morning or late day occurrence of headache, feelings of guilt, weight loss, dizziness, poor concentration, ongoing fatigue and nausea commonly occur. One should seek professional diagnosis for proper treatment if these symptoms exist.