Most people with tension-type headaches (TTH) do not need treatment by a health care provider. If your headaches become a chronic, recurring problem that interferes with your life, schedule a medical appointment. During your appointment, your health care provider will do a medical history, physical exam and neurological exam.

Diagnosis of TTHs is mainly based on your symptoms. Combining a headache diary and list of medicines with the history and exams can help your provider diagnose your headache type. It may also help him or her “rule out” other medical disorders and plan the best treatment.

While most episodic tension-type headaches (TTH) can be managed with NSAIDs or other pain-relievers, chronic TTH is more of a challenge. Chronic TTH usually must be treated with a combination of therapies. Work closely with your provider and be patient, as it may take time to find the best treatment for chronic TTH. Some therapies may work well, while others may not work at all. For example, amitriptyline and biofeedback may help one person, while a different combination of therapies helps someone else.

While the exact causes of TTH have not been clearly identified, important advances are being made. As the causes become clearer, headache experts will be able to develop better, more effective treatments, especially for chronic TTH.

Treatments and drugs

Some people with tension headaches don't seek medical attention, and try to treat the pain on their own. The problem with that is that repeated use of over-the-counter (OTC) pain relievers can actually cause overuse headaches.

A variety of medications, both OTC and prescription, are available to stop or reduce the pain of an existing headache attack, including:

• Analgesics. Analgesics are pain relievers, and a class of analgesics known as nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first line of treatment for reducing headache pain. NSAIDs include the OTC drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Prescription NSAIDs include naproxen (Naprelan, Naprosyn), indomethacin (Indocin) and ketorolac (Ketorolac Tromethamine). Acetaminophen (Tylenol, others) and aspirin are also analgesics, but they may be less effective than some NSAIDs in treating tension headache pain, and they're more likely to cause medication overuse headaches.
• Combination medications. Aspirin or acetaminophen or both are often combined with caffeine or a sedative drug in a single medication. For example, Excedrin combines aspirin, acetaminophen and caffeine. Combination drugs such as this may be more effective than are pure analgesics for pain relief. Although many combination drugs are available OTC, analgesic-sedative combinations can be obtained only by prescription because they may be addictive and can lead to chronic daily headache. Use them only with careful monitoring by your doctor.
• Other medications. For people who experience both migraines and episodic tension headaches, a triptan can effectively relieve the pain of both headaches. Opiates, or narcotics, are rarely used because of their side effects and potential for dependency.

Pain medications don't cure headaches; they just relieve the symptoms temporarily. Over time painkillers and other medications may lose their effectiveness or, they might even cause headaches. To avoid the development of medication overuse headaches, don't use over-the-counter pain relievers for more than nine days a month. In addition, all medications have side effects. If you take medications regularly, including products you buy over-the-counter, discuss the risks and benefits with your doctor. Also, remember that pain medications aren't a substitute for recognizing and dealing with the stressors that may be triggering your headaches.