Tension Type Headache: Symptoms, Causes and Treatments

January 26, 2024
November 12, 2021
Tension Type Headache: Symptoms, Causes and Treatments

Not everyone can experience every type of headache, but everyone can experience tension-type headaches (TTH).  Epidemiologists estimate that 99% of the population experience tension-type headaches at some point in their life, and some people can experience important subtypes.  It is rarely as debilitating as migraine or other headache subtypes, but is important to recognize and differentiate it so it can be treated appropriately. 

What it is, and what it isn’t

TTH is almost better understood for what features it doesn’t have. As opposed to migraine, and many other headaches where the duration of a headache attack is specific, TTH attacks can vary from minutes to hours to days.  Although the classic description of TTH pain is dull, squeezing and vise-like, it can vary significantly as well and does not have to be consistent with a specific type of pain.  

There should not be any other symptoms associated with the headache pain, such as nausea, light or sound sensitivity or vertigo.  It should not be preceded by any neurological symptom like migraine aura preceding a migraine attack. And most importantly, it should not worsen with exertion.  

Subtypes of Tension-Type Headache

The vast majority of TTH comes and goes episodically.  It is possible to experience 15 or more days of headache with TTH as well, and we call this chronic tension-type headache.  We really only consider preventive treatments for chronic rather than episodic tension-type headaches.  

We also distinguish TTH that occurs with the tenderness of the muscles around the head (pericranial tenderness) or not.  Your doctor might consider specific treatments for each of these different kinds of headaches. 


Because TTH is less specific of a headache than most other headache disorders, some concerning medical problems can mimic TTH.  For this reason, it is actually more likely that your doctor will recommend imaging tests, such as an MRI, if your headache has fewer features than a typical migraine and appears to resemble TTH.  There is also a growing body of evidence in the medical literature that associates certain vitamin deficiencies with worsening TTH, and your doctor will likely recommend specific blood test that will look for these. 



The primary focus of TTH treatment is in the acute phase - stopping the headache when it comes.  Over the counter medications typically are effective enough for TTH attacks, and if you experience pericranial tenderness your doctor might also consider adding a muscle relaxant.  

There does not appear to be a “rebound effect” or medication overuse associated with TTH - the effect that increasing amounts of specific medication can lead to more frequent headaches.  That said, most acute medications are not meant to be taken very frequently.  Frequent Tylenol use risks liver toxicity, most anti-inflammatories can lead to stomach ulcers or kidney disease if taken to excess.  

Specific preventive medications can help chronic TTH, specifically two classes of antidepressants.  The tricyclic antidepressants, or TCAs are an older class of medication that is frequently used for migraine prevention, and other medications in this class can help TTH when it becomes chronic as well - such as imipramine.  The serotonin and norepinephrine reuptake inhibitors are another class of antidepressants that help migraine and chronic TTH, duloxetine (Cymbalta) and venlafaxine (Effexor) are most commonly used.  

To find the right solution to treat tension-type of headaches it is necessary to get diagnosed by a professional. If you'd like to speak with a neurologist specializing in headaches about how you can best prepare yourself and manage your headaches, join Neura Health today.

For more great content, follow us:
Instagram IconFacebook Icon
Thomas Berk, MD FAHS
Thomas Berk is Medical Director at Neura Health, where he treats Neura patients via video visit. He is a former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine.
About the Author
Thomas Berk, MD FAHS is Medical Director of Neura Health and a neurologist and headache specialist based in New York City. A former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine, he has over 12 years of clinical experience. He graduated from the NYU Grossman School of Medicine and completed his neurology residency at NYU as well. He completed a headache fellowship at the Jefferson Headache Center in Philadelphia. He is a Fellow of the American Headache Society and has been on the Super Doctors list of rising stars for the past five years.

Share this article

Looking for expert neurology care?

Video visits within days

Talk with neurologists

Get Rx delivered

Learn More

Finally, expert neurology care at your fingertips

Neura Health is a comprehensive virtual neurology clinic. Meet with a neurology specialist via video appointment, and get treatment from home.

Phone and Leaf Mockup