What to Know About Chronic Tension Headache

Tension headaches are commonly caused by stress, anxiety, dehydration, fasting, or a lack of sleep, and they usually resolve with over-the-counter medication such as Tylenol (acetaminophen).

Some people suffer from these headaches on a regular basis, a condition known as chronic tension-type headaches. Chronic tension headaches, a primary headache disorder that affects approximately 3% of the population, can occur on a daily basis and have a negative impact on one's quality of life and daily functioning.


Tension headaches are also known as "stress headaches" and "muscle contraction headaches." They are usually dull and aching, with tightness or pressure across the forehead, sides, or back of your head. Tenderness on the scalp, neck, and shoulders is also reported by some people.


Tight muscles in the shoulders, neck, scalp, and jaw are common causes of tension headaches. Teeth grinding (bruxism) and jaw clenching can also be factors.

Headaches can be caused by stress, depression, or anxiety, and are more common in people who work long hours in stressful jobs, do not get enough sleep at night, skip meals, or drink alcoholic beverages on a regular basis.


Talk to your healthcare provider if you have headaches that interfere with your daily life or if you need to take headache medication more than twice a week.

Keep a headache diary prior to your appointment, taking note of the days, times, and description of the pain, intensity, and other symptoms.

Your healthcare provider will most likely be able to diagnose you based solely on your symptoms. If your headaches do not follow a predictable pattern, your doctor may order imaging tests such as magnetic resonance imaging (MRI) or computerized tomography (CT) scans to rule out other possibilities.

Chronic tension-type headaches are frequently misdiagnosed as chronic migraine, hemicrania continua, temporomandibular joint dysfunction (TMJ), or cluster headaches.


Preventive medication is typically used in the treatment of chronic tension headaches.

Amitriptyline (Elavil) is one medication that has been shown to be effective in the prevention of chronic tension headaches. Amitriptyline, a tricyclic antidepressant, is a sedative that is typically taken at bedtime.

Other antidepressants, such as Remeron (mirtazapine), or anti-seizure medications, such as Neurontin (gabapentin) or Topamax, may be considered preventive medications by your healthcare provider (topiramate).

Non-Drug Treatments 

Acupuncture is an alternative therapy that involves the use of needles to stimulate specific points on the body that are thought to connect with specific pathways (or "meridians") that carry vital energy (or "chi") throughout the body.

According to a 2016 literature review published in the journal Headache, there is evidence to support the use of acupuncture as a treatment for chronic tension-type headaches and other chronic headache conditions. Furthermore, the findings suggest that acupuncture may be a cost-effective therapy.


Electrodes are placed on the scalp, neck, and upper body in Electromyography (EMG) biofeedback to detect muscle contraction. The patient is then taught how to control muscle tension in order to avoid headaches.

However, the procedure is expensive and time-consuming, and there is no evidence to support its effectiveness in treating or preventing tension headaches.

Physical therapy

A physical therapist can recommend exercises to help with tight head and neck muscles.

Cognitive-behavioral therapy (CBT) 

Cognitive-behavioral therapy teaches patients how to recognize headache triggers and deal with them in a more adaptive, less stressful way. When developing a treatment plan for their patients, many headache specialists will frequently recommend CBT in addition to medication.

When teeth grinding and jaw clenching are causing headaches, treating them can help. Furthermore, getting regular exercise and practicing good sleep hygiene can help prevent tension headaches.


Supplements have helped some people who suffer from chronic tension headaches. According to the American Academy of Neurology and the American Headache Society, the following supplements may be helpful: butterbur, feverfew, magnesium, and riboflavin.