Identifying and Treating Tension Headache's Underlying Causes

Tension headaches are caused by muscle contractions in the head, face, neck and shoulders, are usually related to stress, fatigue, emotional conflicts, depression or repressed hostility. Tension headaches often respond to over-the-counter tension headache treatment. Aspirin, acetaminophen or ibuprofen are commonly used for tension headache treatment.

But Dr. Jaime Lopez, assistant professor of neurology and neurosurgery at Stanford University School of Medicine, cautions against taking too many over-the-counter medications to treat tension-type headaches. "If you have frequent headaches and find yourself taking more and more over-the-counter medication, you could set yourself up for rebound headaches." Rebound headaches occur when you stop taking the headache medication.


Dr. Lopez advises that you see a doctor if you regularly take the maximum dosage of an OTC painkiller two or more times a week. Your doctor can better diagnose the cause of your headache and prescribe an appropriate treatment.

Non-Drug Headache Treatments

Treatments that address the underlying causes of the headache, such as stress or depression, are particularly effective for regular or chronic tension-type headaches. Chronic, severe tension headaches may also require prescription medications.

Tension-type headache treatments include:


  • Biofeedback Biofeedback helps control the body's responses, including blood flow, blood pressure, and pulse rate. Techniques for achieving biofeedback include relaxation techniques, imagery, and self-hypnosis. For more information on biofeedback and finding a biofeedback professional, see Headache Resources.
  • Relaxation Techniques Like biofeedback, these techniques can significantly reduce the effects of stress on your body, including, but not limited to, your headaches. For more information on simple relaxation techniques you can try yourself, see Relaxation.
  • Psychological Counseling Chronic tension-type headaches can be manifestations of underlying depression or anxiety, which can be offset with counseling.
  • Quitting Smoking Smoking is a risk factor for every type of headache because it constricts blood vessels and depletes oxygen and blood flow to the head.
  • Regular Habits Getting enough sleep, eating a healthy diet, and having a regular exercise schedule all help to reduce tension-type headache risk.

Headache Medications

Over-the-Counter Headache Medications

Occasional tension-type headaches generally respond to such over-the-counter medications as aspirin, acetaminophen (Tylenol), ibuprofen (Motrin), indomethacin (Indocin) sulindac (Clinoril) naproxen sodium (Aleve), tolmetic (Tolectin) and meclofenamate (Meclomen).

One recent study found that a combination of ibuprofen and caffeine was used successfully to treat episodic tension-type headaches. The medication is not available in the U.S., but the amount of caffeine included in the medication was equivalent to two large cups of coffee.


Prescription Headache Medications

Chronic and occasional serious tension-type headaches that do not respond to over-the-counter medications may require treatment with prescription medications. These include:

  • Acetaminophen mixed with codeine This combination can be prescribed for occasional serious headaches that do not respond to over-the counter medications. Addiction and possible rebound headaches make these advisable only occasionally.
  • Antidepressants Antidepressants, particularly the tricyclics, are used to prevent chronic tension headaches. They can treat both the headache and its underlying cause.
  • Tranquilizers Tranquilizers can be used for short periods when treating chronic tension headaches, but these are highly addictive. The treatment must be monitored carefully.