There are different kinds of headaches. Most people get tension headaches. When you have a tension headache, you may feel a constant ache, tightness, and pressure around your forehead, temples, or the back of your head and neck. It may feel like your head is in a vise.

Tension headaches usually cause mild to moderate pain. Most of the time, they aren’t bad enough to stop you from doing your daily tasks. But some people have very bad headaches that last a long time. These headaches can disrupt your life.

Tension headaches tend to come back, especially when you’re under stress. They can last from 30 minutes to several days.

If you have tension headaches for 15 days or more a month for 3 months, you may have chronic tension headaches. Some people who have chronic headaches also have anxiety and depression.

The cause of tension headaches is not clear. Doctors used to think that these headaches were caused by tension or spasms in the muscles of the neck, face, jaw, or head. Now they think that a change in brain chemicals may also cause these headaches.

First try over-the-counter pain medicines to manage your headaches. Be safe with medicines. Read and follow all instructions on the label.

Nonprescription medicines for headaches include:

• Acetaminophen (such as Tylenol).
• Aspirin (such as Bayer).
• Ibuprofen (such as Advil).
• Naproxen (such as Aleve).
• Combination medicine that includes aspirin, acetaminophen, and caffeine (such as Excedrin).

If the nonprescription medicines above don’t work to stop your headaches, or if you take them more than 3 times a week or have a headache more than 15 days a month, your doctor may recommend you take a prescription medicine every day to help prevent headaches.

Your doctor may also suggest ways to reduce stress and anxiety as a way to manage your headaches.

Your doctor may have you try one of more of the following medicines to help prevent your headaches:

• Antidepressants, such as amitriptyline.
• Seizure medicines, such as gabapentin, topiramate, and valproate.
• Antianxiety medicines, such as buspirone.

Often the best way to treat chronic tension headaches is to use medicine along with treatments that reduce stress and anxiety, such as cognitive-behavioral therapy.

Even with treatment, you may still get some tension headaches. But studies have shown that:

• When you take them each day, antidepressants like amitriptyline can reduce how often you get tension headaches and how bad they get.^{footnote 1}
• Seizure medicines may be able to reduce how often you get tension headaches and how long they last.^{footnote 2}
• The medicine tizanidine may help prevent tension headaches.^{footnote 3}
• The antianxiety medicine buspirone may be able to reduce how often you get tension headaches by reducing anxiety.

You’ll need to take medicine every day, even when you don’t have a headache.

If you don’t feel better after a few weeks of taking the medicine, talk to your doctor. You may need to try several different medicines to find one that works for you.

The medicine can cause side effects. Some of these side effects may last for a few weeks or for as long as you take the medicine. You may need to decide which bothers you more, the side effects of the medicine or your headaches.

Common side effects include:

• Dry mouth.
• Constipation.
• Blurred vision.
• Inability to urinate.
• Weight gain.
• Low blood pressure when you stand up quickly.

Serious side effects can also happen. When taken during pregnancy, anticonvulsants can cause birth defects.

What else can you do to manage your tension headaches?

Some people find other ways to manage headaches besides taking medicine. These include:

• Acupuncture. Tiny needles are put into certain points on your skin to relieve pain. Current evidence shows that acupuncture can help prevent tension headaches.^{footnote 4}
• Biofeedback. With this treatment, you can learn to control a body function that is not normally under your conscious control, such as breathing or muscle tension.
• Cognitive-behavioral therapy or problem-solving therapy. This kind of counseling can help you reduce stress and anxiety.
• Relaxation exercises. These help you learn how to relax each muscle group.
• Electrical nerve stimulation. A mild electrical current is used on specific parts of your body to help treat pain.
• Peppermint oil. There is some evidence that peppermint oil rubbed on the temples or on the tight muscles in the head, neck, and shoulders may help relieve tension headaches.

Here are some things you can do at home:

• Figure out what may cause your tension headaches. Is it stress, anxiety, fatigue, hunger, anger, poor posture, or eye or muscle strain? Are you doing too much? It may help to keep a headache diary to track how often you have tension headaches, how painful they are, and what you think might be causing them.
• Get plenty of exercise, eat healthy foods, and get enough sleep.
• Use good posture to avoid muscle tension.

Your doctor may advise you to take prescription medicine if:

• You have tension headaches on 15 or more days a month.
• You use over-the-counter medicines to stop a headache more than 3 times a week.
• Your tension headache lasts 7 days or more.
• You have tried over-the-counter medicines, but they don’t help.