What is a Chronic Tension Headache?

Definition and Treatment Options

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5 Ways to Avoid a Tension Headache. Peter Augustin/Stone/Getty Images

Imagine having a "rubber-band around-the-head" pain almost every day. Not only does this headache inflict chronic pain, but it also negatively affects your quality of life. Let's review more of what a chronic tension headache is, and the treatment options for it.

Introduction

A chronic tension headache is a primary headache disorder – affecting approximately 2% of the population. Tension headaches are commonly referred to as "stress headaches" or "muscle contraction headaches." They are characterized by a tightening sensation that occurs on both sides of the head.

In the chronic form of this disorder, the headaches can occur daily – negatively impacting one's quality of life and daily functioning.

Symptoms and Diagnosis

Chronic tension headaches occur on 15 or more days per month on average for more than 3 months. They typically last hours or are continuous. Chronic tension headaches generally occur on both sides of the head, create a tightening sensation, and cause mild to moderate pain.

It is important not to confuse chronic tension-type headache with other chronic daily headache disorders like:

Treatment

Pharmacological therapy for sufferers of chronic tension headaches usually involves a preventive medication.

Amitriptyline (Elavil) is one medication that has been found to be beneficial in chronic tension headache prevention. Amitriptyline – a tricyclic antidepressant – is a sedating medication and is usually taken at bedtime.

Additional preventive medications that your doctor may consider include other antidepressants – like Remeron (Mirtazapine), or an anti-seizure medication – like Neurontin (Gabapentin) or Topamax (Topiramate).

Behavioral therapies are sometimes used alone or in combination with medication to prevent chronic tension headaches.

  Examples of behavioral therapies include:

  • Relaxation
  • Acupuncture
  • Electromyography (EMG) biofeedback
  • Cognitive-behavioral therapy (CBT)

In EMG biofeedback, electrodes are placed on the scalp, neck and upper body to detect muscle contraction. The patient is then trained to control that muscle tension in hopes of preventing a headache.  Cognitive-behavioral therapy involves learning how to identify headache triggers and cope with them in a more adaptive, less stressful manner. Overall, the data on the effectiveness of these therapies is inconsistent. Still, headache specialists will often recommend a behavioral therapy in addition to medication when devising a treatment plan for their patients.

Take Home Points

  • Chronic tension headache is an uncommon, debilitating form of a tension headache that occurs 15 or more days per month on average for more than 3 months.
  • Therapy for chronic tension headache often entails a preventive medication – like amitriptyline – to help reduce the number of headaches per month.
  • If you do suffer from nearly daily tension headaches, try not to be frustrated. Speak with your healthcare provider so you can undergo a proper diagnosis. Remain proactive in your headache health.

Sources

Gobel H et al.. Chronic tension-type headache: amitriptyline reduces clinical headache duration and experimental pain sensitivity but does not alter pericranial muscle activity readings. Pain. 1994 Nov;59(2):241-9.

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Hirsch M & Birnbaum RJ. Tricyclic and tetracyclic drugs: Pharmacology, administration, and side effects. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2013.

Jackson JL et al. Tricyclic antidepressants and headaches: systematic review and meta-analysis. BMJ, 2010 Oct 20;341:c5222.

Schwartz BS et al. Epidemiology of a tension-type headache. JAMA. 1998;279:381–3

Silver N. Headache (chronic tension-type). Am Fam Physician. 2007 Jul 1;76(1):114-6.

Taylor F. Tension-type headache in adults: Preventive treatment. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2013.

Verhagen AP, Damen L, Berger MY, Passchier J, & Koes BW. Behavioral treatments of chronic tension-type headache in adults: are they beneficial? CNS Neurosci Ther. 2009 Summer;15(2):183-205.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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