Tension headaches usually start at the back of your head and move forward, covering your whole head with a steady, dull pain.

• The headache starts at the back of your head and spreads.
• Dull pressure or a squeezing pain lasts from half an hour to several hours or days.
• Muscles in your neck, shoulders, and jaw are tight and sore.
• Aching usually continues through the day.
• Your headache does not feel worse if you move about.

When you feel tense, the muscles in your shoulders, neck, and jaw tighten up and press on blood vessels surrounded by nerves, making those nerves send pain messages to your brain. Causes include the following.

• Sitting too long or in an uncomfortable position
• Premenstrual syndrome (PMS)
• Low blood sugar
• Food allergy
• Not enough sleep; not enough fluids
• Clenching your jaw or grinding your teeth
• Pain that originates from other areas, such as your sinuses
• Stress
• Depression or anxiety

Your health care provider will ask questions about your headaches, such as when they occur and how long they last. Your provider may run tests to rule out medical problems that could be causing your headaches.

Stress avoidance and stress management can prevent recurrence of tension headaches. Biofeedback, yoga, and relaxation techniques can be quite effective for both acute relief and decreasing headache frequency. Regular exercise can also reduce how often you get a tension headache. Most people respond well to nonprescription pain relievers, but your health care provider will prescribe painkillers if necessary.

• Over-the-counter pain relievers (analgesics) are usually effective temporary remedies; consult your physician for the proper use of analgesics to prevent recurrring headaches. Caffeine enhances effect of analgesics for some people; excessive caffeine or caffeine withdrawal may itself cause headaches. Prescription analgesics containing codeine or oxycodone relieve severe headache.
• For acute attacks, a physician may prescribe a non-steroidal anti-inflammatory drug (NSAID) such as naproxen (500 mg 2 times a day) or ibuprofen (400 mg 3 times a day)
• For prevention of chronic headache, antidepressants: such as amitriptyline (50 to 100 mg/day) and imipramine (50 to 100 mg/day) may be used
• Beta-blockers such as propanolol (80 mg/day) and atenolol (50 to 100 mg/day) may also be used preventively

Main emphasis of therapies is muscle relaxation and stress management.

• Replacing micronutrients depleted in times of stress is essential; the most critical are the vitamins C, E, beta-carotene, B-complex, and the minerals magnesium, potassium, calcium, zinc, manganese, and selenium. Magnesium (aspartate or glycinate, up to 750 mg per day) is especially critical because of its antispasmodic action.
• Avoid caffeine.
• Essential fatty acids can improve blood flow. Reduce animal fats and increase fish. A mix of omega-6 (evening primrose) and omega-3 (flaxseed) oils may be best (2 tbsp. oil per day or 1,000 to 1,500 IU twice a day).
• Vitamin E: 400 to 800 IU/day may decrease muscle cramping.
• Elimination diet: Some tension headaches respond dramatically to this approach. The most common allergic foods are wheat, dairy products, corn, soy, and chocolate. Eliminate these foods completely for 2 weeks, then reintroduce the foods one at a time, every 3 days, and note reactions. Citrus, alcohol, red meat, flour products, spices, and carbonated drinks may also aggravate headaches.
• Calcium/magnesium: 1,000/500 mg per day may help regulate muscle contraction and relaxation.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Peppermint (Mentha piperita) oil is effective against tension. Add two drops of peppermint essential oil to 1 cup of water. Soak a cloth in the solution and apply as a compress.
• White willow bark (Salix alba) contains salicin, the pain reliever in aspirin. Do not use if you cannot take aspirin.
• Meadowsweet (Filipendula ulmaria) relieves pain, reduces nausea and heartburn, and helps relieve tension and digestive discomfort.
• Valerian (Valeriana officinalis) helps you relax and reduces spasms, and helps relieve tension with anxiety or digestive discomfort.
• Jamaican dogwood (Piscidia piscipula) helps you relax and relieves pain and spasms.
• Ginkgo (Gingko biloba) increases blood circulation to your brain, and can help relieve tension.
• Combine white willow (Salix alba), meadowsweet (Fillipendula ulmaria) and two of the above herbs. Herbs—1 tbsp. in 1 cup water three times a day. Tincture—60 drops three times a day.
• Kava kava (Piper methysticum)—45 to 60 mg of kavalactone content three times a day, has a calming effect if anxiety is prominent.

Studies indicate that homeopathy may be no more effective than placebo in relieving tension headaches. Interestingly, however, one of the most common reasons people seek homeopathic care is to relieve the pain associated with chronic headaches. Many homeopaths report that homeopathy helps treat and prevent recurrent tension headaches.

Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following remedies are commonly prescribed for tension headaches:

• Belladonna — for throbbing headaches that come on suddenly; symptoms tend to worsen with motion and light, but are partially relieved by pressure, standing, sitting, or leaning backwards
• Bryonia — for headaches with a steady, sharp pain that occurs most often in the forehead but may radiate to the back of the head; symptoms tend to worsen with movement and light touch, but firm pressure alleviates the pain; the person for whom this remedy is most appropriate is usually irritable and may experience nausea, vomiting, and constipation�
• Gelsemium — for pain that extends around the head and feels like a tight band of constriction; pain usually originates in the back of the head and may be relieved following urination; this remedy is most appropriate for individuals who feel extremely weak and have difficulty keeping their eyes open�
• Ignatia — for pain that may be described as a feeling of something being driven into the skull; these types of headaches tend to be triggered by emotion, including grief or anxiety, and the treatment is appropriate for both children and adults�
• Iris versicolor — for throbbing headaches that occur on one side of the head, especially after eating sweets; visual disturbances may also occur; these headaches are worse in the early morning, during spring and fall, and symptoms tend to worsen with vomiting�
• Lachesis — for headaches that tend to occur on the left side of the head; symptoms are typically worse in the mornings, before menstruation, and with exposure to warmth and sunlight; symptoms tend to improve with open air and firm pressure
• Nux vomica — for headaches associated with hangovers, overindulgence in foods or alcohol, and overwork; these types of headaches are often accompanied by nausea and/or dizziness; this remedy is most appropriate for individuals who tend to be constipated and irritable
• Pulsatilla — for headaches triggered by eating rich, fatty foods, particularly ice cream; pain tends to move but may be concentrated in the forehead or on one side of the head and may be accompanied by digestive problems or occur around the time of menstruation; children for whom this remedy is appropriate often develop these symptoms while at school�
• Sanguinaria — for right-sided headaches that begin in the neck and move upwards, recur in a predictable pattern (such as every seven days); pain is aggravated by motion, light, or sun exposure, odors, and noise; this remedy is appropriate for children who may have a craving for spicy or acidic foods, despite having a general aversion to eating due to the headache
• Spigelia — for stinging, burning, or throbbing sinus pain that often occurs on the left side of the head; symptoms tend to worsen with cold weather and motion but may be temporarily relieved by cold compresses and lying on the right side with the head propped up

You can do other things to avoid tension headaches or relieve pain.

• Biofeedback to control muscle tension.
• Using small circular motions, press acupressure points at the web between your thumb and index finger.
• Practice gentle neck stretches to ease tightness.
• Put an ice pack on your forehead. To increase the pain-relieving effect, soak your feet in hot water at the same time.
• Breathe deeply or try other relaxation exercises, such as yoga.
• Get regular exercise, especially for your back and abdomen.

An acupuncturist diagnoses headaches not as migraine, tension, or sinus, but rather as conditions deriving from "energetic" imbalances. Headaches are commonly seen and often successfully treated by acupuncturists.

The National Institutes of Health recommends acupuncture as a treatment for headache. Acupuncturists diagnose tension headaches by paying careful attention to the kidney and its associated meridians (bladder, small intestine), as well as liver and gallbladder meridians. The physical location of the headache also helps the acupuncturist to determine an appropriate treatment plan, which (in addition to needling) may include lifestyle/dietary changes or herbal remedies. While results from studies have been mixed, most researchers agree that acupuncture is safe and that headache patients who wish to try this therapy should not be discouraged from doing so.

Spinal manipulation is commonly used to treat tension headaches, especially tension headaches that originate in the neck. Evidence supporting the use of tension headaches that originate in the neck is quite clear; however, studies examining the effectiveness of spinal manipulation for other types of tension headaches have been less conclusive.

In one landmark study, individuals with tension headache were randomly assigned to receive spinal manipulation or an antidepressant medication. Both groups experienced significant improvement while they were being treated, but when treatment was stopped, the beneficial effects of spinal manipulation lasted a significantly longer period of time than did the effects of the antidepressant medication.

In a second study, individuals with tension headache were treated with either a combination of spinal manipulation and massage, or massage and a placebo laser treatment. Both groups experienced an improvement in symptoms, suggesting that spinal manipulation does not appear to add benefit to massage alone for the treatment of headaches.

Tension headaches may keep occurring if you do not treat the underlying causes. Exercise and stress reduction techniques will help.

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