Tension headache

Earlier used terms: tension headache, muscle contraction headache psychomyogenic headache, stress induced headache, common headache, essential headache, idiopathic headache and psychogenic headache.

Individual suffering of the victims varies greatly for tension headaches. While most patients don’t or barely mention their tension headaches as “regular” headaches and are and are not in need of therapy, chronic continuous headaches sometimes take over the whole life.


Tension headaches are separated into two groups, depending on the frequency with which they appear: episodic (< 15 days/month) and chronic (15 or more days/month).

Episodic tension headache (diagnostic criteria IHS-2003)

A. At least 10 episodes which fulfill criteria B-D and exist, for the sporadic form, on average on < 1 days/month (< 12 days/year) and for the more frequent form on 1 or more days/month but < 15 days/month for at least 3 months (12 or more and less than 180 days/year).

B. The duration of the headache is between 30 minutes and 7 days.

C. The headache has at least 2 of the following characteristics:

– localised on both sides

– quality of the pain is pressing or restrictive, not throbbing

– light to medium strength pain

– no intensification with physical routine activity such as walking or climbing stairs

D. Both characteristics need to be fulfilled:

– no nausea or vomiting (lack of appetite can occur)

– no photophobia or phonophobia, but both can occur

E. Not connected to any other disorder

Next to the chronological differentiation, the IHS classification allows another differentiation of the above described main form of tension headaches into a form associated with pericranial sensitivity to pain (verified by manual palpation) or not associated with pericranial sensitivity to pain.


Tension headache is the most common primary type of headache. The distribution among the sexes is even. The lifetime prevalence of the chronic form of tension headaches is about 3 % in Europe, about 38-77 % of the episodic form.


The therapy of tension headaches is distinctly dependent on the chronological course. While acute therapy is often in the foreground of the episodic form, it is the non-medication and medication prophylaxis for the chronic form.

Acute therapy for tension headaches

The few controlled studies verify the empirical effectiveness of acetylsalicylic acid, paracetamol and non-steroidal antiphlogistics. In any case, the maximum frequency of these analgetics is limited to 10 days/month because otherwise, just as with migraine, the development of headaches because of medication overuse is possible. This makes treatment alternatives to analgetics even more important.  In controlled studies, the use of peppermint oil (10% ethanolic solution of oleum menthae pipertae) applied on the skin of the painful regions of the head has proven to be effective.

Medicinal prophylaxis of tension headaches

The possibilities of medicinal prophylaxis are limited. Firstly, tricyclic antidepressants are used, whereas only a convincing verified effect exists for amitriptylin. Other antidepressants, especially selective serotonin re-uptake inhibitors, show to be subordinate to amitriptylin in a direct comparison of studies. Trials with muscle relaxants such as Baclofen, Dantrolen or Tizanidin were not satisfying, because of a poor effect as well as poor tolerance (central side effects)

Non-medicinal prophylaxis

Non-medicinal prophylaxis has a high significance for tension headaches. The acquiring and regular use of progressive muscle relaxation according to Jacobson is not only supposed to allow a general relaxation as it is the goal for patients with lasting muscular or psychosocial stress, but it is also supposed to allow the possibility of coordinated relaxation directly during a stressful situation.

The EMS biofeedback is used for the visualization of tension and relaxation statuses for patients who have difficulty controlling their muscle tone with the pmr alone.

A stress management training is aimed at teaching strategies for coping with typical stressful everyday situations.

Especially patients with chronic tension headaches experience their life as a constant over-straining situation. If a depressive disorder develops, a medicinal and/or psychotherapeutical treatment might be necessary.

Physical measures such as local heat treatments and massages are mostly effective for a short time but can be an important temporary relief for patients and have their significance. The transcutaneous electric nerve stimulation (TENS) has proven to be helpful in individual cases.