A tension headache is the most common headache, and yet it's not well understood. Tension headache generally produces a diffuse, usually mild to moderate pain over your head. Many people liken the feeling to having a tight band around their head. A tension headache may also cause pain in the back of your neck at the base of your skull. Although headache pain sometimes can be severe, in most cases it's not the result of an underlying disease.
The vast majority of headaches are so-called primary headaches. Besides tension headaches, these include migraines and cluster headaches. In many cases, there's no clear cause for a tension headache. Fortunately, effective treatments for tension headaches are available. Managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately. In addition, a number of preventive, self-care and alternative treatments may help you deal with headache pain.

Symptoms
A tension headache can last from 30 minutes to an entire week. You may experience these headaches occasionally, or nearly all the time. If your headaches occur 15 or more days a month for several months, they're considered chronic. Unfortunately, chronic tension headaches sometimes persist for years. A tension headache may cause you to experience a dull, achy pain or sensation of tightness in your forehead or at the sides and back of your head. Many people liken the feeling to having a tight band of pressure encircling their heads. In its most extensive form, the pain feels like a hooded cape that drapes down over the shoulders. The headache is usually described as mild to moderately intense. The severity of the pain varies from one person to another, and from one headache to another in the same person. Many people report that the pain starts first thing in the morning or late in the day when work stress or conflict at home is anticipated.

Causes
The exact cause or causes of tension headache are unknown. Until a few years ago, many researchers believed that the pain of tension headache stemmed from muscle contraction in the face, neck and scalp, perhaps as a result of heightened emotions, tension or stress. But many researchers have questioned this idea. More recent research discredits this theory. Studies using a test called an electromyogram, which records the electric currents generated by muscle activity, haven't detected increased muscle tension in people diagnosed with tension headache. In addition, people with migraine have as much muscle tension as do people with a tension headache, if not more. As a result, The International Headache Society uses the term "tension-type headache" instead of "tension headache," calling attention to the fact that muscle tension may not be the main cause of this kind of head pain.

Treatment
A variety of medications, both over-the-counter (OTC) and prescription, are available for treating tension headache. You may find fast, effective relief by taking pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others). These medications are inexpensive and readily available and don't require a prescription from your doctor. People with severe or chronic tension headaches may require stronger painkillers or preventive medications to reduce the frequency and severity of head pain. Which drug works best varies from one person to another. Whether you have episodic or chronic headaches, don't overuse OTC medications. Limit your use of painkillers to two days a week. Try to take the medications only when necessary, and use the smallest dose needed to relieve your pain. Overusing pain medications can cause rebound headaches or the development of chronic daily headaches, triggering the very symptoms you're trying to stop. In addition, all medications used to treat headache have side effects, some of which may be serious. For prescription medications, of course, follow the recommended dosage and do not exceed it.

Acute therapy
Acute therapy aims to stop or reduce the pain of an existing headache attack. Many different medications are used for the acute treatment of tension headache:

• Analgesics are pain relievers. Acetaminophen (Tylenol, others) and a class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in reducing headache pain. Side effects of acetaminophen are rare, but if you take the drug in large doses for long periods of time, it can cause serious liver damage. NSAIDs include the OTC drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Prescription NSAIDs include naproxen (Naprelan, Naprosyn), indomethacin (Indocin) and ketorolac tromethamine (Toradol). Side effects include nausea, diarrhea or constipation, stomach or abdominal pain, stomach bleeding, and ulcers. You can reduce or eliminate these symptoms by taking NSAIDs after meals or with milk.
• Combination medications. Aspirin or acetaminophen (or both of these analgesics) are often combined with caffeine or a sedative drug in a single medication. For example, Excedrin combines aspirin, acetaminophen and caffeine. Combination drugs such as this may be more effective than are pure analgesics for pain relief. Although many combination drugs are available over-the-counter, analgesic-sedative combinations can be obtained only by prescription because they may be addictive and can lead to chronic daily headache. Don't use these drugs more than two days a week, and use them only with careful monitoring by your doctor.
• Other medications. For people who experience both migraine and episodic tension headaches, a triptan can effectively relieve the pain of both headaches. Opiates, or narcotics, are rarely used because of their side effects and potential for dependency. These include codeine combined with acetaminophen (Tylenol With Codeine No. 3).

Medications don't cure headaches, and over time painkillers and other medications may lose their effectiveness. In addition, all medications have side effects. If you take medications regularly, including products you buy over-the-counter, discuss the risks and benefits with your doctor. Also, remember that pain medications aren't a substitute for recognizing and dealing with the stressors that may be causing your headaches