Tension headache

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In medicine, tension headache, also called tension-type headache, stress headache or idiopathic headache, is a "common primary headache disorder, characterized by a dull, non-pulsatile, diffuse, band-like (or vice-like) pain of mild to moderate intensity in the head; scalp; or neck. the subtypes are classified by frequency and severity of symptoms. there is no clear cause even though it has been associated with muscle contraction and stress.[1][2]


Criteria for diagnosis are available.[2][3]


Tricyclic antidepressant

Tricyclic antidepressants may be effective and may be more effective than second-generation antidepressants acccording to a systematic review.[4] Another systematic review concluded that it is not clear whether any medications taken daily can prevent tension headaches.[5] However, several randomized controlled trials of antidepressant agents included in the systematic review were positive.

Randomized controlled trials of amitriptyline cited by Verhagen et al for prevention of headache.[5]
Trial Author's conclusion
Ashina[6][7] "The lower platelet 5-HT during treatment with citalopram than amitriptyline indicates that 5-HT reuptake was most effectively inhibited by citalopram. In contrast, amitriptyline was most effective in reduction of headache."
Göbel[8] "In the amitriptyline group, a significant reduction in daily headache duration was already found in the 3rd week of treatment."
Holroyd[9] "Cognitive-behavioral therapy and amitriptyline each yielded clinically significant improvements in headache activity...Neither treatment, however, eliminated headache problems.." (no placebo group)
Holroyd[10] "Our results indicate that antidepressant medication and stress management therapy are each modestly effective in treating chronic tension-type headaches. "
Pfaffenrath[11] "Treatment response occurred in 30.3% of the amitriptylinoxide, 22.4% of the amitriptyline and 21.9% of the placebo group."

Botulinum toxin

Botulinum toxin may have small benefit.[12]


  1. Anonymous (2023), Tension headache (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 2.0 2.1 International Headache Society. IHS Classification ICHD-II Tension-type headache
  3. Ad Hoc Committee on the Classification of Headache of the National Institute of Neurological Diseases and Blindness. Classification of headache. JAMA (1962) 179:717–8
  4. Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M et al. (2010). "Tricyclic antidepressants and headaches: systematic review and meta-analysis.". BMJ 341: c5222. DOI:10.1136/bmj.c5222. PMID 20961988. PMC PMC2958257. Research Blogging.
  5. 5.0 5.1 Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW (2010). "Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review.". Fam Pract 27 (2): 151-65. DOI:10.1093/fampra/cmp089. PMID 20028727. Research Blogging.
  6. Ashina S, Bendtsen L, Jensen R (2004). "Analgesic effect of amitriptyline in chronic tension-type headache is not directly related to serotonin reuptake inhibition.". Pain 108 (1-2): 108-14. DOI:10.1016/j.pain.2003.12.012. PMID 15109513. Research Blogging.
  7. Bendtsen L, Jensen R (2000). "Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache.". Cephalalgia 20 (6): 603-10. PMID 11075846.
  8. Göbel H, Hamouz V, Hansen C, Heininger K, Hirsch S, Lindner V et al. (1994). "Chronic tension-type headache: amitriptyline reduces clinical headache-duration and experimental pain sensitivity but does not alter pericranial muscle activity readings.". Pain 59 (2): 241-9. PMID 7892022.
  9. Holroyd KA, Nash JM, Pingel JD, Cordingley GE, Jerome A (1991). "A comparison of pharmacological (amitriptyline HCL) and nonpharmacological (cognitive-behavioral) therapies for chronic tension headaches.". J Consult Clin Psychol 59 (3): 387-93. PMID 2071723.
  10. Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW (2001). "Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial.". JAMA 285 (17): 2208-15. PMID 11325322. PMC PMC2128735.
  11. Pfaffenrath et al. Efficacy and Tolerability of Amitriptylinoxide in the Treatment of Chronic Tension-Type Headache: A Multi-Centre Controlled Study Cephalalgia April 1994 14: 149-155, DOI:10.1046/j.1468-2982.1994.1402149.x
  12. Jackson JL, Kuriyama A, Hayashino Y (2012). "Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis.". JAMA 307 (16): 1736-45. DOI:10.1001/jama.2012.505. PMID 22535858. Research Blogging.