Timothy C. Hain, MD • Page last modified: August 20, 2020

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Tension headache is defined as band-like pain encircling head and radiating down head. It is usually bilateral, and usually relieved by sleep. Tension headache is often precipitated by stress and/or poor sleep. Tension headache does not awaken one from sleep, but sleep may be disturbed by coincident anxiety or depression.

Just because a headache is associated with stress doesn't prove that it is tension headache. Many headaches are worsened by tension

Some authors do not believe tension headache is a distinct entity from Migraine (e.g. Sapir et al, 1993; Silberstein, 1992). We agree.

There are numerous headaches that have the same time pattern (i.e. constant) as tension headache.

Tension headaches are generally posterior or band-like. The main alternative to tension is cervical headache (for posterior location).


Treatment of tension headache is generally eclectic: Common measures include

Recently a controlled trial comparing treatment with amitriptyline and stress management was completed by Holroyd and associates (2001). They concluded that both amitriptyline and stress management were more effective than placebo, but that amitriptyline was more rapid. Combined therapy was the best.


A young urban professional who states that their occupation is a "consultant", comes complaining of a chronic headache. Their job is working doing "financial audits". They fly about once/week. When you ask them -- how many hours do you work/day -- their answer is "14-16". When you ask them -- do you relax on the weekend, they say "no, I work all weekend too". When you ask them -- "do you think that your heavy work schedule has anything to do with your headaches ? They answer "No, I don't think so".