245 5th Avenue, 3rd floor
NY, NY 10016



How to Effectively Deal with Tension Headaches and Recognize Red Flag Symptoms of a Headache

by | December 16, 2019

How to Effectively Deal with Tension Headaches and Recognize Red Flag Symptoms of a Headache

I often get asked about natural ways to effectively deal with tension type headaches. If you suffer from frequent or chronic tension headaches, you have likely wondered if you can avoid or reduce the use of pain killers such as ibuprofen and acetaminophen. Instead, you want to get to the bottom of your headaches, find the causes and triggers, and integrate less invasive approaches to dealing with your headaches.

I’m going to share three things with you in this article. I will write about what tension type headaches are and evidence-based approaches to treating and preventing tension type headaches. I will also tell you about RED FLAG symptoms of a headache that you must know about and that warrant immediate medical attention.

Treatment of a headache depends on what type of a headache it is, as well as what triggered it. Today we will focus on tension type headache, which is the most common type of headache. I am going to talk about not only how to treat a headache, but how to prevent it, because, let’s face it, the end goal is to eliminate headaches, or at the very least, reduce their frequency. 

What is a Tension Headache?

Tension headache affects both sides of the head (unlike migraine headaches which tend to be one-sided) and people may describe it as having a band-like distribution around their head. A tension headache is typically mild to moderate in intensity. Tension The pain is generally dull, aching or feels like a tightness, unlike migraine headaches, which typically present with throbbing pain. Muscle tenderness in the head, neck or shoulders can be present.

Tension type headaches can be classified into the following categories:

  1. Infrequent episodic tension headaches. These headaches occur less than 1 day per month.
  2. Frequent episodic tension headaches. These headaches are more frequent than 1 day/month, but less than 2 weeks per month. 
  3. Chronic tension headaches.

If you have tension headaches that last for hours or are continuous, and occur 15 or more days out of a month for at least 3 months, these are called chronic tension headaches.

What Causes Tension Headaches?

There are many mechanisms thought to be causing this type of headache, but we have more to learn about how these interact and how exactly they cause our symptoms. As in most chronic conditions, there are genetic factors (especially in chronic tension headaches), as well as environmental factors that influence headaches. It was thought for a long time that tense muscles of the neck and scalp were the cause of this headache, but this is no longer considered to be valid. Increased sensitivity of pain pathways of the nervous system are thought to be the main mechanism of tension type headaches. Inflammation is also thought to be involved, especially in those suffering from chronic tension headaches.


Tension type headache has been correlated to stress, anxiety and depression. It is, therefore, crucial that any underlying anxiety and depression be effectively addressed. This may be done through evidence-based conventional, integrative and functional medicine modalities. It is also important that we learn to effectively cope with stress through daily practices that support our mental health. It’s crucial that we get enough sleep (8 hours per night at least), practice mindfulness, practice gratitude, work with a coach and/or a therapist, and have our tribe of close friends and family members. Effective coping with stress may also include doing yoga, exercising regularly, or doing another type of physical activity on a regular basis. Making sure that we are properly hydrated and that our blood sugar is balanced is also important. This can be achieved by eating healthy, balanced meals regularly and avoiding processed food and added sugar. Posture and neck mobility has also been linked to tension type headaches. Certain foods, food additives, caffeine or alcohol can exacerbate headaches, although food triggers are more common in migraines than tension type headaches. Other preventative modalities that have shown benefit include biofeedback, relaxation training and cognitive behavioral therapy, however more research is needed. Similarly, acupuncture and physical therapy may be tried, but more research is needed to determine if these are beneficial. 

What Medications are Commonly Recommended for Tension Type Headaches?

Pharmacological treatments for acute treatment of headaches include non-steroidal anti-inflammatory medications (such as ibuprofen) and acetaminophen. 

Pharmacological treatments used to prevent headaches include medications from the antidepressant classes including tricyclic antidepressants (such as amitriptyline and nortriptyline). Other antidepressants (such as mirtazapine and venlafaxine) have been used in smaller studies, but the data is limited, and more research is needed. Seizure medications have been used to reduce the frequency of headaches as well. These include topiramate and gabapentin. More research is needed to determine their efficacy. Trigger point lidocaine injections also show promise and can be helpful in reducing headaches in individuals suffering from chronic and frequent tension headaches.

It is important to talk to your doctor if you have headaches. It is also important to examine possible triggers, and to work on your self-care to prevent headaches. The better and more consistently you take care of yourself, the better you will feel. When you feel better, you will be able to experience more joy and do things that bring you joy. You will also get to show up for people in your life in the way you want to and do things you love with passion and energy!

What are Red Flags of a Headache?

Now let’s talk red flags. Red flag characteristics of headaches include neurological symptoms such as vision changes, difficulty producing speech, confusion, numbness or weakness. A headache accompanied by a fever and/or a stiff neck is also a red flag. Similarly, any abrupt or severe headache needs immediate attention. Headaches exacerbated by physical activity also require prompt medical attention. If the headache has any of these characteristics listed, or is so severe that it is “the worst headache” of your life, it is important to seek medical help right away. 

If the characteristics of your headaches have changed, they have become more frequent or if you are over 50 years old with new headaches, see your healthcare professional for evaluation.

For treatment of migraine headaches, see my article on How to Take Charge of Your Migraines.




and references hyperlinked in the article

None of the information in this article is a representation or warranty that any particular drug or treatment is safe, appropriate or effective for you, or that any particular healthcare provider is appropriate for you.  Never disregard professional medical advice or delay seeking help from a health care provider due to something you have read or seen in this article.  Your reading/use of this article does not create in any way a physician-patient relationship, any sort of confidential, fiduciary or professional relationship, or any other special relationship that would give rise to any duties.  This article does not recommend or endorse any specific tests, healthcare providers, procedures, or treatments, and if you rely on any of the information provided by this article, you do so solely at your own risk.

Interested in becoming a patient?

Contact us for a complimentary discovery call with Dr. Bojana

About the Author

Dr. Bojana

Dr. Bojana

Dr. Bojana (Boy•ana) Jankovic Weatherly is an award winning physician, double board certified in internal and integrative medicine. After completing internal medicine residency, she did a fellowship in integrative medicine, trained in functional medicine, nutrition and mindfulness. Her approach is rooted in evidence-based medicine that is personalized to each individual she works with.


Submit a Comment

Your email address will not be published. Required fields are marked *

Pin It on Pinterest

Share This