When to call the Doctor

People with episodic or chronic tension-type headache who experience a change in severity or frequency should consult with a doctor.

People without a history of headache   who are older than 50 years and experience pain in the temporal region (near the temple on the head) should see a doctor to be evaluated for temporal arteritis  . In addition, those older than 50 years with new-onset headache should be evaluated for possible malignancy.

When headache is associated with signs of infection, such as fever  , rash, or stiff neck, a doctor should be seen to rule out conditions like meningitis, encephalitis, or Lyme disease.

Persons with new-onset headache who either have risk factors for HIV infection, or who have HIV infection or cancer, may need imaging studies to rule out meningitis  , brain abscess, or the spread of cancer  .

When to go to the hospital

Certain headaches may indicate a more serious underlying problem. In these cases, the person should seek immediate medical attention at a hospital emergency department.

• People who may or may not have a history of headache and feel they are experiencing the worst headache of their life should seek emergency help, especially if the headache feels "explosive" and came on suddenly. This may suggest bleeding within or around the brain. The sudden onset, not necessarily the severity of the pain, is a signal that people with such headaches should be checked.
• People with headache and other associated symptoms, such as loss of vision in one eye, weakness on one side of the body, slurring or garbled speech, or inability to understand and follow commands, should be evaluated at once.
• Any person, but especially an elderly person, who sustains any form of trauma associated with the onset of headache must be evaluated in an emergency department.

Self-Care at Home

Most people with tension-type headache   find relief with over-the-counter medications such as aspirin, acetaminophen, and other nonsteroidal anti-inflammatory drugs (NSAIDs).

• Certain people may require prescription-strength pain relievers for particularly severe episodes.
• Frequent use of medications to treat symptoms of headache may actually cause episodic tension-type headache to become chronic in nature.

Follow-up

People with the diagnosis of tension-type headache should take medications as directed and arrange a return visit to the doctor in 1-2 weeks. At that time, the doctor can make medication adjustments or provide further diagnostic work if the diagnosis remains uncertain.

• Medical attention should be sought immediately if new symptoms or a profound change in symptoms are experienced.
• If a person has depression   or anxiety disorders  , or if he or she simply overuses medications, detoxification is necessary before effective treatment can begin. Some people with very complex situations may benefit from combinations of medications. In these cases, the doctor may make referrals to neurologists, psychiatrists, or anesthesiologists.

Prevention

Medications used for prevention of tension-type headache include antidepressants, beta-blockers, and anticonvulsants. These medications are usually worth trying, but they are more likely to be effective if the person also has migraine or cluster headaches. Most doctors choose to start with the newer generation antidepressants, which have fewer side effects, and gradually increase the dose to reach a therapeutic effect. Antidepressants may have to be tried for 1-2 months to determine if they help.

Outlook

Tension-type headache is a harmless medical condition that responds well to over-the-counter pain relievers taken when an occasional headache strikes. Some people with episodic tension-type headache overuse medications and cause headaches to progress into chronic tension-type headaches.

At present, no studies associate tension-type headache with the development of more severe or life-threatening medical conditions. Additionally, no studies specifically evaluate chronic tension-type headache. The outlook for people with chronic tension-type headache is not well understood.