How Tension-Type Headache Is Treated

Fifteen or more headache days a month, with migraine features present on at least eight of them. It is a numerical definition rather than a description of severity, and it determines candidacy for several preventive treatments. Episodic migraine, meaning fewer than fifteen headache days a month, is managed differently, so establishing which side of that line you sit on changes which options are open to you.

Because treatment decisions run on how many days a month are affected rather than how bad the worst day was. Most people underestimate their count substantially when reconstructing from memory, which is why a month of dates is worth more than any description. A written record of dates is the only thing that settles the count reliably.

Frequently. Migraine activates a pathway producing nasal congestion, facial pressure and tearing, which are exactly the symptoms people attribute to sinuses. Recurrent sinus headache without infection is uncommon, so episodic attacks with clear intervals point toward migraine. Sinus imaging in these patients is frequently normal, and that is often the point at which migraine is finally considered.

Yes. Acute headache medication taken frequently enough can sustain the headaches it was taken to relieve. It is common and not a failure of willpower, but addressing it usually has to come before or alongside a new preventive. The pattern to watch for is acute medication on more than about ten days a month, sustained across several months.

No. It is a defined headache disorder with its own diagnostic features and its own preventive treatment classes. Being told it is only tension is neither accurate nor useful, and chronic tension-type headache is disabling. Frequency again decides the approach: occasional attacks need effective acute treatment, while frequent ones need a preventive.

Because in this disorder the medication pattern is frequently the diagnosis. Milder attacks get self-treated with over-the-counter analgesics, frequency creeps up, and the medication begins sustaining the headaches it was taken to relieve. Coming off the overused medication is uncomfortable for a period, so it is planned deliberately and with support rather than attempted abruptly and alone.

A month is ideal and two weeks is useful. Record the date, roughly how bad it was, and what you took including anything bought without a prescription. That record is what establishes frequency, and frequency rather than severity decides which treatments are open to you, so it does more work than any description can.

Yes, and a normal scan is the expected finding in migraine. Imaging looks for a structural cause; it does not diagnose or exclude a headache disorder, which is established from the pattern. Bring the report rather than repeating the scan, because knowing it was normal changes what still needs considering.

Not abruptly, and not without a plan. Where an acute medication is being taken often enough to be sustaining the headaches, reducing it is planned deliberately alongside starting a preventive, because doing one without the other usually fails. Bring the bottles so the actual pattern can be seen rather than estimated.

The practice fields five board-certified neurologists and four advanced practice providers, and routing is by clinical question rather than by request. An advanced practice provider handles a great deal of continuity care well; a physician sees the presentations needing that depth. If you want to know in advance, ask when you book.