Treatment:

Understanding your headache triggers can help you avoid situations that cause your headaches. A headache diary can help you identify your headache triggers. When you get a headache, write down the day and time the pain began. The diary should include notes about what you ate and drank in the last 24 hours, how much you slept and when, and what was going on in your life immediately before the pain started. For example, were you under any unusual stress? Also include information about how long the headache lasted, and what made it stop.

Hot or cold showers or baths may relieve a headache for some people. You may need to make lifestyle changes if you have chronic tension headaches. This may include changing your sleep habits (usually to get more sleep), increasing exercise, and stretching the neck and back muscles. In some situations, you may need to change your job or recreational habits.

Over-the-counter painkillers such as aspirin, ibuprofen, or acetaminophen may relieve pain if relaxation techniques do not work. If you are planning to take part in an activity that you know will trigger a headache, taking one of these painkillers beforehand may be helpful.

Narcotic pain relievers are sometimes prescribed. Remember that pain medications only relieve headache symptoms for a short period of time. After a while, they do not work as well or the help they provide does not last as long. Regular, overuse of pain medications can lead to rebound headaches.

Other prescription treatments may include:

• Muscle relaxants such as tizanidine
• Selective serotonin-reuptake inhibitors (SSRIs) such as paroxetine (Paxil) or citalopram (Celexa) taken daily to help prevent or decrease the number of headaches
• Tricyclic antidepressants such as amitriptyline, nortriptyline, or doxepin taken daily to help prevent or decrease the number of headaches

Combining drug treatment with relaxation or stress-management training, biofeedback, cognitive behavioral therapy, or acupuncture may provide better relief for chronic headaches.

Botox (botulinum toxin) is becoming popular as a treatment for chronic daily headaches, including tension headaches. However, it is currently not approved for such use.

Expectations (prognosis):

Tension headaches usually respond well to treatment without residual effects.

Although they are not medically dangerous, chronic tension headaches can have a negative impact on the quality of life and work productivity.

Complications:

Rebound headaches -- headaches that keep coming back -- may occur from overuse of painkillers.

It's important to see a doctor if you have chronic headaches. In some cases, the headache may be a symptom of a more serious disorder.

Calling your health care provider:

Call 911 if:

• You are experiencing "the worst headache of your life"
• You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before
• Your headaches are more severe when lying down
• The headache starts very suddenly

Also, call your doctor if:

• Your headache patterns or pain change
• Treatments that once worked are no longer helpful
• You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
• You are pregnant or could become pregnant -- some medications should not be taken when pregnant

See the general article on headaches for more emergency headache symptoms