This 39 year-old female presented to an outside institution with a 2 week history of chills and non-productive cough. Attention to lifestyle factors such as stress, posture, and exercise may help to prevent headaches.
It usually occurs on both sides of your head, and often spreads down your neck, or seems to come from your neck. So, some people may inherit a tendency to be more prone to develop tension-type headaches more easily than others when stressed or anxious. So, if you have a tension-type headache, a doctor's examination will be normal apart from the muscles around the head perhaps being a little tender when a doctor presses on them. A similar headache is also common if you don't have caffeine for a while and were used to drinking lots of caffeine-rich drinks, such as a lot of coffee - a caffeine withdrawal headache.
You think this is just another tension-type headache, and so you take a further dose of painkiller. When the effect of each dose of painkiller wears off, a further withdrawal headache develops, and so on. Also, there is nothing abnormal to find if a doctor examines you (apart from some tenderness of the muscles around the head when a headache is present).
Tests are not needed unless you have unusual symptoms, or something other than tension-type headaches is suspected. Compared to migraine (the other common type of headache that comes and goes), a tension-type headache is usually less severe, and is constant rather than throbbing. Also, migraine attacks usually cause a one-sided headache, and many people with a migraine attack feel sick or vomit. In general, unlike migraine, you are usually able to continue with normal activities if you have a tension-type headache. But note: you should not take painkillers for headache for more than a couple of days at a time.

On average, anti-inflammatory painkillers, rather than paracetamol, probably ease the pain in more people with headaches.
However, some people develop side-effects such as stomach problems, and paracetamol does work in a lot of people. So, it is probably best to see how you get on with paracetamol first before trying an anti-inflammatory painkiller.
Always read the leaflet which comes with the medicine packet for a list of possible side-effects and cautions. For example, if you are pregnant or breast-feeding, there are some restrictions on the use of anti-inflammatory painkillers. Aspirin Research trials suggest that aspirin, at full dose, is probably the most effective drug for easing a tension-like headache. In one study, 3 in 4 people reported relief of headache two hours after aspirin, and relief was not affected by pain intensity at the time of treatment. However, some doctors do not recommend aspirin, as it has an even higher risk of causing stomach side-effects than anti-inflammatory painkillers have.
Bearing this in mind, you may wish to try aspirin if you do not tend to get much relief from paracetamol or anti-inflammatory painkillers. Read the leaflet which comes with the medicine packet for a list of possible side-effects and cautions. Other painkillers Opiate painkillers such as codeine, dihydrocodeine and morphine are not normally recommended for tension-type headaches. This includes combination tablets that contain paracetamol and codeine, such as co-codamol. They are also the most likely type of painkiller to cause medication-overuse headache if used regularly (described earlier). People who take opiate painkillers are also at increased risk of developing chronic tension-type headache.

Breathing and relaxation exercises, or coping strategies, may ease anxiety in stressful situations and prevent a possible headache. It is an antidepressant medicine and you have to take it every day with the aim of preventing headaches. So, although amitriptyline is classed as an antidepressant, it is not used here to treat depression.) A low dose is started at first and may need to be increased over time. As a general rule, if you are regularly having tension-type headaches more than four times a month then it is best to discuss things with a doctor.
It is thought that preventative treatment sooner rather than later is best before headaches become very frequent.
This may prevent frequent episodic tension-type headaches from becoming chronic tension-type headaches. The goals of preventative treatment are to reduce the frequency and intensity of headaches.
So, with treatment, the headaches may not go completely, but they will often develop less often and be less severe. Any headache that does occur whilst taking preventative medication may also be eased better than previously by a painkiller. Therefore, it is best to keep a headache diary for a couple of weeks or so before starting preventative medication. This is to record when and how severe each headache was, and also how well it was eased by a painkiller. Then, keep the diary going as you take the preventative medicine to see how well things improve.

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