Learn to recognize and avoid triggers for tension headaches

Q: I get tension headaches fairly often. What's the best way to treat and prevent them?

A: Tension headaches are the most common type of headache. The pain — usually a dull tightness or pressure — may envelop your entire head, or it may strike only your forehead or the back or top of your head. (I've put an illustration showing where tension headaches usually strike on my website, AskDoctorK.com.)

Tension headaches occur when muscles of the scalp and the back of the neck tighten up. A variety of factors can trigger this muscle tightness. Common triggers include stress, missed meals, lack of sleep, fatigue, eyestrain, whiplash and poor posture. These same problems can worsen an existing tension headache.

Tension headaches generally respond to over-the-counter (OTC) painkillers. However, pain relievers target only the symptom of tension headaches (pain), without addressing the underlying cause (muscle tension). Targeting the muscle tension is a better strategy for both treatment and prevention.

If you already have a tension headache, a fast-acting but short-lived muscle relaxant can loosen head and neck muscles. These medications don't relieve pain more effectively than painkillers, but they do address the cause of the tension headache.

To prevent tension headaches, start by getting enough sleep and not skipping meals. Pace yourself to avoid becoming overly tired. Apply a heating pad to your neck and shoulders to relax muscles when they feel tight. Or rub peppermint oil on your temples.

Don't subject your head and neck muscles to prolonged strain. If you have a desk job, take frequent breaks to get up and change your position. Don't rest your chin on your chest when reading. And don't spend hours with a phone cupped between your shoulder and ear; use a hands-free headset instead.

Try a relaxation strategy such as biofeedback. In this technique, you learn to recognize when your muscles are becoming tense and how to relax them, based on signals from your own body. If you get tension headaches frequently, particularly if you also have pain in the neck and shoulders, do regular stretching exercises of the neck muscles.

Some people have trigger points at the back of the neck or shoulders. Touching these tender areas can prompt a tension headache. Injecting a local anesthetic into the trigger points may eliminate the pain and prevent a headache. The effect usually lasts for a few days. Injections are typically given every few weeks. Usually, though, such treatments aren't necessary; simpler measures do the job.

Your doctor can also prescribe medications to help prevent tension headaches. These include tricyclic antidepressant medications and long-acting muscle relaxants.

With tension headaches, as with many conditions, an ounce of prevention is worth a pound of cure. Avoid the triggers and keep your neck and shoulder muscles loose: That's the ounce of prevention. It will greatly reduce your need for pain medicines and keep tension headaches from interfering with your life.

• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.