What is the current thinking regarding Chronic Tension Type Headache?

I've been waking up with headaches since winter of 2025. Thought it was sinus headaches until June 2026 when I saw allergist who said, nope. She said I'm having, Tension Headaches. Saw my PCP last week and she gave me Nurtec samples. My insurance does not cover Nurtec so Dr's office gave me more samples. Sometimes it works, sometimes it doesn't. Had CT scans of head and neck... C3-C7. No obvious reasons for my chronic conditions. Help! Please and thank you!

Botox helps me with headaches. It doesn't stop all the headaches but it does redues them. Is it worth it I think yes. I have bo side effects.

@karenschank28
MRIs of brain are much better imaging for brain malformations (with blood vessels, aneurysms) than CT scans. Do not do open sided MRI - imaging isn't as good either. I found that out myself this summer. But waking up with headaches is a symptom of sleep apnea, are you tired all the time, low energy? you might need sleep study. are your pillows too fat? try a posturepedic pillow to keep your neck in good alignment when sleeping - Amazon has good assortment. I saw neurologist again for my headaches this past spring - had me start Vit B2 (riboflavin) 400 mg every day, it has helped immensely! Its hard to find, I find it at smaller pharmacies. My insurance had poor coverage for Nurtec and Ubrelvy also. Neurologist also said to avoid MSG, nitrates & nitrites(meat preservatives), ASPARTAME (in drinks), TYRAMINE (in red wine). he also rec Magnesium citrate or glycinate 400 mg every day. Magnesium can cause loose stools, and if you have any kidney disease you have to talk to primary provider before starting the magnesium. Try not to treat your headaches more than 9 times per month with OTC analgesics, there is such a thing as rebound headaches, the more you treat - the more you have. I learned that 10 yrs ago from neurologist, you have to "grade" your headaches on pain scale 1 - 10, treat only for greater than 5. Find other measures to relieve headaches. Essential oils can help, put along hairline. I have essential oil "recipes" I use to manage headaches before reaching for ibuprofen. Message back if you are interested in those. Good luck!

rx35285 @rx35285,

My Neurologist found that I have/had a very tense neck (which effect the muscles going over the head). Prescribed Physical Therapy Dry Needling (needling at the base of the skull). The insurance covers everything except the needles $23.00. I started weekly sessions and after 8 months was able to go once a month.
After the first session - wowza, first time in 5 years I didn't have a headache/ migraine, the effect lasted 4 hours. Over time, the relief lasted longer and I have been going once a month.

Since I had a good reaction, added Baclofen (muscle relaxer).

Best Wishes,
🍀

What was the possible solution for Tension type chronic headache?
Tell me By physical exercises
Mindfulness exercises
Progressive Muscle relaxation
It's been 3 days since it's not working for me to rewire these headaches

@taliya - welcome to Mayo Clinic Connect. I moved your post to this discussion where other members were talking about chronic tension type headache:

- What is the current thinking regarding Chronic Tension Type Headache?https://connect.mayoclinic.org/discussion/what-is-the-current-thinking-regarding-chronic-tension-type-headache/

Fellow members such as @fourleaf @purple26 @bernieboy and others here may have some information for you on what has helped with their headaches.

While you wait for more responses, you may want to read this Mayo Clinic article:

- Tension headache https://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/syc-20353977

So, if I understand you correctly, taliya, you've been doing physical exercixses, progressive muscle relaxation and mindfulness exercises over the last three days, and it's not helped with your headaches? What has your doctor suggested for relief?

@fourleaf Have you tried what is called an ice sandwich? You place ice on your neck and upper back for 15 minutes, followed by 15 minutes of moist heat, then repeat the 15 minutes of ice. It can sometimes reset to correct muscle tone in the region. I have cervical dystonia, where my muscles in that region are constantly in severe spasms. Since 2001 I have needed to get Botox injections to the area every three months - it’s the only thing that controls the migraines triggered by the dystonia. Have you seen a Neurologist? If not, you should.

@mbixler
First I'm hearing of ice sandwich, I will try it. Thank You.

Neurologist - Yes, I'm seeing one.

@bernieboy I get Botox too. Its seems to help a little but not much