Tension headache relief: what helps most

Regular meals, water and steady sleep help most, and they come first in Mayo Clinic's self-care guidance for tension-type headache. Eat on a regular schedule and don't skip meals, especially breakfast. Drink plenty of water. Keep the same wake time and bedtime 7 days a week, weekends included. If you are not asleep within 15 minutes, Mayo suggests getting up and doing something calming until you feel drowsy.

Both sources come back to sleep. NINDS notes that too little or too much sleep can worsen headaches, and that daytime naps cut into deep nighttime sleep and can trigger headaches in some adults. Mayo flags sleep apnea: it can cause tension-type headaches, and a typical sign is waking up with a headache. If that is your pattern, getting checked and treated for apnea may ease the headaches at the source.

Exercise helps too, with a caveat. Mayo says exercise releases chemicals that block pain signals to the brain and names 3 options (walking, swimming and cycling), but advises starting slowly, because very intense exercise can bring on certain headaches. NINDS also counts exercise and a healthy diet as prevention. Smoking works the other way: Mayo explains that nicotine reduces blood flow to the brain and triggers a reaction in the nerves at the back of the throat, and either change can lead to a headache.

Both, depending on the dose. Mayo says caffeine may help curb headaches, which is why some headache medicines contain it, but heavy daily use leads to them: more than 400 milligrams a day, roughly 4 cups of coffee, can bring on headaches and irritability. Regular caffeine use also raises headache risk over time.

Quitting is its own trigger. Mayo notes that stopping caffeine can cause headaches whether you stop suddenly or taper off, and NINDS lists both caffeine and caffeine withdrawal among the things that can set off an attack. If your weekend headaches arrive a few hours after your usual second coffee, the habit itself may be the cause. A steady, moderate amount every day may work better than 5 cups on a workday and none on Saturday.

Heat is Mayo Clinic's direct advice for tense neck and shoulder muscles, and it lists 5 ways to apply it: a heating pad on low, a hot water bottle, a hot shower or bath, a warm compress or a hot towel. The alternative is cold, such as ice or a cool washcloth on the forehead. Both are cheap and low-risk, and you can try them tonight.

Mayo's claim for massage is measured: it "also can relieve muscle tension — and sometimes headache pain." Mayo then describes self-massage with your own fingertips, gently working the temples, scalp, neck and shoulders, or gently stretching the neck.

The research supports that caution. NCCIH's summary of the science on massage says only a small number of studies have looked at massage for headache, and the results have not been consistent. The most relevant trial it cites, from 2015, split 56 people with tension headaches 3 ways: massage at myofascial trigger points, an inactive sham (detuned ultrasound), each twice a week for 6 weeks, or a waiting list. Headache frequency dropped in both the massage and the sham groups, with no difference between them.

So the evidence that massage cuts how often tension headaches come is weak. It is stronger for the muscles a tension headache often rides on: NCCIH reports that massage may give short-term relief for neck and shoulder pain. A 2013 review of 12 studies (757 participants) found massage more helpful for neck and shoulder pain than inactive therapies, though not better than other active treatments, and the shoulder benefit was short-term only. A 2014 dosing trial of 228 people with chronic neck pain found that sessions of 60 minutes, several times a week, beat fewer or shorter ones. If your headaches come with a knotted neck and shoulders, loosening those muscles may help.

NINDS lands in the same place: a doctor may add physical therapy, massage and gentle exercise to a treatment plan, as options worth considering rather than proven cures. For tension headache relief, start with heat, use gentle self-massage of the temples, neck and shoulders for the muscle tension, and don't count on massage to stop the headaches themselves.

Yes. Mayo Clinic says that using over-the-counter pain medicine on more than 9 days a month can make headaches harder to treat, and advises seeing a health care provider rather than taking more. NINDS puts it more broadly: regular overuse of headache medicine can worsen attacks or create new headache symptoms, and the agency recommends working out a safe-use plan with a doctor.

That is how a manageable headache problem turns chronic, with the medicine causing the next headache. Count the days you take painkillers, and raise it with a clinician if they climb past a couple of days most weeks.

A headache diary shows patterns that memory misses, and both Mayo and NINDS recommend one. You won't notice that headaches follow short sleep or a skipped lunch by trying to remember later. Mayo's version is simple: note when each headache starts, what you were doing, how long it lasts and what helped, then look for patterns in your daily habits.

NINDS asks for more detail. After each headache, record these 6 things:

After a couple of weeks of notes, the diary may show patterns that guessing would miss. If you do see a doctor, NINDS says the diary helps them identify the headache type and choose a treatment. It also shows any painkiller overuse, because writing down each dose makes you count.

See a doctor right away for any of the 10 warning signs NINDS lists: a sudden, severe headache, possibly with a stiff neck; a severe headache with fever, nausea or vomiting not tied to another illness; a "first" or "worst" headache that also brings confusion, weakness, double vision or loss of consciousness; a headache that worsens over days or weeks, or changes its pattern; a headache after a head injury; a headache with loss of sensation or weakness anywhere in the body, which can signal a stroke; a headache with convulsions or trouble breathing; two or more headaches a week; a constant headache in someone who never had headaches before, especially over age 50; or new headaches in someone with a history of cancer or HIV/AIDS.

NINDS also says to talk with a doctor any time headaches affect your daily life, and to get care for headaches in children that keep coming back or that follow a brain injury. For children, check with a doctor before giving headache medicine, and seek care quickly for a headache that comes with a rash, fever or sleepiness.

A safety note on massage: NCCIH says the risk of harm from massage appears low, but rare serious side effects have been reported, including blood clots, nerve injury and bone fracture, often with vigorous techniques such as deep tissue work or in people already at higher risk of injury. Keep self-massage of your temples and neck gentle.

For this week, work through these 6 steps in order, and give them 2 weeks before deciding nothing helps: