It is important to note that large daily doses of paracetamol should be avoided as it may cause liver damage especially in those that consume 3 or more drinks/day and those with pre-existing liver disease. Ibuprofen, one of the NSAIDs listed above, is a common choice for pain relief but may also lead to gastrointestinal discomfort.Analgesic/caffeine combinations are popular such as the aspirin-caffeine combination or the aspirin, paracetamol and caffeine combinations. Frequent use (daily or skipping just one day in between use for 7–10 days) of any of the above analgesics may, however, lead to medication overuse headache.Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations, analgesic/barbiturate combinations such as Fiorinal).Muscle relaxants are typically used for and are helpful with acute post-traumatic TTH rather than ETTH. Opioid medications are not utilized to treat ETTH. Botulinum toxin does not appear to be helpful. Chronic
Classes of medications involved in treatment of CTTH include tricyclic antidepressants (TCAs), SSRIs, benzodiazepine (Clonazepam in small evening dose), and muscle relaxants. The most commonly utilized TCA is amitriptyline due to the postulated role in decreasing central sensitization and analgesic relief. Another popular TCA used is Doxepine. SSRIs may also be utilized for management of CTTH. For patients with concurrent muscle spasm and CTTH, the muscle relaxant Tizanidine can be a helpful option.These medications however, are not effective if concurrent overuse of over the counter medications or other analgesics is occurring. Stopping overuse must occur prior to proceeding with other forms of treatment. Manual therapy
Current evidence for acupuncture is slight.
Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches. Pain medications, such as paracetamol and ibuprofen, are effective for the treatment of tension headache. Tricyclic antidepressants appear to be useful for prevention. Evidence is poor for SSRIs, propranolol and muscle relaxants.As of 2016, tension headaches affect about 1.89 billion people and are more common in women than men (23% to 18% respectively). Signs and symptoms
According to the third edition of the International Classification of Headache Disorders, the attacks must meet the following criteria:

A duration of between 30 minutes and 7 days. At least two of the following four characteristics:
bilateral location
pressing or tightening (non-pulsating) quality
mild or moderate intensity
not aggravated by routine physical activity such as walking or climbing stairs
Both of the following:
no nausea or vomiting
no more than one of photophobia (sensitivity to bright light) or phonophobia (sensitivity to loud sounds)Tension-type headaches may be accompanied by tenderness of the scalp on manual pressure during an attack. Risk factors
Various precipitating factors may cause tension-type headaches in susceptible individuals:
Anxiety
Stress
Sleep problems
Young age
Poor health

Mechanism
Although the musculature of the head and neck and psychological factors such as stress may play a role in the overall pathophysiology of TTH, neither is currently believed to be the sole cause of the development of TTH.