The name is wrong, and has been for thirty years. "Tension" implies a clench, but between attacks the muscles aren't contracted ¹. Instead the small pain nerves around the skull get primed to fire at lower thresholds, and the more often the headache happens the more the whole pain pathway turns up ². Stress, screens, jaw clenching and skipped meals feed a sensitised system; they aren't the whole story.

For an attack, one real anti-inflammatory dose beats everything cautious. Ibuprofen 400 mg is the most-studied option and clearly ends attacks ³. Paracetamol 1000 mg works, but barely ⁴. Either can make you feel better; the anti-inflammatory is the one that ends it.

For frequent headaches, prevention is a different tool. Amitriptyline, an old cheap drug, roughly halves headache days over months and is first-line in the specialist guideline ^{5 6}. Biofeedback matches it drug-free ⁷, and acupuncture is a third route ⁸. Botulinum toxin, useful for migraine, does nothing here ⁶.

Hit an attack hard and early, then keep an honest count. The number that re-orders everything is headache days per month; the pill count per attack barely matters.

The arc, once the count is running:

• Week one: an attack ends in the time it used to take to half-end, because the dose was right and early. The written-off afternoon comes back.
• Month three: an honest tally. If you were already under four days a month, the rules kept you there; if higher, headache days are roughly halving on amitriptyline or biofeedback ⁷.
• Year one: you stop calling yourself someone who "just gets headaches," because the count is small ¹⁰.