Tension-type headaches (TTHs) are the most common and least studied primary headache disorder. These headaches are characterized by mild to moderate bilateral pain that is described as dull, aching, and bandlike. Episodic TTHs may be treated with mild analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; although treatment should be individualized, data suggest that NSAIDs may be considered first line. Chronic and frequent episodic TTHs often require prophylactic therapy. Although tricyclic antidepressants are considered the drugs of choice for chronic TTHs, preliminary trials with venlafaxine, mirtazapine, tizanidine, and topira-mate have shown promise. Lifestyle interventions such as physical therapy, behavioral therapy, and acupuncture are often employed, despite the lack of sound clinical evidence to support their use. Preliminary data support the combination of a tricyclic ...