Tension Type Headache
A tension type headache is generally a diffuse, mild to moderate pain in
your head that's often described as feeling like a tight band around
your head. A tension headache (tension-type headache) is the most common
type of headache, and yet its causes aren't well understood.
Treatments for tension type headache are available. Managing a tension type headache is often a balance between fostering healthy habits, finding
effective non-drug treatments and using medications appropriately.
Signs and Symptoms
Signs and symptoms of a tension headache include:
- Dull, aching head pain
- Sensation of tightness or pressure across your forehead or on the sides and back of your head
- Tenderness on your scalp, neck and shoulder muscles
Tension headaches are divided into two main categories -
Episodic tension headaches
Episodic tension headaches can last from 30 minutes to a week.
Frequent episodic tension headaches occur less than 15 days a month for
at least three months. Frequent episodic tension headaches may become
Chronic tension headaches
This type of tension headache lasts hours and may be continuous. If
your headaches occur 15 or more days a month for at least three months,
they're considered chronic.
Tension headaches vs. Migraines
Tension headaches can be difficult to distinguish from migraines.
Plus, if you have frequent episodic tension headaches, you can also have
Unlike some forms of migraine, tension headache usually isn't
associated with visual disturbances, nausea or vomiting.
physical activity typically aggravates migraine pain, it doesn't make
tension headache pain worse. An increased sensitivity to either light or
sound can occur with a tension headache, but these aren't common
The cause of tension headache is not known. Experts used to think
tension headaches stemmed from muscle contractions in the face, neck and
scalp, perhaps as a result of heightened emotions, tension or stress.
But research suggests muscle contractions aren't the cause.
The most common theories support a heightened sensitivity to pain in
people who have tension headaches and possibly a heightened sensitivity
to stress. Increased muscle tenderness, a common symptom of tension
headache, may result from a sensitized pain system.
Stress is the most commonly reported trigger for tension headaches.
Risk factors for tension headache include:
- Being a woman. One study
found that almost 90 percent of women and about 70 percent of men
experience tension headaches during their lifetimes
- Being middle-aged. The
incidence of tension headaches appears to peak in the 40s, though people
of all ages can get this type of headache
Because tension headaches are so common, their effect on job
productivity and overall quality of life is considerable, particularly
if they're chronic. The frequent pain may render you unable to attend
activities. You might need to stay home from work, or if you do go to
your job, your ability to function is impaired.
Test and Diagnosis
If you have chronic or recurrent headaches, your doctor may conduct
physical and neurological exams, then try to pinpoint the type and cause
of your headaches using these approaches:
Your pain description
Our doctor can learn a lot about your headaches from a description of your pain. Be sure to include these details:
- Pain characteristics. Does your pain pulsate ? Or is it constant and dull ? Sharp or stabbing ?
- Pain intensity. A good indicator of the
severity of your headache is how much you're able to function while you
have it. Are you able to work? Do your headaches wake you or prevent you
- Pain location. Do you feel pain all over your head, on only one side of your head, or just on your forehead or behind your eyes?
If you have unusual or complicated headaches, your doctor may order
tests to rule out serious causes of head pain, such as a tumor. Two
common tests used to image your brain include:
- Computerized tomography (CT). A CT scan is a
diagnostic imaging procedure that uses a series of computer-directed
X-rays to provide a comprehensive view of your brain.
- Magnetic resonance imaging (MRI). An MRI scan combines a magnetic field, radio waves and computer technology to produce clear images.
Some people with tension headaches don't seek medical attention and
try to treat the pain on their own. Unfortunately, repeated use of
over-the-counter (OTC) pain relievers can actually cause overuse
Treatment and Medication:
A variety of medications, both OTC and prescription, are available to reduce the pain of a headache, including:
- Pain relievers. Simple OTC pain relievers are
usually the first line of treatment for reducing headache pain. These
include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and
naproxen (Aleve). Prescription medications include naproxen (Naprosyn),
indomethacin (Indocin) and ketorolac (Ketorolac Tromethamine).
- Combination medications. Aspirin or
acetaminophen or both are often combined with caffeine or a sedative
drug in a single medication. Combination drugs may be more effective
than are single-ingredient pain relievers. Many combination drugs are
- Triptans and narcotics. For people who
experience both migraines and episodic tension headaches, a triptan can
effectively relieve the pain of both headaches. Opiates, or narcotics,
are rarely used because of their side effects and potential for
Your doctor may prescribe medications to reduce the frequency and
severity of attacks, especially if you have frequent or chronic
headaches that aren't relieved by pain medication and other therapies.
Preventive medications may include:
- Tricyclic antidepressants. Tricyclic
antidepressants, including amitriptyline and nortriptyline (Pamelor),
are the most commonly used medications to prevent tension headache. Side
effects of these medications may include weight gain, drowsiness and
- Other antidepressants. There also is some
evidence to support the use of the antidepressants venlafaxine (Effexor
XR) and mirtazapine (Remeron) in people who don't also have depression.
- Anticonvulsants and muscle relaxants. Other
medications that may prevent tension headache include anticonvulsants,
such as topiramate (Topamax). More study is needed.
Preventive medications may require several weeks or more to build up
in your system before they take effect. So don't get frustrated if you
haven't seen improvements shortly after you begin taking the drug.
Your doctor will monitor your treatment to see how the preventive
medication is working. In the meantime, overuse of pain relievers for
your headaches may interfere with the effects of the preventive drugs.
Lifestyle and home remedies
Rest, ice packs or a long, hot shower may be all you need to relieve a
tension headache. A variety of strategies can help reduce the severity
and frequency of chronic tension headaches without using medicine. Try
some of the following:
- Manage your stress level. One way to help
reduce stress is by planning ahead and organizing your day. Another way
is to allow more time to relax. And if you're caught in a stressful
situation, consider stepping back.
- Go hot or cold. Applying heat or ice -
whichever you prefer - to sore muscles, may ease a tension headache. For
heat, use a heating pad set on low, a hot-water bottle, a warm compress
or a hot towel. A hot bath or shower also may help. For cold, wrap ice,
an ice pack or frozen vegetables in a cloth to protect your skin.
- Perfect your posture. Good posture can help
keep your muscles from tensing. When standing, hold your shoulders back
and your head level. Pull in your abdomen and buttocks. When sitting,
make sure your thighs are parallel to the ground and your head isn't
- Deep breathing, biofeedback and behavior therapies. A variety of relaxation therapies are useful in coping with tension headache, including deep breathing and biofeedback.
Coping and support
Living with chronic pain can be difficult. Chronic pain can make you
anxious or depressed and affect your relationships, your productivity
and the quality of your life.
Here are some suggestions:
- Talk to a counselor or therapist. Talk therapy may help you cope with the effects of chronic pain.
- Join a support group. Support groups can be
good sources of information. Group members often know about the latest
treatments. Your doctor may be able to recommend a group in your area.
In addition to regular exercise, techniques such as biofeedback training and relaxation therapy can help reduce stress.
- Biofeedback training. This technique teaches
you to control certain body responses that help reduce pain. During a
biofeedback session, you're connected to devices that monitor and give
you feedback on body functions such as muscle tension, heart rate and
blood pressure. You then learn how to reduce muscle tension and slow
your heart rate and breathing yourself.
- Cognitive behavioral therapy. This type of talk
therapy may help you learn to manage stress and may help reduce the
frequency and severity of your headaches.
- Other relaxation techniques. Anything that
helps you relax, including deep breathing, yoga, meditation and
progressive muscle relaxation, may help your headaches. You can learn
relaxation techniques in classes or at home using books or tapes.
Using medications in conjunction with stress management techniques
may be more effective than is either treatment alone in reducing your
Additionally, living a healthy lifestyle may help prevent headaches:
- Get enough, but not too much sleep.
- Don't smoke.
- Exercise regularly.
- Eat regular, balanced meals.
- Drink plenty of water.
- Limit alcohol, caffeine and sugar.