Tension Headache

  • Medical Author:
    Danette C. Taylor, DO, MS, FACN

    Dr. Taylor has a passion for treating patients as individuals. In practice since 1994, she has a wide range of experience in treating patients with many types of movement disorders and dementias. In addition to patient care, she is actively involved in the training of residents and medical students, and has been both primary and secondary investigator in numerous research studies through the years. She is a Clinical Assistant Professor at Michigan State University's College of Osteopathic Medicine (Department of Neurology and Ophthalmology). She graduated with a BS degree from Alma College, and an MS (biomechanics) from Michigan State University. She received her medical degree from Michigan State University College of Osteopathic Medicine. Her internship and residency were completed at Botsford General Hospital. Additionally, she completed a fellowship in movement disorders with Dr. Peter LeWitt. She has been named a fellow of the American College of Neuropsychiatrists. She is board-certified in neurology by the American Osteopathic Board of Neurology and Psychiatry. She has authored several articles and lectured extensively; she continues to write questions for two national medical boards. Dr. Taylor is a member of the Medical and Scientific Advisory Council (MSAC) of the Alzheimer's Association of Michigan, and is a reviewer for the journal Clinical Neuropharmacology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

A Guide to Migraine Headaches

Tension headache facts

  • Tension headache is thought to be one of the most common types of headache.
  • Although the precise cause of tension headache is unknown, there are factors that seem to contribute to tension headaches, such as
  • Different conditions may contribute to tension headaches such as vision problems or eye strain, overexertion, muscle strains caused by poor posture have all been associated with development of tension headache.
  • While certain foods (processed or aged foods, chocolate, red wine) can trigger migraine headache, in some cases head and neck movement or physical exertion might trigger a migraine; this is not typical of tension headache.
  • Some individuals have both migraine and tension headache; additionally, tension headache can trigger migraine pain, and may be relieved by migraine medications. Symptoms of migraine include
    • light and sound sensitivity,
    • nausea or
    • vomiting, and
    • (often one-sided) throbbing head pain which worsens with exertion
  • Both tension headaches and migraines are diagnosed by physical examination and headache history of the patient.
  • Treatments for tension headaches can include OTC and prescription pain relievers, exercise (including formal physical therapy), stress management and relaxation techniques, and alternative therapies.

What is a tension headache?

Headache -- a condition so common it's the punch line for a number of jokes, but when you're experiencing a headache, it's no laughing matter.

When most people discuss headache, they're typically referring to the most frequently experienced type of headache, a tension headache (also known as tension-type or stress headache). Almost half of adults experienced a headache in the past year; fortunately, for the majority of those individuals, the headache was mild, short-lived, and likely fell into the category of tension headache.

Children and teens can experience tension headache; with a significant percentage of children having experienced tension headache by age 15. Females are often diagnosed with tension headaches (more often, about twice as often) than males.

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Tension Headache Symptoms: Neck Pain

Pain in the neck can be more than just a hassle. Neck pain can come from disorders and diseases of any structure in the neck. There are seven vertebrae that are the bony building blocks of the spine in the neck (the cervical vertebrae) that surround the spinal cord and canal. Between these vertebrae are discs and nearby pass the nerves of the neck. Within the neck, structures include the neck muscles, arteries, veins, lymph glands, thyroid gland, parathyroid glands, esophagus, larynx, and trachea. Disease of any of these structures can lead to neck pain.

Neck pain is medically referred to as cervicalgia. Neck pain can be associated with:

  • headaches,
  • tingling in the arms,
  • muscle pain,
  • fever,
  • stiff neck,
  • throat pain,
  • tenderness,
  • weakness of the arms.

What causes tension headaches?

The exact cause of tension headache isn't known; and many factors probably play a role in why people develop headache. These factors may include:

  • lack of sleep,
  • skipping meals, or
  • increased stress (leading to a frequent description of these headaches as stress headaches).

Underlying diseases or conditions may frequently cause a headache, for example:

  • eye strain,
  • muscular tension caused by poor posture,
  • over exertion, or
  • anxiety.

In children, headache may be seen as a response to changes in school or home situations such as:

  • a new sibling,
  • testing at school, or
  • social isolation.

What are the symptoms of tension headache?

Most tension headaches occur infrequently, and are usually short-lived (resolves within minutes to a few hours). In rare cases the headache may last for many days. A tension headaches that occur more than 15 days each month are referred to as chronic tension headache.

Tension headache pain

  • The pain of chronic tension headache tends to wax and wane in severity.
  • The pain associated with tension headache typically impacts the whole head, but may begin in the back of the head or above the eyebrows.
  • Some people experience a cap or band-like sensation which encircles their skull, while others describe their pain as a muscle tension in their neck or shoulder regions.
  • The pain is frequently described as constant and pressure-like.
  • The pain tends to come on gradually and even at maximum intensity is not incapacitating.
  • Most people who have a tension headache are able to continue their daily activities despite the pain.

Other tension headache symptoms

  • In some cases, people with tension headache report some sensitivity to light or sound.

Are tension headaches associated with symptoms of other types of headache?

Tension headaches are not associated with nausea or vomiting, and do not have symptoms like flashing lights, blind spots, or numbness or weakness of the arms or legs which precede the headache. These symptoms can help distinguish tension headaches from other types of headaches (for example, migraine headaches).

How are tension headaches diagnosed?

Tension headaches are diagnosed based on the patient's reported history of the headache and physical examination. There is no test to specifically confirm tension headache. Because the physical examination in patients with tension headache is generally normal, additional testing such as CT scan or MRI scan usually isn't required. Some basic blood work may be done to confirm that no underlying abnormality is present.

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What is the treatment for tension headache?

Treatment for tension headaches include prescription medications, over-the-counter (OTC) pain relievers, combination drugs containing aspirin, acetaminophen, caffeine, and stress management.

Prescription medications for tension headaches

If a diagnosis of chronic tension headache is made or suspected, prescription medications may be used in an effort to lessen the frequency and decrease the severity of the headaches. Medications used include antidepressants and antiseizure agents; a physician can help determine which agent is best for a patient.

OTC drugs for tension headaches

Many people treat tension headache on their own, using OTC (over-the-counter) medications like acetaminophen (Tylenol), ibuprofen (Motrin), or combination medications containing acetaminophen, aspirin, and caffeine (Excedrin). While these medications can be effective and when taken as directed are safe for most people, overuse can lead to headaches which are more frequent and severe. This can occur if these agents are used more than 2 days each week routinely. If tension headache occurs during pregnancy, the patient should contact her physician about medications that are safe to use.

  • Products which contain aspirin should not be given to children due to the risk of Reye's syndrome.
  • Chronic use of acetaminophen, or use of acetaminophen in large amounts may lead to liver toxicity (current recommended maximal dose is 3 grams per 24 hours), and a number of medications are combined with acetaminophen so patients should discuss all OTC drugs they are taking with their doctors.

Managing stress

For people who experience recurrent tension headache, stress management techniques have been an effective way of helping to decrease headache frequency and severity. This can include regular exercise, deep breathing techniques, and relaxation training. Other non-medicinal approaches can include massage therapy, heat, ice, or acupuncture. Learning to identify stressful situations which trigger headache and taking steps to avoid these is also a useful strategy for many individuals.

Are there effective home remedies a cure for tension headache?

  • Alternative treatments or therapies: Alternative therapies such as a hot compress or an ice pack may provide substantial benefit for some individuals.
  • Hydrate: Sometimes headaches can be triggered by mild dehydration or lack of food; if so, drinking some non-caffeinated fluids or eating something may help.
  • Flaxseed: People who eat flaxseed, which is rich in omega-3 fatty acids, may experience a decrease in headaches. This is thought to be related to the anti-inflammatory properties of the omega-3 fatty acids.
  • Peppermint or lavender oil: Inhaling the scent of peppermint oil or lavender oil may help decrease headache pain (lavender oil should not be consumed orally).
  • Scalp massage: A scalp massage is easily done and may provide significant relief; concentrating efforts over the temporal regions or the occipital area (the back of the scalp) may lead to the best response.
  • Whole-body massage: Whole body massage may provide relief.
  • Stress management: If stress seems to be a trigger, learning stress-management techniques or relaxation techniques can provide substantial benefit.
  • Exercise: Exercise, whether regular aerobic activities or specific movements to improve posture, has been shown to be quite effective in decreasing the frequency of tension headaches.

Can tension headaches be prevented?

Often, the best defense is a good offense and this approach is frequently effective when trying to prevent tension headache. Identifying headache triggers and then attempting to avoid or modify those triggers can be a successful strategy to decrease or even eliminate a tension headache. Some people find that scheduled exercise and eating on a regular basis is beneficial. Learning and practicing relaxation techniques, including deep breathing exercises, directed relaxation of specific muscles, or meditation, can also be effective.

See your doctor if any of the following situations occur:

  • If a person experiences regular headaches or if they have changed in severity, location or frequency
  • If a person experiences a headache that is very different from his or her usual headaches
  • If previously helpful treatments are no longer effective
  • If someone is experiencing "The worst headache of my life" they need to be evaluated emergently.

Medically reviewed by Joseph Palermo, DO; American Osteopathic Board Certified Internal Medicine

REFERENCES:

Blanda, Michelle, et al. "Tension Headache." Medscape. 17 May 2012.

Taylor, FR. Tension-type headache in adults: Pathophysiology, clinical features, and diagnosis. UpToDate, March, 2015.

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.

Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment

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Reviewed on 8/10/2016
References
Medically reviewed by Joseph Palermo, DO; American Osteopathic Board Certified Internal Medicine

REFERENCES:

Blanda, Michelle, et al. "Tension Headache." Medscape. 17 May 2012.

Taylor, FR. Tension-type headache in adults: Pathophysiology, clinical features, and diagnosis. UpToDate, March, 2015.

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.

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