Tension headache

Overview

A tension-type headache causes mild to moderate pain that's often described as feeling like a tight band around the head. A tension-type headache is the most common type of headache, yet its causes aren't well understood.

Treatments are available. Managing a tension-type headache is often a balance between practicing healthy habits, finding effective nonmedicine treatments and using medicines appropriately.

Symptoms

Symptoms of a tension-type headache include:

• Dull, aching head pain.
• Feeling of tightness or pressure across the forehead or on the sides and back of the head.
• Tenderness in the scalp, neck and shoulder muscles.

Tension-type headaches are divided into two main categories — episodic and chronic.

Episodic tension-type headaches

Episodic tension-type headaches can last from 30 minutes to a week. Frequent episodic tension-type headaches occur less than 15 days a month for at least three months. This type of headache can become chronic.

Chronic tension-type headaches

This type of tension-type headache lasts hours and may be constant. Chronic tension-type headaches occur 15 or more days a month for at least three months.

Tension-type headaches versus migraines

Tension-type headaches can be hard to tell apart from migraines. And if you have frequent episodic tension-type headaches, you also can have migraines.

But unlike some forms of migraine, tension-type headaches usually aren't associated with visual disturbances such as seeing bright spots or flashes of light. People with tension-type headaches also don't usually experience nausea or vomiting with head pain. While physical activity tends to make migraine pain worse, it doesn't affect tension-type headache pain. Sometimes a tension-type headache occurs with sensitivity to light or sound, but this symptom isn't common.  

When to see a doctor

Make an appointment with a health care professional

See your health care professional if you need to take medicine for tension-type headaches more than twice a week. Also make an appointment if tension-type headaches disrupt your life.

Even if you have a history of headaches, see your health care professional if the headache pattern changes. Also see your care professional if your headaches suddenly feel different. Occasionally, headaches may be caused by a serious medical condition. These can include a brain tumor or rupture of a weakened blood vessel, known as an aneurysm.

When to seek emergency help

Get emergency care if you have any of these symptoms:

• A sudden, very bad headache.
• Headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking.
• Headache after a head injury, especially if the headache gets worse.

Causes

The cause of tension-type headaches is not known. Experts used to think tension-type headaches stemmed from muscle contractions in the face, neck and scalp, perhaps as a result of heightened emotions, tension or stress. But research suggests that muscle contraction isn't the cause.

The most common theory supports a heightened sensitivity to pain in people who have tension-type headaches. Increased muscle tenderness, a common symptom of tension-type headaches, may result from a sensitized pain system.

Triggers

Stress is the most commonly reported trigger for tension-type headaches.

Complications

Because tension-type 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 may be impaired.

Prevention

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, videos or apps.

Using medications in conjunction with stress management techniques may be more effective than either treatment alone in reducing your tension-type headaches.

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.