Overview

A tension-type headache (TTH) is generally a 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 for tension-type headaches are available. Managing a tension-type headache is often a balance between practicing healthy habits, finding effective nondrug treatments and using medications appropriately.

Symptoms

Signs and symptoms of a tension-type headache include:

  • Dull, aching head pain
  • Sensation 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. Frequent episodic tension-type headaches may become chronic.

Chronic tension-type headaches

This type of tension-type 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-type headaches versus migraines

Tension-type headaches can be difficult to distinguish from migraines. Plus, if you have frequent episodic tension-type headaches, you can also have migraines.

Unlike some forms of migraine, tension-type headaches usually aren't associated with visual disturbances, nausea or vomiting. Although physical activity typically aggravates migraine pain, it doesn't make tension-type headache pain worse. An increased sensitivity to either light or sound can occur with a tension-type headache, but this symptom isn't common.

When to see a doctor

Make an appointment with your doctor

If tension-type headaches disrupt your life or you need to take medication for your headaches more than twice a week, see your doctor.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different. Occasionally, headaches may indicate a serious medical condition, such as a brain tumor or rupture of a weakened blood vessel (aneurysm).

When to seek emergency help

If you have any of these signs or symptoms, seek emergency care:

  • Abrupt, severe headache
  • Headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties
  • 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.

Sept. 29, 2021
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