Tension Headache

A tension headache feels like there’s a tight band wrapped around your head, putting pressure on your forehead and temples. It’s the most common type of primary headache. Other names for it include:

• Tension-type headache
• Muscle contraction headache
• Stress headache

Many factors cause tension headaches, and you can’t prevent all of them.

Home remedies like pain relievers and relaxation often help provide relief. If they don’t, your healthcare provider may suggest medications and other therapies to ease the pain.

Types

Healthcare providers classify tension-type headaches based on how often you have them:

• Infrequent episodic: One day a month or fewer
• Frequent episodic: One to 14 headaches every month for at least three months
• Chronic: More than 15 headaches every month for three months

Symptoms of tension headaches

Tension headaches may come on slowly. They can last from 30 minutes to a week. But the average duration is four to six hours.

Symptoms can include:

• Constant mild to moderate pressure and dull pain
• Feeling like something is squeezing your head
• Aching or tight scalp, neck and shoulder muscles

Tension headaches are usually better in the morning and worse in the evening. They typically don’t get worse with light physical activity, like walking or climbing stairs. They also don’t involve extreme sensitivity to light or sound, like migraines often do.

If you have chronic tension headaches, you may feel as if you’re always dealing with headache pain and pressure.

Tension headache causes

Researchers don’t know the exact cause of tension headaches. Some believe they start when muscles between your head and neck knot up, eventually tightening your scalp muscles.

Factors that may trigger a tension-type headache include:

• Stress
• Poor posture and neck strain
• Arthritis in your neck
• Depression or anxiety
• Eye strain — for example, from staring at a computer screen or documents for a long time
• Sleep issues, like lack of sleep, sleep apnea and insomnia
• Temporomandibular joint (TMJ) disorders

Risk factors

Tension headaches tend to affect females more than males. They’re more common in adults than in children. Most people will experience this type of headache at some point in their lives.

Complications

Chronic tension-type headaches that last for weeks and months may affect your quality of life. Ongoing pain may make it hard for you to focus on your work or family responsibilities.

Tension headaches can become worse if you overuse pain medicines for them. Overuse can cause rebound headaches, which are very hard to treat.

How doctors diagnose tension headaches

Healthcare providers typically diagnose tension headaches by asking about your medical history and symptoms. They may ask:

• How often do you have symptoms?
• Do symptoms feel worse at certain times of the day?
• Do they feel worse after doing certain activities?
• Do headache medicines help you feel better?

Providers only do tests, like blood tests and imaging tests, if there are red flags of a more serious underlying condition.

How is it treated?

Treatments vary based on the tension headache type.

For episodic headaches, your provider may recommend taking over-the-counter pain relievers, like:

• Acetaminophen (Tylenol®, Panadol®)
• Aspirin
• Ibuprofen (Advil®, Motrin®)
• Naproxen (Aleve®, Naprosyn®)

You should limit pain reliever use to 10 days in any given month. Using these medicines more than this increases your risk of overuse headaches.

Managing stress is also key. Regular physical activity and quality sleep can go a long way toward helping. Therapies like massage therapy, acupuncture and meditation may help, as well.

If you have chronic tension headaches, your provider may suggest:

• Antidepressants, like amitriptyline, that relieve pain
• Antiseizure medications, like gabapentin or topiramate
• Talk therapy for mental health conditions and stressors
• Physical therapy for TMJ disorders
• Sleep apnea treatments, like a CPAP machine or an oral appliance

When should I see my healthcare provider?

True tension-type headaches aren’t dangerous. But certain signs can mean a headache is part of a more serious medical issue. Talk to a healthcare provider if you have a headache and:

• A stiff neck
• Numbness or weakness
• Intense pain
• Pain or tenderness in your jaw when you chew, or at your temple
• Fever above 103 degrees Fahrenheit (39.4 degrees Celsius) that doesn’t go away
• Pain that only happens in certain positions, like standing up or lying down (positional headache)

You should also see your provider if headaches feel different or happen more frequently than usual. Especially if you have cancer or an autoimmune disease.

Is there anything I can do to feel better?

Pain relievers and relaxation techniques, like massage, can relieve tension headaches that happen every once in a while. And practicing better posture may help prevent headaches in the future.

If you have frequent headaches, turn to your healthcare provider for help. Especially if the pain affects your ability to function.