Tension Headaches


A tension 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 headaches are available. Managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately

Why it Occurs

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
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


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 and chronic.
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.
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 migraines.
Unlike some forms of migraine, tension headache usually isn’t associated with visual disturbances, nausea or vomiting. Although 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 symptoms.
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


Treatment can be helped with a complete history of the headache type, pattern, and any changes. This can be helped by keeping a “Headache Diary” somewhat like the following:

Keep a headache diary. To gather information about your headaches that will help your doctor, keep a headache diary. For each headache, jot down:
Date. Charting the date and time of each headache can help you recognize patterns.
Duration. How long did your headache last?
Intensity. Rate your headache pain on a scale from 1 to 10, with 10 being the worst.
Triggers. List possible triggers of your headache, such as certain foods, physical activities, noise, stress, smoke, bright lights or changes in weather.
Symptoms. Did you have symptoms before you got the headache?
Medications. What medications have you taken? List any, including dosage, even if they’re unrelated to your headache.
Relief. Have you experienced any pain relief and from what?

Other treatment plans can include the following:

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 headaches. 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 available OTC.
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 dependency.
Preventive medications
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 dry mouth.
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).
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.