Tension Headaches

What Are Tension Headaches?

Tension headaches are dull pain, tightness, or pressure around your forehead or the back of your head and neck. Some people say it feels like a clamp squeezing their skull. They’re also called stress headaches, and they’re the most common type for adults.

There are two types:

• Episodic tension headaches happen fewer than 15 days per month.
• Chronic tension headaches happen more than 15 days a month.

These headaches can last 30 minutes to a few days. The episodic kind usually starts slowly, often in the middle of the day.

Chronic ones come and go over a longer period of time. The pain may get stronger or ease up through the day, but it’s almost always there.

Although your head hurts, tension headaches usually don't keep you from your daily activities, and they don’t affect your vision, balance, or strength.

Where does it hurt?

This type of headache can:

• Start at the back of your head and spread forward
• Become a band of dull pressure or squeezing pain around your entire head
• Affect both sides of your head equally
• Make the muscles in your neck, shoulders, and jaw feel tight and sore

Tension Headache Symptoms

Common symptoms include:

• Mild to moderate pain or pressure in the front, top, or sides of your head
• A headache that starts later in the day
• Trouble sleeping
• Feeling very tired
• Irritability
• Trouble focusing
• Mild sensitivity to light or noise
• Muscle aches

Unlike with migraine headaches, you won’t have other nerve symptoms, such as muscle weakness or blurred vision. And tension headaches don’t usually cause severe sensitivity to light or noise, stomach pain, nausea, or vomiting.

Tension Headache Causes

There's no single cause of tension headaches. They don’t run in families. Some people get them because of tight muscles in the back of the neck and scalp.

Tension headache triggers

Most of the time, tension headaches are triggered by stress from work, school, family, friends, or other relationships.

Episodic ones are usually set off by a single stressful situation or a buildup of stress. Daily stress can lead to the chronic kind.

Tension headache triggers may include:

• Not enough rest
• Poor posture
• Emotional or mental stress, including depression
• Anxiety
• Fatigue
• Hunger
• Low iron levels
• Alcohol
• Caffeine
• Jaw or dental problems
• Straining your eyes
• Dehydration
• Skipping meals
• Smoking
• A cold, the flu, or a sinus infection

Tension Headache Risk Factors

Up to 80% of adults in the U.S. get them from time to time. About 3% have chronic daily tension headaches. Women are twice as likely to get them as men.

Most people with episodic tension headaches have them no more than once or twice a month, but they can happen more often.

Many people with the chronic type have usually had them for more than 60 to 90 days.

When to See Your Doctor

See your doctor if you have frequent or severe headaches, or if they get in the way of your daily life.

Call 911 for a headache that is sudden and severe or also makes your face droop, causes weakness or numbness, or makes it hard to talk, see, or think.

Tension Headache Diagnosis

Your doctor may diagnose you based only on your symptoms. They might ask you things like:

• Where does your head hurt?
• What does the pain feel like?
• When do you have headaches?
• How long do they last?
• Do your headaches get in the way of your daily life?
• Do they keep you from sleeping?
• Are you under a lot of stress?
• Have you had a head injury?
• Have you noticed any changes in your behavior or personality?

They can also do tests to rule out other conditions. These include:

• Blood tests
• Imaging tests such as X-rays, CT scans, or MRI exams to make pictures of the inside of your head

Tension Headache Treatment

It’s best to treat tension headaches soon after they begin, when the symptoms are still mild. The goal is to ease your pain and prevent more of them from happening.

Medications

Over-the-counter (OTC) painkillers are often the first treatments for tension headaches. People with the chronic kind can use some of these drugs to prevent headaches. But if you take them a lot, they can lead to what’s called a medication overuse or rebound headache.

Common OTC treatments include:

• Acetaminophen (Tylenol)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve)

If OTC pain relievers don't help, your doctor may prescribe a stronger medicine such as:

• Indomethacin (Indocin, Indochron E-R)
• Ketoprofen (Actron, Orudis, Oruvail)
• Ketorolac (Toradol)
• Naproxen (Naprelan, Naprosyn)

They could also recommend a muscle relaxer like:

• Cyclobenzaprine (Amrix, Fexmid, Flexeril)
• Methocarbamol (Robaxin)

Some other kinds of drugs can keep you from getting a tension headache. You take them every day, even if you aren’t in pain, so that you end up using less medication over time. Your doctor may prescribe:

• Tricyclic antidepressants like amitriptyline (Elavil) and protriptyline (Vivactil)
• Selective serotonin reuptake inhibitors (SSRIs) including fluoxetine (Prozac), paroxetine (Paxil), or venlafaxine (Effexor)
• Anti-seizure drugs such as topiramate (Topamax)

Keep in mind that medications don't cure headaches and that, over time, pain relievers and other medicines might not help as much as they did at first. Plus, all medicines have side effects. If you take one regularly, talk with your doctor about the pros and cons. You'll still need to identify and deal with the things that are causing your headaches.

Supplements

Some studies have found that certain dietary supplements are effective against migraine headaches. They may also help prevent tension headaches. These supplements include:

• Butterbur
• Feverfew
• Magnesium
• Riboflavin
• Coenzyme Q10

Talk with your doctor before starting any supplements.

Tension Headache Prevention

Try these treatments to make your headaches less severe or less frequent.

Find ways to relax and manage stress like:

• Biofeedback
• Cognitive behavioral therapy
• Acupuncture
• Massage therapy
• Physical therapy
• Deep breathing
• Meditation
Yoga
• Hypnotherapy

Lifestyle changes may also help. Consider these:

• Limit stress. Try to plan. Get, and stay, organized. Things that help you relax, like massage or meditation, can also help.
• Try to pace yourself. Take breaks. Carve out time to do things you enjoy. For some people, mindfulness -- staying in the here and now, instead of following thoughts of worry and fear -- can help.
• Build your support system. Spend time with people you love. You may also want to book some sessions with a therapist to find solutions and to manage any anxiety or depression you may have.
• Exercise regularly. At least 30 minutes five times a week is ideal. It eases stress and keeps you fit. It also helps to stretch. Pay close attention to your jaw, neck, and shoulders. These are areas where we tend to hold a lot of tension.
• Get enough sleep. When you’re well-rested, it’s much easier to deal with daily stress.
• Improve your posture. A strong stance can help keep your muscles from tensing. When you stand, hold your shoulders back and your head level. Tighten your belly and buttocks. When you sit, make sure your thighs are parallel to the floor and your head and neck don’t slump forward.
• Drink lots of water. If you’re dehydrated, you’re more likely to get a tension headache. Drink several glasses of fresh water each day, even if you’re not thirsty. It also helps to eat foods that are naturally rich in water, like most fruits and vegetables.
• Eat regular, balanced meals. Skipping a meal can cause a throbbing headache. Try to eat at the same times every day. Include plenty of fruits, vegetables, and whole grains in your diet.
• Limit caffeine and alcohol. There is caffeine in many over-the-counter headache medicines, but it can also trigger headaches. Drink less coffee and tea, and fewer energy and soft drinks.
• Limit how much pain-relieving medication you take. Use the smallest possible dose. Don't take painkillers more than one or two times a week.
• Keep your sense of humor. It reduces tension.
• Use a headache diary. This will help you spot triggers. It’ll also help your doctor come up with a treatment plan. When you get a headache, note things like the date, the time, any warning signs or other symptoms, the location and intensity of the pain, what you were doing, medications you’d taken, and food you had eaten.

Tension Headaches vs. Migraines

How do you tell them apart?

Tension headaches:

• What do they feel like? Steady, mild to moderate pain that doesn’t throb. It can ease or get worse over the course of the headache.
• Where do they hurt? It can hurt all over your head, but you’ll most likely feel a band of pain around your forehead or the back of your head or around your neck. The headache does not get worse with activity. Your jaw, shoulders, neck, and head may also be tender.
• Are there any other symptoms? This type of headache doesn’t come with the nausea, vomiting, light sensitivity, or aura that people with migraines have.
• Do you notice symptoms before the headache starts? You might feel stress or tension.
• Who gets them? Mostly adults.
• How often do you get them? It varies.
• How long do they last? Thirty minutes to 7 days.

Migraines:

• What do they feel like? They come on slowly. The pain becomes intense. It can be moderate or severe. It might throb or pulse, and it will get worse with physical activity.
• Where do they hurt? Often it’s only one side of your head. It might affect your eye, temple, or the back of your head.
• Are there other symptoms? Some people get a visual disturbance called an aura before the headache starts. During the headache you might be extra-sensitive to light and sound. You might get nauseated and throw up. Some people have trouble moving or speaking.
• Who gets them? Anyone. Boys get them more than girls before puberty, but afterward women get them more than men.
• How often do you get them? It varies.
• How long do they last? Between 4 and 72 hours.

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