Tension headache

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 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.

The cause of tension-type headaches is not known. In the past, experts thought tension-type headaches were caused by muscle contractions in the face, neck and scalp. They thought the muscle contractions were a result of emotions, tension or stress. But research suggests that muscle contraction isn’t the cause.

The most common theory is that people who have tension-type headaches have increased sensitivity to pain. Muscle tenderness, a common symptom of tension-type headaches, may result from this sensitized pain system.

Triggers

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

Because tension-type headaches are so common, they can have an effect on job productivity and quality of life, particularly if they’re chronic. Frequent headache pain may make it hard to attend activities. You might need to stay home from work. If you do go to your job, it may be hard to function as usual.

Regular exercise can help prevent tension-type headaches. Other techniques also can help, such as:

• Biofeedback training. This training teaches you to control certain body responses that help reduce pain. A device monitors and gives you feedback on your muscle tension, heart rate and blood pressure. You then learn how to reduce muscle tension and slow your heart rate and breathing.
• Cognitive behavioral therapy. This type of talk therapy may help you learn to manage stress. Doing this may help you have fewer or less painful headaches.
• Other relaxation techniques. Anything that helps you relax may help your headaches. This can include deep breathing, yoga, meditation and progressive muscle relaxation. You can learn these methods in classes or at home using books or apps.

Using medicines along with stress management may be more effective than any one treatment in reducing your tension-type headaches.

Also, living a healthy lifestyle may help prevent headaches:

• Get enough, but not too much, sleep.
• Don’t smoke.
• Stay physically active.
• Eat regular, balanced meals.
• Drink plenty of water.
• Limit alcohol, caffeine and sugar.

If you have regular headaches, your health care professional may give you a physical and a neurological exam. Your care professional works to pinpoint the type and cause of your headaches using these approaches.

Your pain description

Your doctor can learn a lot about your headaches from the information you provide about the pain. Be sure to include these details:

• Pain description. Is the pain throbbing? Is it constant and dull? Is it sharp or stabbing?
• Pain intensity. A good indicator of pain intensity is how much you’re able to do during the headache. Are you able to work? Do headaches wake you or prevent you from sleeping?
• Pain location. Do you feel pain all over your head? Is the pain on one side of your head? Or is the pain only on your forehead or behind your eyes?

Imaging tests

Your doctor may order tests to rule out serious causes of head pain, such as a tumor. Two common imaging tests include:

• Magnetic resonance imaging (MRI). An MRI scan is done using a powerful magnet and computer-generated radio waves to create images of your brain.
• Computerized tomography (CT). A CT scan combines a series of X-ray images taken from different angles. It creates cross-sectional images to provide a detailed view of your brain.

Some people with tension-type headaches don’t see a health care professional and try to treat the pain on their own. But repeated use of pain relievers available without a prescription can cause another type of headache known as medication overuse headache. Your health care professional can work with you to find the right treatment for your headaches.

Medicines to take during a tension-type headache

Several medicines can help reduce the pain of a headache. They include medicines you can buy at the store without a prescription and medicines available with a prescription.

• Pain relievers. Pain relievers available without a prescription are usually the first line of treatment for reducing headache pain. These include aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
• Combination medicines. Aspirin, acetaminophen (Tylenol, others) or both are often combined with caffeine or a sedative in a single medicine. Combination medicines may be more effective than single-ingredient pain relievers. Many combination medicines are available without a prescription.
• Triptans. For people who experience both migraines and episodic tension-type headaches, a triptan can effectively relieve the pain of both headaches.

Prescription opioids are rarely used because of their side effects and potential for dependency.

Preventive medicines

Your health care professional may prescribe medicines that help you have fewer headaches or headaches that are less painful. Preventive medicines may help if you have regular headaches that aren’t relieved by pain medicine and other therapies.

Preventive medicines may include:

• Tricyclic antidepressants. Tricyclic antidepressants are the most commonly used medicines to prevent tension-type headaches. They include amitriptyline, nortriptyline (Pamelor) and protriptyline. These medicines can cause side effects such as constipation, drowsiness and dry mouth.
• Other antidepressants. The antidepressants venlafaxine (Effexor XR) and mirtazapine (Remeron) also can help prevent tension-type headaches.
• Anti-seizure medicines and muscle relaxants. The anti-seizure medicines gabapentin (Gralise, Horizant, Neurontin) and topiramate (Topamax, Qsymia, others) may help prevent headache pain. But more study is needed to understand how well they work to prevent tension-type headaches. The muscle relaxant tizanidine (Zanaflex) also can be used for prevention.

It can take several weeks or more for preventive medicines to build up in your system and take effect.

Your health care professional monitors your treatment to see how the preventive medicine is working. In the meantime, overusing pain relievers may interfere with the effects of the preventive medicines. Ask your health care professional about how often to use pain relievers while you’re taking preventive medicine.

These nontraditional therapies may help if you have tension-type headache pain:

• Acupuncture. Acupuncture may provide temporary relief from chronic headache pain. Acupuncture involves using very thin, disposable needles that generally cause little pain or discomfort. Acupuncture is typically safe when performed by an experienced acupuncturist who follows safety guidelines and uses sterile needles.
• Massage. Massage can help reduce stress and relieve tension. It’s especially effective for relieving tight, tender muscles in the back of the head, neck and shoulders. For some people, it may also provide relief from headache pain.
• Deep breathing, biofeedback and behavior therapies. These techniques and therapies can be useful for coping with tension-type headaches.

Rest, ice packs or a long, hot shower may be all you need to relieve a tension-type headache. If you experience chronic tension-type headaches, these strategies can help you reduce how many you have or how painful they are:

• Manage your stress level. One way to help reduce stress is by planning ahead and organizing your day. Another way is to allow more time to relax.
• Go hot or cold. Applying heat or ice — whichever you prefer — to sore muscles may ease a tension-type headache. For heat, use a heating pad set on low, a hot-water bottle, a warm compress or a hot towel. A hot bath or shower also may help. For cold, wrap ice, an ice pack or frozen vegetables in a cloth to protect your skin.
• Perfect your posture. Good posture can help keep your muscles from tensing. When standing, hold your shoulders back and your head level. Pull in your abdomen and buttocks. When sitting, make sure your thighs are parallel to the ground and your head isn’t slumped forward.

Chronic pain can cause anxiety and depression. It also can affect your relationships, your productivity and the quality of your life.

Here are some suggestions:

• Talk to a counselor or therapist. Talk therapy may help you cope with the effects of chronic pain.
• Join a support group. Support groups can be good sources of information and a source of comfort. Group members often know about the latest treatments. Your health care provider may be able to recommend a group in your area.