Tension headaches are the most common type of headache, with up to 80% of adults in the U.S. occasionally experiencing one. However, 3% of U.S. adults have chronic, daily tension headaches, with women twice as likely as men to suffer from these headaches.
A tension headache generally has diffused, mild to moderate pain, often described as feeling like a tight band around the head. Despite the prevalence of tension headaches, the causes are not well-understood.
An episodic tension-type headache may last only 30 minutes. But it can linger for as long as seven days. Most people with episodic tension headaches have them no more than once or twice a month, but they can happen more often.
Fortunately, various 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.
Tension headaches (also called muscle-tension headaches or stress headaches) are the most common type of headache. These headaches are not caused by disease and are often considered to be “normal” headaches.
Tension headaches do not usually keep someone from normal daily activities, and they do not affect vision, balance, or strength as do migraine headaches.
Most tension headaches occur infrequently and are usually short-lived (resolves within minutes to a few hours or even a few days). In rare cases, the headache may last for several days.
There are two classifications for tension headaches:
Episodic. These headaches occur less than 15 days per month. They usually begin gradually, often in the middle of the day.
Chronic. These headaches occur more than 15 days a month. They come and go over a more extended period. The intensity of pain may fluctuate throughout the day, but it’s almost always present. The pain can also be continuous.
What Causes Tension Headaches?
There’s no single cause for a tension headache, and the exact cause is typically unknown. This type of headache doesn’t appear to run in families. However, experts believe there are several contributing factors to tension headaches. In part, doctors believe the headaches result from changes in how the nerves of the head, neck, and shoulders sense pain.
For instance, any activity that causes the head to be held in one position for a long time without moving (e.g., computer work, or fine work with the hands) can trigger a headache. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.
Emotional stress and muscular tension can also act as triggers. The muscle tension can be the result of:
Alcohol. Tyramine (found in aged and fermented foods) in red wine and some alcoholic drinks can contribute to headaches. Because alcohol boosts blood flow to the brain, the effect may be even more intense.
Anxiety. Any emotional, physical, or mental stress, including depression, can cause a headache.
Bad posture. Slouching can build up pressure in the head and neck muscles resulting in a headache.
Caffeine. In moderation, caffeine can help with headaches – it’s even in many headache medications. However, excessive consumption of coffee or sodas can also cause headaches. Be aware, though, that suddenly reducing caffeine intake resulting in caffeine withdrawal is another headache trigger.
Cold cuts and processed meats. Food additives such as nitrites and tyramine may trigger headaches.
Illness. Colds, the flu, or a sinus infection can trigger a headache.
Dental conditions. Jaw clenching, teeth grinding, and other dental conditions can be a trigger for tension headaches.
Exercise or overexertion. Strenuous activity (like jogging and weightlifting) can sometimes lead to a headache.
Eye strain. This is a common condition that occurs when your eyes get tired from intense use, such as driving long distances or staring at computer screens and other digital devices.
Fatigue. Headaches and an array of physical, mental, and emotional symptoms can be caused by fatigue.
Hair accessories. How you wear your hair (e.g., a too-tight ponytail) can strain the connective tissue in the scalp, leading to a headache. Headbands, braids, and tight-fitting hats can do the same.
Lack of rest. A study by Missouri State University found that a lack of REM (rapid eye movement) sleep is linked to headaches.
Low iron levels. This condition can result in the brain’s blood vessels swelling, causing pressure and headaches.
Skipping meals. Hunger headaches aren’t always obvious. If you don’t eat, your head could start to ache before you realize you’re hungry. The cause is likely a dip in blood sugar.
Smoking. In some individuals, smoking may trigger headaches for both smokers and others. The smoke contains nicotine, which causes blood vessels in the brain to narrow.
Stress is the most commonly reported trigger for tension headaches. Anything that increases stress in a person’s life can make them more vulnerable to tension headaches or even migraines.
Strong scents. Strong smells, even nice ones, can trigger a headache. The most common offenders are paint, perfume, and certain types of flowers.
Weather. Pressure changes related to weather changes are thought to trigger chemical and electrical changes in the brain, which can irritate nerves and trigger a headache.
Work can be a major stressor, contributing to tension headaches and even migraines.
Headache sufferers may simultaneously experience a tension headache and a migraine, partially because a tension headache can trigger migraine pain. Fortunately, a tension headache may also be relieved by migraine medications.
Furthermore, the National Headache Foundation reports that people with gastrointestinal problems experience migraines and tension headaches more frequently than people without the disorder. The research shows that migraines and tension-type headaches may share genetic links with irritable bowel syndrome (IBS), the most common gastrointestinal disorder.
What are the Symptoms of Tension Headaches?
Typically, a tension headache causes mild to moderate pain, usually on both sides of the head. The headache does not get worse with routine physical activity and does not have pulsating pain, nor does it cause nausea.
The headache causes a dull pain, tightness, or pressure sensation around your forehead or the back of your head and neck. Some people say it feels like a clamp squeezing the skull or a band tightening around the head. Patients describe the pain as constant and pressure-like, which tends to come on gradually. However, most people with a tension headache can continue their daily activities.
Other common symptoms include:
Feeling very tired.
Trouble focusing and concentrating.
Mild sensitivity to light or noise.
Unlike a migraine headache, you do not have other nerve symptoms such as muscle weakness or blurred vision. Also, there is not usually a severe sensitivity to light or noise. However, a person can simultaneously experience both migraine and tension-type headaches.
The symptoms of tension-type headaches and migraine headaches can also overlap. For example, both types of headaches may be made worse by bright lights or loud noises.
Migraine headaches generally tend to be throbbing.
Tension-type headaches cause a more constant pain. But the pain of a migraine or tension-type headache can be steady or throbbing or alternate between the two.
Because tension headaches are so common, their effect on job productivity and overall quality of life can be substantial, 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 go to your job, your ability to function may be impaired.
How are Tension Headaches Diagnosed?
Unfortunately, there is no specific test to confirm the diagnosis of a tension-type headache. Instead, the diagnosis is determined by the patient’s description of the headache, medical history, and a physical examination.
A detailed description of the headache pain is helpful in making the diagnosis. Be sure to include these details when talking to the doctor:
Pain characteristics. Does your pain pulsate, or is it constant? Is the pain dull, sharp, or stabbing?
Pain intensity. A good indicator of the severity of a headache is how well you can function while experiencing a headache. Are you able to work? Do the headaches wake you or prevent you from sleeping?
Pain location. Where is the pain located? Is it all over your head, just one side, on the forehead, or behind your eyes?
The doctor may order special imaging tests to rule out any serious causes of head pain, such as a tumor. The imaging tests can help diagnose headache pain that is associated with unexpected or unusual symptoms. Two standard tests used to image the brain include:
Magnetic resonance imaging (MRI). An MRI scan combines a magnetic field, radio waves, and computer technology to produce clear images.
Computerized tomography (CT). A CT scan is a diagnostic imaging procedure that uses a series of computer-directed X-rays to provide a comprehensive view of the brain.
The National Headache Foundation has a Headache Impact Test tool to help patients communicate the severity of their headache pain to their healthcare provider. The test helps to:
Determine the impact headaches have on the patient’s life.
Better communicate the information to the healthcare provider.
Track the patient’s headache history and the effectiveness of therapy over time.
When a healthcare provider understands “how headaches are affecting their patient, they are better able to provide a successful treatment program.” Download the test here.
How are Tension Headaches Treated?
The goal of treating tension headaches at the pain clinic in Lakeland, Florida, is to treat the symptoms as soon as they start and then prevent future headaches by avoiding or changing the triggers. To discover your specific headache triggers, keep a headache diary. Every day, note the foods you eat, stressful events, weather changes, and physical activity.
When a headache occurs, record the time it starts and stops in your diary. The diary helps identify specific headache triggers so that you can make lifestyle changes to help reduce the number of headaches.
When a headache first begins, some people find headache relief in a hot or cold shower (or bath). If a shower or bath is not possible, try to rest in a quiet room with a cool cloth on your forehead. Also, gently massaging your head and neck muscles may help provide relief.
Over-the-counter pain medicine such as aspirin, ibuprofen, or acetaminophen can help relieve tension headache pain. Some people find products that also contain caffeine work better to relieve pain.
Some drugs can help keep you from getting a tension headache, like antidepressants, blood pressure medications, and anti-seizure drugs. A doctor may prescribe these for use every day, even on days there is no headache, because the patient will use less medication over time. Some of these medicines include:
Tricyclic antidepressants. Drugs such as amitriptyline and protriptyline are the most commonly used to prevent tension headaches.
Other antidepressants. There is evidence to support the use of antidepressants to help prevent headaches.
Anticonvulsants and muscle relaxants. Other medications that may prevent tension headaches include anticonvulsants, such as topiramate (Topamax), and muscle relaxers.
Carefully follow your health care provider’s instructions regarding medication. Rebound headaches (recurring headaches) can result from the overuse of pain medicine, which can occur when taking certain pain medicine more than three days a week regularly.
Also, be aware that:
Taking too much acetaminophen can damage your liver. The maximum safe dosage limit is 4,000 mg of acetaminophen (in any form – including cold medicines) in 24 hours.
Too much ibuprofen or aspirin can irritate your stomach or damage your kidneys.
Repeated use of pain relievers and other medicines may become less effective over time.
It is essential to keep in mind that medications don’t cure headaches, and all medicines have side effects, including over-the-counter medications. To stop the headaches, you must deal with the triggers.
Lifestyle and Home Remedies
Rest, ice packs, or a long hot shower may be all that is necessary to relieve a tension headache. However, there are a variety of strategies that can help reduce the severity and frequency of chronic tension headaches without using medications. These include:
Managing stress. Allow time to relax during the day by planning ahead and organizing quiet time throughout the day. When you find yourself in a stressful situation, consider stepping back.
Hot/Cold therapy. Apply heat or ice (whichever works best for you) to sore muscles to help ease a tension headache. For heat therapy, use a heating pad set on low, a hot-water bottle, a warm compress, or a hot towel. A hot bath or shower may also help. For cold therapy, wrap ice, an ice pack, or frozen vegetables in a cloth to protect your skin from frostbite.
Correct 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, your thighs should be parallel to the ground, and your head should not slump forward.
Exercise. Regular aerobic activity can be quite effective in decreasing the frequency of tension headaches. Also, jogging and working out at the gym (in moderation), as well as physical therapy, can help.
Hydrate. Sometimes mild dehydration or lack of food can trigger headaches. If this is the case, drinking non-caffeinated fluids or eating healthy food may help.
The following nontraditional therapies may help relieve tension headache pain without medication:
Acupuncture. Acupuncture may provide temporary relief from chronic headache pain. As a key component of traditional Chinese medicine, acupuncture involves inserting thin needles into the skin at strategic body points that generally cause little pain or discomfort.
Massage. Massage can help reduce stress and relieve tension. It’s especially useful for relieving tight, tender muscles in the back of your head, neck, and shoulders. For some people, it may also provide relief from headache pain.
Deep breathing, biofeedback, and behavior therapies. A variety of relaxation therapies can be useful in coping with tension headaches.
Flaxseed. Rich in omega-3 fatty acids with anti-inflammatory properties, flaxseed may help decrease headaches.
Peppermint or lavender essential oil. Inhaling the scent of peppermint or lavender essential oil can be soothing and relaxing, which may help decrease the intensity of a headache.
Living with chronic pain can be difficult. Chronic pain can make you anxious or depressed and affect your relationships, productivity, and quality of life. If you find medications and alternative therapies fail to relieve your headaches, consider:
Talking to your pain doctor. Chronic pain can result from numerous conditions that have a variety of treatment options. A pain specialist is equipped to diagnose and treat all types of chronic pain.
Talking to a counselor or therapist. Talk therapy may help you cope with the effects of chronic pain.
Joining a support group. Support groups can be good sources of information. Group members often know about the latest treatments. Your doctor may be able to recommend a group in your area.
Is It Possible to Prevent Tension Headaches?
When you know you must participate in an activity that typically triggers a headache, taking pain medicine beforehand can help lessen the severity of the headache. Additionally, living a healthy lifestyle may help prevent headaches. Consider these:
As much as possible, try to identify and avoid situations that cause tension or stress.
Take short breaks from intense tasks.
Practice good posture when reading, working, or during other activities.
Exercise the neck and shoulders frequently when working on computers or doing other close work.
Get regular exercise.
Get enough, but not too much, sleep. Too much sleep can be as harmful as not getting enough.
Use a different pillow or change sleeping positions.
Try not to push yourself too hard.
Eat regular, well-balanced meals.
If you drink alcohol, drink only in moderation.
Drink plenty of water.
Limit caffeine and sugar consumption.
Get plenty of sleep and rest.
Keep your sense of humor — it reduces tension.
Your doctor may prescribe medications to reduce the frequency and severity of tension headaches, especially if you have frequent or chronic headaches that aren’t relieved by pain medication and other therapies. Pain medication to prevent tension headaches include:
Anticonvulsants and muscle relaxants.
Preventive medications may require several weeks or more to build up in your system before taking effect. It is essential to follow your doctor’s orders. Do not become frustrated if you haven’t seen improvements shortly after you begin taking the medication.
Your doctor will monitor your treatment to see how the preventive medication is working. The overuse of pain relievers for headaches may interfere with the effects of preventive drugs.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating tension headaches. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.