Mayo Clinic Health Library

Tension headache

Updated: 07-16-2013

Definition

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.

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Symptoms

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.

When to see a doctor
Make an appointment with your doctor

If tension headache disrupts your life or you need to take medication for your headaches more than twice a week, see your doctor.

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
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Causes

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.

Triggers
Stress is the most commonly reported trigger for tension headaches.

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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.
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Complications

Because tension headaches are so common, their effect on job productivity and overall quality of life is considerable, 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 do go to your job, your ability to function is impaired.

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Preparing for your appointment

You're likely to start by seeing your family doctor. You then may be referred to a doctor who specializes in treating nervous system disorders, such as headache (neurologist).

Here's some information to help you get ready for your appointment and to know what to expect from your doctor.

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to your headaches.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you're taking, and share this information with your doctor.
  • Write down questions to ask your doctor.

For tension headaches, some basic questions to ask your doctor include:

  • What type of headache do you think I'm experiencing?
  • What tests do I need? What will these tests rule out?
  • Is my condition likely temporary or chronic?
  • What treatments are available? Which do you recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Do I need to see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • What are common side effects of the medications you're prescribing?
  • Do you have brochures or other printed material I can take home? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor
Your doctor will likely ask you questions, such as:

  • When did you begin experiencing symptoms?
  • Have you noticed any common triggers, such as stress or hunger?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • How often do you have headaches?
  • How long does each headache last?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime
While you're waiting to see your doctor, you can take an over-the-counter painkiller, such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) to temporarily relieve the pain.

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?
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Tests and diagnosis

If you have chronic or recurrent headaches, your doctor may conduct physical and neurological exams, then try 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 a description of your pain. Be sure to include these details:

  • Pain characteristics. Does your pain pulsate? Or is it constant and dull? Sharp or stabbing?
  • Pain intensity. A good indicator of the severity of your headache is how much you're able to function while you have it. Are you able to work? Do your headaches wake you or prevent you from sleeping?
  • Pain location. Do you feel pain all over your head, on only one side of your head, or just on your forehead or behind your eyes?

Imaging tests
If you have unusual or complicated headaches, your doctor may order tests to rule out serious causes of head pain, such as a tumor. Two common tests used to image your brain include:

  • 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 your brain.
  • Magnetic resonance imaging (MRI). An MRI scan combines a magnetic field, radio waves and computer technology to produce clear images.
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Treatments and drugs

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). More study is needed.

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.

Your doctor will monitor your treatment to see how the preventive medication is working. In the meantime, overuse of pain relievers for your headaches may interfere with the effects of the preventive drugs.

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Lifestyle and home remedies

Rest, ice packs or a long, hot shower may be all you need to relieve a tension headache. A variety of strategies can help reduce the severity and frequency of chronic tension headaches without using medicine. Try some of the following:

  • 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. And if you're caught in a stressful situation, consider stepping back.
  • Go hot or cold. Applying heat or ice — whichever you prefer — to sore muscles, may ease a tension 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.
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Alternative medicine

The following nontraditional therapies may help if you have tension headache pain:

  • Acupuncture. Acupuncture may provide temporary relief from chronic headache pain. Acupuncture practitioners treat you using extremely thin, disposable needles that generally cause little pain or discomfort. The American Academy of Medical Acupuncture website provides referrals to medical doctors who use acupuncture in their practices.
  • Massage. Massage can help reduce stress and relieve tension. It's especially effective 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 are useful in coping with tension headache, including deep breathing and biofeedback.
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Coping and support

Living with chronic pain can be difficult. Chronic pain can make you anxious or depressed and 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. Group members often know about the latest treatments. Your doctor may be able to recommend a group in your area.
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Prevention

In addition to regular exercise, techniques such as biofeedback training and relaxation therapy can help reduce stress.

  • Biofeedback training. This technique teaches you to control certain body responses that help reduce pain. During a biofeedback session, you're connected to devices that monitor and give you feedback on body functions such as muscle tension, heart rate and blood pressure. You then learn how to reduce muscle tension and slow your heart rate and breathing yourself.
  • Cognitive behavioral therapy. This type of talk therapy may help you learn to manage stress and may help reduce the frequency and severity of your headaches.
  • Other relaxation techniques. Anything that helps you relax, including deep breathing, yoga, meditation and progressive muscle relaxation, may help your headaches. You can learn relaxation techniques in classes or at home using books or tapes.

Using medications in conjunction with stress management techniques may be more effective than is either treatment alone in reducing your tension headaches.

Additionally, living a healthy lifestyle may help prevent headaches:

  • Get enough, but not too much sleep.
  • Don't smoke.
  • Exercise regularly.
  • Eat regular, balanced meals.
  • Drink plenty of water.
  • Limit alcohol, caffeine and sugar.
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