A tension headache is generally a diffuse, mild to moderate pain that's often described as feeling like a tight band around your head. A tension headache — or tension-type headache as it's medically known — is the most common type of headache, and yet its causes aren't well understood.
It may feel as if muscle contractions are responsible for your head pain, which is why this type of headache is generally referred to as a tension-type headache, though experts no longer think muscle contractions are the cause.
Fortunately, effective 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.
Signs and symptoms of a tension headache include:
A tension headache can last from 30 minutes to an entire week. You may experience these headaches only occasionally, or nearly all the time. If your headaches occur 15 or more days a month for at least three months, they're considered chronic. If you have headaches that occur fewer than 15 times in a month, your headaches are considered episodic. However, people with frequent episodic headaches are at a higher risk of developing chronic headaches.
The headache is usually described as mild to moderately intense. The severity of the pain varies from one person to another, and from one headache to another in the same person.
Tension headaches can sometimes be difficult to distinguish from migraines, but unlike some forms of migraine, tension headache usually isn't associated with visual disturbances (blind spots or flashing lights), nausea, vomiting, abdominal pain, weakness or numbness on one side of the body, or slurred speech. And, while physical activity typically aggravates migraine pain, it doesn't make tension headache pain worse. An increased sensitivity to light or sound can occur with a tension headache, but these aren't common symptoms.
When to see a 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
The exact cause or causes of tension headache are unknown. Experts used to think that the pain of tension headache stemmed from muscle contraction in the face, neck and scalp, perhaps as a result of heightened emotions, tension or stress. But research suggests that there doesn't appear to be a significant increase in muscle tension in people diagnosed with tension headache.
The most common theories support interference or "mixed signals" involving nerve pathways to the brain, which is demonstrated by a heightened sensitivity to pain in people who have tension headaches. Increased muscle tenderness, a common symptom of tension headache, may be the result of overactive pain receptors.
Risk factors for tension headache include:
Because tension headaches are so common, their effect on job productivity and overall quality of life is considerable. The frequent pain may make you feel unable to attend family and social activities. You might need to stay home from work, or if you do go to your job, you often work at only a fraction of your normal efficiency.
Preparing for your appointment
You're likely to start by seeing your family doctor. However, you may be referred to a neurologist, a doctor who specializes in treating nervous system disorders, such as headache.
Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions may help you make the most of your time together. List your questions from most important to least important in case time runs out. For tension headaches, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
What you can do in the meantime
Keep a headache diary. One of the most helpful things you can do is keep a headache diary. Each time you get a headache, jot down these details that may help your doctor diagnose your particular kind of headache and discover possible headache triggers.
Tests and diagnosis
If you have chronic or recurrent headaches, your doctor may try to pinpoint the type and cause of your headaches using these approaches:
Your pain description
Treatments and drugs
Some people with tension headaches don't seek medical attention and try to treat the pain on their own. The problem with that is that 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 stop or reduce the pain of an existing headache attack, including:
Pain medications don't cure headaches; they just relieve the symptoms temporarily. Over time, painkillers and other medications may lose their effectiveness or they might even cause headaches. To avoid the development of medication overuse headaches, don't use over-the-counter pain relievers for more than nine days a month. In addition, all medications have side effects. If you take medications regularly, including products you buy over-the-counter, discuss the risks and benefits with your doctor. Also, remember that pain medications aren't a substitute for recognizing and dealing with the stressors that may be triggering your headaches.
Doctors may prescribe antidepressants to prevent tension headache, especially the chronic form. These drugs aren't painkillers. Rather, they work to stabilize the levels of brain chemicals such as serotonin, which may be involved in the development of a headache. You don't have to have depression in order to use these drugs.
Preventive medications may include:
Preventive medications may require several weeks or more to build up in your nervous system before they take effect. So don't get frustrated if you haven't seen improvements shortly after you begin taking the drug — it may take a couple of months or longer. Also be aware that overusing caffeine or painkillers for acute relief may reduce the effect of a preventive drug.
To obtain the greatest benefit from preventive medication, keep your use of acute pain relievers to a minimum. Your doctor will monitor your treatment to see how the preventive medication is working. If your headaches are under control, your dose of medication may be reduced gradually over time.
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. This approach can be a vital part of any treatment plan for headache. Try some of the following suggestions to see which work best for you.
The following nontraditional therapies may help if you have tension headache pain:
Coping and support
Living with chronic pain can be extremely difficult. In addition to the physical symptoms, chronic pain can make you anxious or depressed. Ultimately, it may affect your relationships with friends and family, your productivity at work, and the overall quality of your life.
Talking to a counselor or therapist can help you cope with the effects of chronic pain. Or you may find encouragement and understanding in a headache support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area.
In addition to regular exercise, techniques such as biofeedback training and relaxation therapy can help reduce stress.
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 — getting enough sleep, not smoking, exercising regularly and eating healthy foods — may help prevent tension headaches.
Last Updated: 2011-02-08
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