Learn About Tension Headache

View Main Condition: Headache

What is the definition of Tension Headache?

A tension headache is the most common type of headache. It is pain or discomfort in the head, scalp, or neck, and is often associated with muscle tightness in these areas.

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What are the alternative names for Tension Headache?

Tension-type headache; Episodic tension-type headache; Muscle contraction headache; Headache - benign; Headache - tension; Chronic headaches - tension; Rebound headaches - tension

What are the causes of Tension Headache?

Tension headaches occur when neck and scalp muscles become tense or contract. The muscle contractions can be a response to stress, depression, head injury, or anxiety.

They may occur at any age, but are most common in adults and older teens. It is slightly more common in women and tends to run in families.

Tension-type headache

Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Activities may include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.

Other triggers of tension headaches include:

  • Physical or emotional stress
  • Alcohol use
  • Caffeine (too much or withdrawal)
  • Colds, the flu, or a sinus infection
  • Dental problems such as jaw clenching or teeth grinding
  • Eye strain
  • Excessive smoking
  • Fatigue or overexertion

Tension headaches can occur when you also have a migraine. Tension headaches are not associated with brain diseases.

What are the symptoms of Tension Headache?

The headache pain may be described as:

  • Dull, pressure-like (not throbbing)
  • A tight band or vise on or around the head
  • All over (not just in one point or one side)
  • Worse in the scalp, temples, or back of the neck, and possibly in the shoulders

The pain may occur once, constantly, or daily. Pain may last for 30 minutes to 7 days. It may be triggered by or get worse with stress, fatigue, noise, or glare.

You may have difficulty sleeping. Tension headaches usually do not cause nausea or vomiting.

People with tension headaches try to relieve pain by massaging their scalp, temples, or the bottom of the neck.

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What are the current treatments for Tension Headache?

The goal is to treat your headache symptoms right away and to prevent headaches by avoiding or changing your triggers. A key step in doing this involves learning to manage your tension headaches at home by:

  • Keeping a headache diary to help you identify your headache triggers so that you and your health care provider can make changes in your lifestyle to reduce the number of headaches you get
  • Learning what to do to relieve a headache when it starts
  • Learning how to take your headache medicines the correct way

Many people can treat their tension headaches with conservative therapy, such as relaxation or stress-management training, including:

  • Massage
  • Biofeedback
  • Cognitive behavioral feedback
  • Acupuncture
  • Ice or hot packs

When needed, medicines that may relieve a tension headache include:

  • Over-the-counter (OTC) pain medicines, such as aspirin, ibuprofen, or acetaminophen
  • Narcotic pain relievers are generally not recommended
  • Muscle relaxers
  • Tricyclic antidepressants to prevent recurrences

Be aware that:

  • Taking medicines more than 3 days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine.
  • Taking too much acetaminophen can damage your liver.
  • Too much ibuprofen or aspirin can irritate your stomach or damage the kidneys.

If these medicines do not help, talk to your provider about prescription medicines.

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What is the outlook (prognosis) for Tension Headache?

Tension headaches often respond well to treatment. But if the headaches are long-term (chronic), they can interfere with life and work.

When should I contact a medical professional for Tension Headache?

Call 911 if:

  • You are experiencing "the worst headache of your life."
  • You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before.
  • The headache starts very suddenly.
  • The headache occurs with repeated vomiting.
  • You have a high fever.

Also, contact your provider if:

  • Your headache patterns or pain change.
  • Treatments that once worked are no longer helpful.
  • You have side effects from medicines, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst.
  • You are pregnant or could become pregnant. Some medicines should not be taken when pregnant.
How do I prevent Tension Headache?

Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for long-term (chronic) tension headache.

Tips to prevent tension headaches:

  • Keep warm if the headache is associated with cold.
  • Use a different pillow or change sleeping positions.
  • Practice good posture when reading, working, or doing other activities.
  • Exercise the neck and shoulders frequently when working on computers or doing other close work.
  • Get plenty of sleep and rest.

Massaging sore muscles may also help.

What are the latest Tension Headache Clinical Trials?
A Randomized, Wait-list Controlled Trial of Daily, Home-based Biofeedback Therapy Using Cerebri for the Prevention of Migraine Attacks in Adults With Episodic Migraine

Summary: The goal of this clinical trial is to test an app-based biofeedback treatment in adults with migraine. The aim of the study is to investigate the safety and effectiveness of biofeedback treatment using the medical device Cerebri, compared to wait-list controls. Participants will perform 10 minutes biofeedback daily, in addition to daily registrations in the headache diary. Wait-list controls will ...

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Cross-cultural Adaptation, Reliability and Validity of the Turkish Version of the Headache Impact Questionnaire

Summary: The purpose of this study was to investigate cultural adaptation, reliability and validity of the Turkish version of the Headache Impact Questionnaire (HIQ).

What are the Latest Advances for Tension Headache?
Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review.
Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache. A systematic review and network meta-analysis.
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Who are the sources who wrote this article ?

Published Date: November 09, 2021
Published By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Garza I, Robertson CE, Smith JH, Whealy MA. Headache and other craniofacial pain. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 102.

Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol. 2018;17(1):75-83. PMID: 29174963 www.ncbi.nlm.nih.gov/pubmed/29174963/.

Rozental JM. Tension-type headache, chronic tension-type headache, and other chronic headache types. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 20.