Tension Headache

A tension headache is the most common headache, and yet it's not well understood. A tension headache generally produces a diffuse, usually mild to moderate pain over your head. Many people liken the feeling to having a tight band around their head. A tension headache may also cause pain in the back of your neck at the base of your skull.

Although headache pain sometimes can be severe, in most cases it's not the result of an underlying disease. The vast majority of headaches are so-called primary headaches. Besides tension headaches, these include migraines and cluster headaches. In many cases, there's no clear cause for a tension headache. 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. In addition, a number of preventive, self-care and alternative treatments may help you deal with headache pain.

A tension headache can last from 30 minutes to an entire week. You may experience these headaches occasionally, or nearly all the time. If your headaches occur 15 or more days a month for several months, they're considered chronic. Unfortunately, chronic tension headaches sometimes persist for years. A tension headache may cause you to experience a dull, achy pain or sensation of tightness in your forehead or at the sides and back of your head. Many people liken the feeling to having a tight band of pressure encircling their heads. In its most extensive form, the pain feels like a hooded cape that drapes down over the shoulders. 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. Many people report that the pain starts first thing in the morning or late in the day when work stress or conflict at home is anticipated. Some people with tension headache experience neck or jaw discomfort. There may also be:

  • Tenderness on your scalp, neck and shoulder muscles
  • Difficulty sleeping (insomnia)
  • Fatigue
  • Irritability
  • Loss of appetite
  • Difficulty concentrating

Two classifications
Tension headache is classified into two forms: episodic and chronic. These forms distinguish between occasional headaches separated by varying lengths of time between attacks and frequent headaches that occur, in many cases, almost daily.

  • Episodic. Episodic tension headaches occur on fewer than 15 days a month. These headaches are usually brief, lasting a few minutes to a few hours. Episodic tension headaches may cause scalp and neck muscle tenderness in addition to head pain. People with increasingly frequent attacks of the episodic form may be at higher risk of developing the chronic form of the headache over a period of years.

  • Chronic. Chronic tension headaches occur on 15 days a month or more for at least three months. Compared with the episodic form, chronic tension headache is less common, but twice as many women as men have the chronic form. The duration and the severity of episodic and chronic tension headaches are similar, although for many people with the chronic form, pain is daily and almost continuous. Like the episodic form, chronic tension headache can be with or without scalp tenderness.

Triggers and aggravators
There are many possible triggers of tension headache. You may have no identifiable or consistent trigger, or have several obvious ones. Potential triggers include:

  • Stress
  • Depression and anxiety
  • Lack of sleep or changes in sleep routine
  • Skipping meals
  • Poor posture
  • Working in awkward positions or holding one position for a long time
  • Lack of physical activity
  • Occasionally, hormonal changes related to menstruation, pregnancy, menopause or hormone use
  • Medications used for other conditions, such as depression or high blood pressure
  • Overuse of headache medication

Half the people with tension headache report that they felt stressed or hungry before their headache began. Tension headache may be made worse by jaw pain from clenching or grinding teeth (bruxism) or by head trauma, such as a blow to the head or whiplash injury. People with stiff joints and muscles due to arthritis of the neck or inflammation of the shoulder joints may develop tension headache.

Tension headache probably accounts for a majority of all primary headaches. And it's more common in women than in men. Almost 90 percent of women and about 70 percent of men experience tension headaches during their lifetimes. Tension headache is most prevalent in people between the ages of 20 and 50. The majority of people who get migraines also get tension-type pain.

In addition, see your doctor or go to the emergency room immediately if you have any of these warning signs and symptoms:

  • Abrupt, severe headache, often like a thunderclap
  • Headache with a fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties
  • Headache after a head injury, especially if it gets worse
  • Chronic, progressive headache that is precipitated by coughing, exertion, straining or a sudden movement

If you have chronic or recurrent headaches, your doctor may try to pinpoint the type and cause of your headaches using these approaches:

  • Getting a description of your pain. Your doctor can learn a lot about your headaches from your description of the type of pain, including its severity, location, frequency and duration, and other signs and symptoms you may have.

  • Conducting 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 or an aneurysm. Two common tests used to image your brain are computerized tomography (CT) and magnetic resonance imaging (MRI) scans. 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. An MRI doesn't use X-rays. Instead, it combines a magnetic field, radio waves and computer technology to produce clear images.

  • Asking you to keep a headache calendar. One of the most helpful things you can do is keep a headache calendar for at least two months. Each time you get a headache, jot down a description of the pain, including how severe it is, where it's located and how long it lasts. Also note any medications you take. A headache calendar can offer valuable clues that may help your doctor diagnose your particular kind of headache and discover possible headache triggers.

Although medications can provide temporary relief, lifestyle changes are ultimately the best way to combat tension headaches. Make sure you're following a regular sleep schedule and eating balanced meals. In addition, the following tips may help:

  • Exercise regularly. Regular aerobic exercise, such as walking, swimming or biking, can help reduce the frequency and intensity of headaches. Exercise relieves stress, relaxes your muscles and increases the levels of one of your body's natural stress relievers, beta-endorphin. Yoga, massage, stretching and posture classes also can help prevent tension headaches. If you already have a headache, exercise can help relieve the pain. In some cases, however, exercise may bring on a headache, so check with your doctor before starting any exercise program. Your doctor may recommend that you work with a physical therapist to learn exercise techniques that may specifically benefit people with chronic tension headaches.

    Manage stress. In addition to regular exercise, techniques such as biofeedback training and relaxation therapy can help reduce stress. The goal of biofeedback is to help you enter a relaxed state so that you can better cope with your pain.

Rest, ice packs or a long, hot shower may be all you need to relieve a tension headache. A variety of nonmedication strategies can help reduce the severity and frequency of chronic headaches. 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.

Healthy lifestyle. Behaviors that promote general good health also may help prevent headache. These lifestyle measures include following regular eating and sleeping schedules and avoiding excess caffeine. It's also important to stay physically active. Regular aerobic exercise, such as walking, swimming or biking, can help reduce the frequency of tension headache. If you already have a headache, exercise may help relieve the pain. But be sure to talk to your doctor before starting any exercise program.

Stress management. Stress is a commonly reported trigger for tension headache. 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 and allowing emotions to settle. A variety of relaxation techniques are useful in coping with tension headache, including deep breathing and biofeedback. If anxiety or depression is an issue, behavior therapy may be helpful for dealing with stress and pain.

Muscle relaxation. Muscle tension is associated with tension headache. Applying heat or ice to sore muscles may ease the tension. Which treatment to apply is a matter of personal preference. Some people find heat more effective, while others prefer cold. If heat is your choice, you may 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. If cold is your choice, wrap an ice pack in a cloth before use to protect your skin.

Massage is a wonderful way to relieve muscle tension. For some people, it may also provide relief from headache pain. Gently massage the muscles of your head, neck and shoulders with your fingertips. Or have someone else do the massage for you.

Perfecting your posture. Good posture can help keep your muscles from tensing up. It places minimal strain on your muscles, ligaments, tendons and bones. Good posture supports and protects all parts of your body and allows you to move efficiently. When standing, hold your shoulders back and your head high. Pull in your abdomen and buttocks and tuck in your chin. When sitting, make sure your thighs are parallel to the ground and your head isn't slumped forward.