Tension Headache

Content provided by the Faculty of the Harvard Medical School

Tension Headache

What Is It?

Tension headaches are the most common type of headache, affecting up to 40% of people at some time in their lives. These headaches are not caused by disease and are often considered to be "normal" headaches. Tension headaches fall into two general categories:

• Episodic — Fewer than 15 headaches per month

• Chronic — 15 or more headaches per month

The exact cause of tension headaches is unknown, but there appear to be several contributing factors. Tension headaches are caused at least in part by changes in how the nerves of the head, neck and shoulders sense pain. They are also caused by changes in the brain's interpretation of the pain signals sent to the brain from the muscles in the head and neck. Emotional stress and muscular tension also probably act as triggers for these headaches in many people.

Symptoms

The main symptom of a tension headache is usually a sense of tightness around the head — the "tight hatband" or "vise" sensation. Neck and shoulder muscles are often tense and sore to the touch. Other symptoms may include trouble concentrating and difficulty sleeping. It is common for some people to have symptoms of both tension and migraine headaches. For example, headaches may be made worse by bright lights or loud noises, which is typical of migraine headaches, but will also have a constant, non-throbbing quality, which is more typical of tension headache.

Diagnosis

There is no specific test to confirm the diagnosis of a tension headache. The diagnosis is determined by your symptoms, your medical history and a physical examination by your doctor. In some patients, a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the head may be ordered to investigate headache pain that is associated with unexpected or unusual symptoms.

Expected Duration

An episodic tension headache may last only a few hours or it may linger for a day or more. A chronic tension headache typically lasts for part or all of the day for most days of the week, although the intensity of pain may fluctuate during that time.

Prevention

Relaxation techniques and avoidance of stressful situations may help to prevent tension headaches. Dental problems, sinus disease, inadequate sleep and improper posture can act as triggers for tension headaches. By identifying one or more these issues and correcting it, headache frequency and severity may diminish.

In some people, a medication taken daily may help as well. Typically, one of the tricyclic antidepressants is used. Even for people without depression, this class of drug has been found to offer significant relief from tension headache pain.

Treatment

For episodic tension headaches that occur less than three times per week, over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others) are convenient and effective. Combination products with formulas that combine pain medication with caffeine may help some people, but also may be habit forming. The use of any over-the-counter pain reliever should be limited to no more than two or three days per week. If pain medications are used more frequently, "rebound" headaches may occur on the days that medications are not taken.

Chronic tension headaches are more difficult to treat, especially because rebound headaches are common when pain relievers are stopped. It is often more effective to prevent these headaches with a daily prescription medication such as a tricyclic drug.

Some people are able to treat their tension headaches without medications. You can try an ice compress, heating pad or massage to any tight areas in the neck and shoulders. Relaxation techniques, such as deep-breathing exercises, biofeedback or acupuncture may help to decrease the frequency of headaches.

When To Call A Professional

Most headaches are harmless and only rarely are caused by a serious medical problem. There is no reason to see a health care professional if you are able to control your headaches without medications or with only occasional use of a pain reliever.

However, you should call or visit your doctor if you have any of the following symptoms:

• A headache that occurs after a head injury

• A headache accompanied by fever or vomiting

• A headache associated with blurred vision, difficulty speaking, or numbness or weakness of the arms or legs

• Headaches that seem to be increasing in intensity or frequency over time

• A "thunderclap" headache or headache associated with loss of consciousness

• Headaches that require daily use of pain-relieving medications

Prognosis

Given time, most tension headaches will go away on their own. You may recover more quickly if you take pain-relieving medication and avoid any situations that cause tension.

Additional Info

National Institute of Neurological Disorders and Stroke P.O. Box 5801 Bethesda, MD 20824 Toll-Free: (800) 352-9424 http://www.ninds.nih.gov/

National Headache Foundation 428 West Saint James Place 2nd Floor Chicago, IL 60614-2750 Toll-Free: (800) 643-5552 http://www.headaches.org/

American Council for Headache Education (ACHE) 19 Mantua Rd. Mt. Royal, NJ 08061 Phone: (856) 423-0258 Toll-Free: (800) 255-2243 Fax: (856) 423-0082 http://www.achenet.org/

Last updated:	September 18, 2008