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Tension Headache

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(Muscle Contraction Headache; Tension-Type Headache)

Definition

Tension headache refers to head pain associated with stress and muscle contraction. These headaches may occur only occasionally in response to a stressful event. They may also be chronic, occurring frequently. Some tension headaches are nearly constant, with daily pain that may vary in intensity.
Tension Headache: Areas of Pain
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Causes

Tension headaches may occur when muscles in the neck, face, and scalp contract, which produce pain. The precise cause of this muscle contraction is unknown. Factors that may contribute to tension headache include:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Your risk of getting a tension headache increases with:
  • Depression
  • Anxiety
  • Sex: female
  • Teeth clenching or grinding
  • Sleep apnea
  • Medications
  • Sleep disruption
  • Low physical activity
  • Being Overweight
  • Smoking

Symptoms

Tension headache symptoms usually start slowly and build.
Symptoms include:
  • Constant, steady pain and pressure
  • Dull and achy pain
  • Pain felt on both sides of the head, in the forehead, temples, and the back of the head
  • Pressure may feel like a tight band around the head
  • Intensity ranges from mild to severe and can vary during the day
  • Tightness in head and neck muscles
Headaches can become so severe and constant that they interfere with normal activities and sleep.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The cause of a headache can be difficult to determine.
Tests may include:
  • Neurological exam
  • Blood tests
  • Neck x-ray—a test that uses radiation to take a picture of structures inside the body, especially bones
  • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the head
  • MRI scan—a type of machine that uses a magnetic field, radio waves, and a computer to make pictures of structures inside the head

Treatment

Tension headaches are managed, rather than cured. Therapies aim to stop the headache and reduce the frequency of future episodes.
Treatment may include:

Medications

Medications may include:
  • Over-the-counter pain pills—Continuous use of some over-the-counter medication may create rebound pain when you stop taking the drug. Using these medicines too much can cause headaches. Pain medications are most effective when taken at the first sign of pain and before it becomes severe.
  • Prescription nonsteroidal anti-inflammatory drugs (NSAIDs)or muscle relaxants
  • Drugs to prevent headaches, if you suffer from daily tension headaches
  • Antidepressant medications, even if you are not clinically depressed
  • Botulinum toxin injections (Botox)

Self-care during the Headache

Self-care may include:
  • Rest
  • Put an ice pack or heat pack on your head or neck to ease discomfort
  • Take a warm shower, with water running over tense muscles
  • Massage your temples and neck
  • Practice relaxation techniques

Lifestyle Changes

Lifestyle changes may include:
  • Exercise regularly
  • Improve your posture
  • Get plenty of sleep
  • Take breaks from tasks
  • Learn and practice stress management and relaxation techniques
  • Consider seeing a counselor to:
    • Develop new coping skills
    • Identify events that trigger the headaches and work toward resolution

Additional Therapies

Additional therapies may include:
  • Acupuncture—Acupuncture may help you to have more headache-free days and lessen the intensity of headaches when they do occur.
  • Physical therapy—Physical therapists can help you develop a home-exercise program.
  • Massage therapy if the pain is in your neck and shoulders
If you are diagnosed with a tension headache, follow your doctor's instructions.
If you are diagnosed with a tension headache, follow your doctor's instructions.

Prevention

You may be able to reduce the chance of a tension headache by learning how to manage stress. Try the following strategies:
  • Keep a diary, marking when headaches occur and what you were doing before they started.
  • Learn to recognize what provokes a tension headache.
  • Avoid or minimize stressful situations.
  • Take frequent breaks to walk or move around.
  • Make time for pleasurable activities.
  • Practice relaxation techniques, such as deep breathing and focusing on something pleasant.
  • Learn techniques for coping with difficult or stressful situations.
  • Make time for friends and build a strong support system.
  • Go to bed early and get a good night's sleep.
  • Exercise regularly.
  • Do not slouch.
  • Hold the phone, rather than cradling it on your shoulder, or use a headset.

RESOURCES

American Headache Society http://www.americanheadachesociety.org

National Headache Foundation http://www.headaches.org

CANADIAN RESOURCES

Headache Network Canada http://www.headachenetwork.ca

Help for Headaches http://www.headache-help.org

References

American Medical Association website. Available at: http://www.ama-assn.org. Accessed October 12, 2005.

Dambro MR. Griffith's 5-Minute Clinical Consult. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.

Goetz CG. Textbook of Clinical Neurology. Philadelphia, PA: WB Saunders Co; 1999.

Melchart D, Streng A, Hoppe A, et al. Acupuncture in patients with tension-type headache: randomized controlled trial. Brit Med J. 2005;331:376-379.

National Headache Foundation website. Available at: http://www.headaches.org. Accessed October 12, 2005.

National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/. Accessed October 12, 2005.

Rakel RE, Bope ET. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Tension headache. EBSCO Publishing DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Accessed October 20, 2007.

Tension headache. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/tension-headach/DS00304. Accessed January 17, 2009.

12/16/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN. Acupuncture in patients with headache. Cephalalgia. 2008;28:969-979.

8/27/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA. An unfavorable lifestyle and recurrent headaches among adolescents: The HUNT Study. Neurology. 2010;75(8):712-717.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 09/2011 -
  • Update Date: 09/20/2011 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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