Tension Headache

views updated

Tension Headache


This most common type of headache is caused by severe muscle contractions triggered by stress or exertion. The American Council for Headache Education (ACHE) estimates that 95% of women and 90% of men in the United States and Canada have had at least one headache in the past twelve months. Tension headaches are considered a type of primary headache, which means that they are not caused by another medical condition or disorder.

Other names for tension headaches include muscle contraction headache, ordinary headache, psycho-myogenic headache, and stress headache.


While most American adults get a tension headache from time to time, women and people with more education are slightly more likely to suffer with them; the female: male ratio is reported to be 1.4: 1. People who are so anxious that they grind their teeth or hunch their shoulders may find that the physical strain in their body can be experienced as pain and tension in the muscles of the neck and scalp, producing almost constant pain.

In terms of age groups, chronic tension headaches have been reported in children younger than six years, but most people report that their tension headaches start in adolescence or the early twenties.

Causes and symptoms

Tension headaches are caused by tightening in the muscles of the face, neck and scalp because of stress or poor posture. They can last for days or weeks and can cause pain of varying intensity. The tightening muscles cause more expansion and constriction of blood vessels, which can make head pain worse. Eyestrain caused by dealing with a large amount of paperwork or reading can cause a tension headache as well.

Many people report tension headache pain as a kind of steady ache (as opposed to a throb) that forms a tight band around the forehead, affecting both sides of the head. Tension headaches usually occur in the front of the head, although they also may appear at the top or the back of the skull.

Tension headaches often begin in late afternoon and can last for several hours; they can occur every day and last throughout most of the day, but most (82%) go away within a few hours. A tension headache that occurs on 15 or more days per month over a period of six months or longer is called a chronic tension headache. Unlike migraines, tension headaches don't cause nausea and vomiting, sensitivity to light, or any kind of aura before the headache begins.

It is possible for children as well as adults to have more than one type of headache. It is not unusual for patients with chronic tension headaches to suffer from migraine headaches as well.


Diagnosis of tension headaches is made from a medical history, discussion of symptoms, and elimination of other types of headaches or underlying disorders.

Very few headaches are the sign of a serious underlying medical problem. However, sufferers should call a physician at once if they:

  • have more than three headaches a week
  • take painkillers almost every day
  • need more than the recommended dose of painkiller
  • have a stiff neck and/or fever in addition to headache
  • are dizzy, unsteady, or have slurred speech, weakness, or numbness
  • have confusion or drowsiness with the headache
  • have headaches that began with a head injury
  • have headaches triggered by bending, coughing or exertion
  • have headaches that keep getting worse
  • have severe vomiting with the headache
  • have the first headache after age 50
  • awaken with headache that gets better as the day goes on


There are many different treatments for tension headaches, which respond well to both medication and massage. If these headaches become chronic, however, they are best treated by identifying the source of tension and stress and reducing or eliminating it.


Tension headaches usually respond very well to such over-the-counter analgesics as aspirin, ibuprofen, or acetaminophen. However, some of these drugs (especially those that contain caffeine ) may trigger rebound headaches if discontinued after they are taken for more than a few days.

More severe tension headaches may require combination medications, including a mild sedative such as butalbital; these should be used sparingly, though. Chronic tension headaches may respond to low-dose amitriptyline taken at night.


Massaging the tense muscle groups may help ease pain. Instead of directly massaging the temple, patients will get more relief from rubbing the neck and shoulders, because tension headaches can arise from tension in this area. In fact, relaxing the muscles of the neck can cut the intensity and duration of tension headaches at least in half.

To relax these muscles, the neck should be rotated from side to side as the shoulders shrug. Some people find that imagining a sense of warmth or heaviness in the neck muscles can help. Taking three very deep breaths at the first hint of tension can help prevent a headache.

Other therapy

If tension headaches are a symptom of either depression or anxiety, the underlying problem should be treated with counseling, medication, or a combination of both.

Injections of botulinum toxin (Botox) have been reported to relieve tension headaches in some patients, but this treatment is still regarded as experimental as of 2004.

Alternative treatment

Eliminating the source of the tension as much as possible will help prevent tension headaches. Acupuncture may be helpful in treating some chronic tension headaches. Homeopathic remedies and botanical medicine can also help relieve tension headaches. Valerian (Valeriana officinalis ), skullcap (Scutellaria lateriflora ), and passionflower (Passiflora incarnata ) are three herbal remedies that may be helpful. A tension headache can also be relieved by soaking the feet in hot water while an ice cold towel is wrapped around the neck.


Cutting down on stress and relying less on caffeine-containing medications can reduce the number of tension headaches for most people.


Tension headaches can often be prevented by managing everyday stress and making some important lifestyle changes. Those who are prone to tension headaches should:

  • take frequent "stress breaks"
  • get regular exerciseeven a brisk 15-minute walk can help prevent tension headaches
  • get enough sleep
  • release angry feelings


Analgesic A medication that relieves pain without causing loss of consciousness. Over-the-counter analgesics include aspirin and NSAIDs.

Primary headache A headache that is not caused by another disease or medical condition. Tension headaches are a subtype of primary headache.

Rebound headache A type of primary headache caused by overuse of pain relievers. It is also known as analgesic abuse headache.



Beers, Mark H., MD, and Robert Berkow, MD., editors. "Headache." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Headache." New York: Simon & Schuster, 2002.


Argoff, C. E. "The Use of Botulinum Toxins for Chronic Pain and Headaches." Current Treatment Options in Neurology 5 (November 2003): 483-492.

Balottin, U., F. Nicoli, G. Pitillo, et al. "Migraine and Tension Headache in Children under 6 Years of Age." European Journal of Pain 8 (August 2004): 307-314.

Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders," 2nd ed. Cephalalgia 24, Supplement 1 (2004): 1-150.

Padberg, M., S. F. de Bruijn, R. J. de Haan, and D. L. Tavy. "Treatment of Chronic Tension-Type Headache with Botulinum Toxin: A Double-Blind, Placebo-Controlled Clinical Trial." Cephalalgia 24 (August 2004): 675-680.

Seshia, S. S. "Mixed Migraine and Tension-Type: A Common Cause of Recurrent Headache in Children." Canadian Journal of Neurological Sciences 31 (August 2004): 315-318.

Singh, Manish K., MD. "Muscle Contraction Tension Headache." eMedicine October 5, 2001. http://www.emedicine.com/neuro/topic231.htm.


American Headache Society (AHS). 19 Mantua Road, Mt. Royal, NJ 08061. (856) 423-0043. Fax: (856) 423-0082. http://www.ahsnet.org.

National Headache Foundation. 428 W. St. James Place, Chicago, IL 60614. (800) 843-2256. http://www.headaches.org.

National Institute of Neurological Disorders and Stroke (NINDS). "HeadacheHope Through Research." Bethesda, MD: NINDS, 2001. http://www.ninds.nih.gov/health_and_medical/pubs/headache_htr.