Tension Headaches

What Are Tension Headaches?

Tension headaches are dull pain, tightness, or pressure around your forehead or the back of your head and neck. Some people say it feels like a clamp squeezing their skull. They’re also called stress headaches, and they’re the most common type for adults.

Video Transcript

Michael Smith, MD<br>Chief Medical Editor at WebMD

MICHAEL SMITH: The differences between tension and migraine headaches aren't absolute, meaning there's overlap. So for instance, migraine headaches, we tend to think of as more severe. But it's not to say that someone with a tension headache can't have a severe headache. But generally, when we think about a migraine headache, we think about a sudden, severe headache that just comes out of nowhere, pounding, throbbing pain. Might be one side of the head or the other. People with migraine headaches typically have nausea. They might have noise and light sensitivity, meaning they just want to curl up in a dark, quiet room somewhere. Now tension headache sufferers can have some of these characteristics, but typically it tends to come on bit more slowly, a bit more moderate, can affect the entire head, but not that throbbing kind of pain. Usually no nausea, and typically, they don't have noise and light sensitivity.

There are two types:

  • Episodic tension headaches happen fewer than 15 days per month.
  • Chronic tension headaches happen more than 15 days a month.

These headaches can last 30 minutes to a few days. The episodic kind usually starts slowly, often in the middle of the day.

Chronic ones come and go over a longer period of time. The pain may get stronger or ease up through the day, but it’s almost always there.

Although your head hurts, tension headaches usually don't keep you from your daily activities, and they don’t affect your vision, balance, or strength.

Where does it hurt?

This type of headache can:

  • Start at the back of your head and spread forward
  • Become a band of dull pressure or squeezing pain around your entire head
  • Affect both sides of your head equally
  • Make the muscles in your neck, shoulders, and jaw feel tight and sore

Tension Headache Symptoms

Common symptoms include:

  • Mild to moderate pain or pressure in the front, top, or sides of your head
  • A headache that starts later in the day
  • Trouble sleeping
  • Feeling very tired
  • Irritability
  • Trouble focusing
  • Mild sensitivity to light or noise
  • Muscle aches

Unlike with migraine headaches, you won’t have other nerve symptoms, such as muscle weakness or blurred vision. And tension headaches don’t usually cause severe sensitivity to light or noise, stomach pain, nausea, or vomiting.

Tension Headache Causes

There's no single cause of tension headaches. They don’t run in families. Some people get them because of tight muscles in the back of the neck and scalp.

Tension headache triggers

Most of the time, tension headaches are triggered by stress, whether from work, school, family, friends, or other relationships.

Episodic ones are usually set off by a single stressful situation or a buildup of stress. Daily stress can lead to the chronic kind.

Tension headache triggers may include:

Continued

Tension Headache Risk Factors

Up to 80% of adults in the U.S. get them from time to time. About 3% have chronic daily tension headaches. Women are twice as likely to get them as men.

Most people with episodic tension headaches have them no more than once or twice a month, but they can happen more often.

Many people with the chronic type have usually had them for more than 60 to 90 days.

Tension Headache Diagnosis

Your doctor may diagnose you based only on your symptoms. They might ask you things like:

  • Where does your head hurt?
  • What does the pain feel like?
  • When do you have headaches?
  • How long do they last?
  • Do your headaches get in the way of your daily life?
  • Do they keep you from sleeping?
  • Are you under a lot of stress?
  • Have you had a head injury?
  • Have you noticed any changes in your behavior or personality?

They can also do tests to rule out other conditions. These include:

  • Blood tests
  • Imaging tests such as X-rays, CT scans, or MRI exams to make pictures of the inside of your head

Tension Headache Treatment

It’s best to treat tension headaches soon after they begin, when the symptoms are still mild. The goal is to ease your pain and prevent more of them from happening.

Medications

Over-the-counter (OTC) painkillers are often the first treatments for tension headaches. People with the chronic kind can use some of these drugs to prevent headaches. But if you take them a lot, they can lead to what’s called a medication overuse or rebound headache.

Common OTC treatments include:

If OTC pain relievers don't help, your doctor may prescribe a stronger medicine such as:

They could also recommend a muscle relaxer like:

Some other kinds of drugs can keep you from getting a tension headache. You take them every day, even if you aren’t in pain, so that you end up using less medication over time. Your doctor may prescribe:

Continued

Keep in mind that medications don't cure headaches and that, over time, pain relievers and other medicines might not help as much as they did at first. Plus, all medicines have side effects. If you take one regularly, talk with your doctor about the pros and cons. You'll still need to identify and deal with the things that are causing your headaches.

Supplements

Some studies have found that certain dietary supplements are effective against migraine headaches. They may also help prevent tension headaches. These supplements include:

Talk with your doctor before starting any supplements.

Tension Headache Prevention

Try these treatments to make your headaches less severe or less frequent.

Find ways to relax and manage stress like:

Lifestyle changes may also help. Consider these:

  • Try to identify and avoid triggers like situations that cause tension or stress.
  • Take breaks from intense tasks.
  • Get regular exercise.
  • Get enough sleep.
  • Try not to push yourself too hard.
  • Eat regular meals.
  • Don’t smoke.
  • If you drink alcohol, drink in moderation.
  • Keep your sense of humor. It reduces tension.

Tension Headaches vs. Migraines

How do you tell them apart?

Tension headaches:

  • What do they feel like? Steady, mild to moderate pain that doesn’t throb. It can ease or get worse over the course of the headache.
  • Where do they hurt? It can hurt all over your head, but you’ll most likely feel a band of pain around your forehead or the back of your head or around your neck. The headache does not get worse with activity. Your jaw, shoulders, neck, and head may also be tender.
  • Are there any other symptoms? This type of headache doesn’t come with the nausea, vomiting, light sensitivity, or aura that people with migraines have.
  • Do you notice symptoms before the headache starts? You might feel stress or tension.
  • Who gets them? Mostly adults.
  • How often do you get them? It varies.
  • How long do they last? Thirty minutes to 7 days.

Migraines:

  • What do they feel like? They come on slowly. The pain becomes intense. It can be moderate or severe. It might throb or pulse, and it will get worse with physical activity.
  • Where do they hurt? Often it’s only one side of your head. It might affect your eye, temple, or the back of your head.
  • Are there other symptoms? Some people get a visual disturbance called an aura before the headache starts. During the headache you might be extra-sensitive to light and sound. You might get nauseated and throw up. Some people have trouble moving or speaking.
  • Who gets them? Anyone. Boys get them more than girls before puberty, but afterward women get them more than men.
  • How often do you get them? It varies.
  • How long do they last? Between 4 and 72 hours.
WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on August 18, 2020

Sources

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