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 the skull. Often called stress headaches, 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 less than 15 days per month.
  • Chronic tension headaches happen more than 15 days a month.

These headaches can last from 30 minutes to a few days. The episodic kind usually starts gradually, 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 throughout 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.

Who Gets Them?

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 60-90 days.

What Are the Symptoms?

A few common ones include:

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

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

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

Continued

What Causes Tension Headaches?

There's no single cause for them. Most of the time, they’re 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.

This type of headache doesn’t run in families. Some people get them because of tightened muscles in the back of the neck and scalp. This muscle tension can come from:

  • Not enough rest
  • Bad posture
  • Emotional or mental stress, including depression
  • Anxiety
  • Fatigue
  • Hunger
  • Low iron levels
  • Alcohol use
  • Caffeine
  • Jaw or dental problems

For others, tightened muscles aren’t part of tension headaches, and there’s no clear cause.

How Are They Treated?

It’s best to treat tension headaches when they first begin and the symptoms are still mild. The goal is to prevent more of them from happening and to relieve any pain you're already in. For prevention, you can:

  • Take medications
  • Avoid the causes or triggers
  • Manage your stress or learn relaxation techniques
  • Practice biofeedback
  • Try home remedies, like a hot bath, ice packs, or better posture

Over-the-counter (OTC) painkillers are often the first treatments doctors recommend for tension headaches. People with the chronic kind can use some of these drugs to prevent headaches.

If OTC pain relievers don't help, your doctor may recommend a prescription-strength med or a muscle relaxant.

Some drugs can keep you from getting a tension headache, like antidepressantsblood pressure meds, and anti-seizure drugs. You take them every day even if you aren’t in pain, so that you end up using less medication over time.

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, including products you buy over-the-counter, talk about the pros and cons with your doctor. You'll still need to find out and deal with the things that are causing your headaches, too.

Continued

How Do You Prevent Them?

Try these treatment options to lessen the severity and frequency of your headaches.

Find ways to help you relax and manage stress like:

  • Biofeedback
  • Relaxation techniques
  • Cognitive behavioral therapy
  • Acupuncture
  • Massage therapy
  • Physical therapy

Lifestyle changes may also help. Consider these:

  • Try to identify and avoid 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.

Your doctor may give you medications to prevent tension headaches. These include:

  • Antidepressants
  • Anticonvulsants and muscle relaxants

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 Neil Lava, MD on May 06, 2018

Sources

SOURCES:

National Institute of Neurological Disorders and Stroke: "Headache: Hope Through Research."

National Headache Foundation: "Tension-Type Headache."

MedlinePlus Medical Encyclopedia: "Tension headache."

American Headache Society: "Types of Headaches."

University Health Services, University of California, Berkeley: "Tension Headache Fact Sheet."

National Center for Complementary and Integrative Health: “Headaches: In Depth.”

Mayo Clinic: “Tension headache,” “Tension-type headaches: Self-care measures for relief.”

Pain research and treatment: “Is There a Relation between Tension-Type Headache, Temporomandibular Disorders and Sleep?”

PennState Hershey: “Tension headache.”

Wayne State University Physician Group: “Tension Headache.”

Harvard Health Publishing: “What type of headache do you have?”

UpToDate: “Evaluation of headache in adults,” “Patient education: Headache causes and diagnosis in adults (Beyond the Basics).”

© 2018 WebMD, LLC. All rights reserved.

Pagination