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.
Michael Smith, MD<br />Chief Medical Editor at WebMD
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.
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
- 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 pain, nausea, 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
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
- Low iron levels
- Alcohol use
- 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 antidepressants, blood 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.
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:
- Relaxation techniques
- Cognitive behavioral therapy
- 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:
- Anticonvulsants and muscle relaxants
Tension Headaches vs. Migraines
How do you tell them apart?
- 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.
- 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.