Tension Headache

Definition

Tension headache refers to radiating, steady pain in the head, neck, or eyes that can be mild or intense. Tension headaches may be occasional or chronic.

Tension Headache: Areas of Pain
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Causes

Tension headaches may occur when muscles in the neck, face, and scalp contract. In some cases, muscle contraction is the result of teeth grinding and jaw clenching. In others, it may be unknown.

Risk Factors

Tension headaches are more common in women. Other factors that may increase your chance of getting a tension headache include:

Symptoms

Some tension headaches are nearly constant, with daily pain that may vary in intensity, while others occur once in a while. Symptoms usually start slowly and build.

Tension headache may cause:

  • Constant, steady pain and pressure
  • Dull and achy pain
  • Pain which may be 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. A physical exam will be done. Diagnosis can be made on exam, based on specific features. The cause of the headaches however, may be more difficult to determine.

Tests may include:

  • Neurological exam
  • Imaging is not usually needed, but if pain is unusual or severe it may be done to look for other causes of the headache. Imaging tests include:

Treatment

There are no specific cures for tension headaches, but they can be managed. Therapies aim to stop the headache and reduce the frequency of future episodes.

Treatment may include:

Medications

For occasional headaches, your doctor may recommend:

  • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain
  • Prescription pain relievers

Note: Pain medications are most effective when taken at the first sign of pain and before it becomes severe. Overusing some over-the-counter medications may actually cause headaches. Continuous use of medications may create rebound pain when you stop taking the drug.

For chronic headaches, your doctor may recommend the following to treat or prevent headaches:

  • Antidepressants
  • Muscle relaxers
  • Botulinum toxin injections (Botox)
  • Anti-seizure medication
  • Beta blocker medication

Self-care During the Headache

Self-care may include:

  • Rest if needed
  • An ice pack or heat pack on your head or neck to ease discomfort
  • A warm shower, with water running over tense muscles

Lifestyle Changes

Lifestyle changes may include:

  • Regular exercise
  • Improving your posture
  • Adequate sleep
  • Regular breaks from tasks
  • Stress management and relaxation techniques
  • Counseling to:
    • Develop new coping skills
    • Identify events that trigger the headaches and work toward resolution

Additional Therapies

Additional therapies may include:

  • Acupuncture—to have more headache-free days and lessen the intensity of headaches when they do occur
  • Physical therapy—to develop a home exercise program.
  • Massage therapy

Prevention

To help reduce your chances of getting a tension headache, 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.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 12/2013 -
  • Update Date: 05/12/2014 -
  • American Headache Society

    http://www.americanheadachesociety.org

  • National Headache Foundation

    http://www.headaches.org

  • Headache Network Canada

    http://www.headachenetwork.ca

  • Help for Headaches

    http://www.headache-help.org

  • 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.

  • NINDS headache information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/headache/headache.htm. Updated November 8, 2013. Accessed December 30, 2013..

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

  • Tension headache. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 19, 2013. Accessed December 30, 2013.

  • Tension-type headache. National Headache Foundation website. Available at: http://www.headaches.org/education/Headache%5FTopic%5FSheets/Tension-Type%5FHeadache. Accessed December 30, 2013.

  • 12/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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 http://www.ebscohost.com/dynamed: 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.

  • 5/12/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Yancey JR, Sheridan R, et al. Chronic daily headache: diagnosis and management. Am Fam Physician. 2014 Apr 15;89(8):642-8.

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