Tension-Type Headaches

Tension headaches are the most common type of headache. Stress and muscle tension are often factors in these headaches. Tension headaches often don’t cause nausea, vomiting, or sensitivity to light. They do cause a steady ache, rather than a throbbing one and tend to affect both sides of the head. Tension headaches may be chronic, occurring often, or every day.

The exact cause of a tension headache is not known. Several factors, such as genetics and environment, are thought to be involved. Muscle contractions in the head and neck are thought to be a major factor in getting a tension headache. Some people get tension headaches from stressful events or hectic days. This type of headache disorder may also be associated with pericranial tenderness.

These are common symptoms of a tension headache:

• Slow start of the headache.

• Head often hurts on both sides.

• Pain is dull or feels like a band or vice around the head.

• Pain may involve the back part of the head or neck.

• Pain is often mild to moderate, but not severe.

The symptoms of tension headaches may look like other health problems. Always see your healthcare provider for a diagnosis.

Tension headaches are mainly diagnosed based on your symptoms and a physical exam.

Tracking and sharing information about your headache with your healthcare provider helps make an accurate diagnosis.

Questions often asked during the exam may include:

• When do headaches occur?

• Where is the headache?

• What do the headaches feel like?

• How long do the headaches last?

• Have there been changes in behavior or personality?

• Do changes in position or sitting up cause the headache?

• Do you have trouble sleeping?

• Do you have a history of stress?

• Have you had a head injury?

• How many headache days you have? 

• How many days do you take a pain killer to treat those headaches?

• Do you miss work or life activities because of headaches?

Your healthcare provider may also do other tests. These can rule out other health problems that may be causing your symptoms. You may need:

• Blood tests. These and other lab tests may be run to check for underlying conditions.

• Sinus X-rays. This imaging test checks for congestion, infection, or other problems that may be fixed.

• MRI. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures in the body.

CT scan. This test uses X-rays and a computer to make detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.

The goal of treatment is to stop headaches from occurring. Reducing stress and tension can help. Some suggestions are:

• Going to sleep and waking at the same time each day.

• Exercising regularly each day for at least 30 minutes.

• Eating regular meals without skipping any, especially breakfast.

• Staying away from headache triggers, such as certain foods and lack of sleep.

• Resting in a quiet, dark place as needed.

• Handling stress, such as with yoga, massage, or other relaxation exercises.

• Medicine, as recommended by your healthcare provider.

Most people find over-the-counter medicines such as acetaminophen, ibuprofen, or naproxen are all they need. Using these medicines too often can cause more headaches. So use them carefully.

Identifying and staying away from headache triggers may prevent a tension headache. Keeping a regular sleep, exercise, and meal schedule is also helpful. If tension headaches occur often, therapies such as cognitive-behavioral therapy, relaxation therapy, or biofeedback may reduce or stop headaches. Talk with your healthcare provider about medicines to prevent tension headaches.

• A severe headache that is the “worst headache ever” requires care right away.

• Any change in headache pattern.

• Any associated neurological deficit like any limb weakness, sensory changes on skin, sudden vision changes etc.

• Any new headache in a person who has never had a headache on a regular basis, especially in older adults.

• Any headache associated with fever, neck stiffness or change in cognition, etc.