Overview of Tension Headaches

A tension headache is the most common type of headache disorder, and you can experience them once in a while or chronically (more than 15 days per month). You may have head pain, irritability, or trouble concentrating with a tension headache.

These headaches are a type of primary headache disorder that they are not caused by a serious medical or neurological problem. Typically, tension headaches are diagnosed based on symptoms, but you may need some diagnostic tests to rule out a medical cause of your headaches. Tension headaches are bothersome, but they are not dangerous, and they are usually managed with over-the-counter (OTC) medication and getting some rest.

Tension headaches are common, and the vast majority of children and adults have experienced them at some point in their lives. They can begin at any age, and you can have bouts of frequent tension headaches that recur for weeks or months at a time.

Head pain is the most prominent symptom of a tension headache. These headaches are characterized by a dull tightening or pressure on both sides of the head. They typically start at the forehead and radiate around to the back of the head. A tension headache may feel like a nagging "rubber-band around the head" sensation.

Aside from head pain, a tension headache can cause:

• Irritability
• Trouble sleeping
• Difficulty concentrating
• Fatigue
• Shoulder or upper back stiffness

Tension headaches can last anywhere from 30 minutes to 7 days.

Unlike migraines, tension headaches are not associated with nausea or vomiting. You may experience a slight decrease in your appetite when you have a tension headache, however.

If you overuse pain medication for your tension headaches, you can develop rebound headaches, also called medication overuse headaches or medication withdrawal headaches. These headaches occur when your body becomes accustomed to the medication. Recurrent head pain can begin as pain medication wears off—resulting in a cycle that is hard to break.

Talk to your doctor before taking any medication so you can avoid complications like rebound headaches.

There are a number of triggers that can increase your likelihood of developing a tension headache. While anyone can develop a tension headache, some people are more prone to them than others.

Common triggers that precipitate tension headaches include:

• Lack of sleep: When you don't sleep well or if you don't get enough sleep, you can develop a headache. These usually improve after a good restorative sleep.
• Stress or anxiety: Worrying, overthinking, and conflicts can trigger a tension headache.
• Hunger or dehydration: When your body is lacking in nutrients and fluid, it can manifest as a headache.
• Uncorrected vision defects: Straining your eyes can cause a headache. If you wear corrective lenses, an increase in headaches could be a signal that you need an updated prescription due to new vision changes.
• Stress release: After a stressful time—such as studying for exams, working hard on a project, or resolving a conflict—you can experience a headache when you relax and release your pent up tension.
• Alcohol: Some people develop tension headaches from drinking alcohol. These headaches are less severe than a migraine or a hangover.
• Dental problems: Teeth clenching, cavities, and dental work can all trigger tension headaches.
• Climate: You may get tension headaches when you feel too hot or too cold. Humidity can trigger headaches as well.
• Boredom: For some people, feeling bored can cause a headachy feeling.

While triggers may precede a tension headache, you can experience these types of headaches even in the absence of any triggers.

Usually, your description of your headaches can help your medical team distinguish between tension headaches, migraines, cluster headaches, and headaches that are caused by serious neurological issues.

An accurate diagnosis of tension headaches is important because there are some health problems that can cause headaches, such as meningitis (an infection surrounding the brain), brain tumors, multiple sclerosis, brain aneurysms, strokes or transient ischemic attacks (TIAs) and head trauma. It is vital that these health problems are detected and treated in a timely manner.

You may need to have some diagnostic tests as part of the evaluation for your headaches.

If there is a concern that you could have a serious disorder, you may have one or more diagnostic tests.

• Brain imaging: A computerized tomography (CT) or magnetic resonance imaging (MRI) of the brain can detect headache-inducing changes such as tumors, bleeds, or inflammation.
• Blood tests: Severe medical illnesses, such as liver failure or sepsis (a blood infection) can cause headaches. Blood tests such as a complete blood count (CBC), electrolyte levels, or liver function tests can help identify these problems.
• Lumbar puncture (LP): An LP, often referred to as a spinal tap, is a diagnostic procedure that involves collecting spinal fluid with a needle that is placed in the lower back. This test is used when there is a chance of an infection or inflammation in or near the brain.
• Sleep study: A sleep study is a non-invasive test that is usually done overnight. It can help in identifying sleep issues that could prevent you from getting enough restorative sleep.

Tension headaches usually resolve with simple home remedies like sleep, food, or exercise, or with OTC medications.

When you have a tension headache you can try strategies such as:

• Getting some sleep
• Taking a break from what you are doing
• Making your environment more comfortable by adjusting the temperature
• Moderate intensity exercise
• Drinking fluids
• A caffeinated beverage
• A cold pack on your head or shoulders
• Doing something enjoyable

You might have improvement of your tension headaches with some of these strategies, but not others. It is important to do what works for you when it comes to managing your tension headaches.

Examples of medications often used for treating a tension headache include:

• Tylenol (acetaminophen)
• Non-steroidal anti-inflammatories (NSAIDs) like Aleve (naproxen sodium), Motrin/Advil (ibuprofen), and Bayer/Bufferin/Ecotrin (aspirin)  
• Excedrin Tension Headache contains a combination of acetaminophen and caffeine

​​As always, it's important to talk with your doctor before taking any medication, including OTC therapies, to ensure it's safe for you. Be sure to limit any medication for your tension headache to no more than twice a week to prevent medication overuse headaches or side effects like stomach upset (common with NSAIDs) or kidney or liver problems (which can happen with acetaminophen overuse or from using acetaminophen if you are a heavy alcohol drinker).

Prevention is a key component of managing tension headaches. If you notice that things like sleep deprivation, alcohol, or certain stressful situations trigger your headaches, it can help to avoid these precipitating factors. Maintaining a regular sleep schedule can be effective at reducing tension headaches for many people.

While it is not possible to completely avoid stress, it helps to think about ways to manage stressful situations and to pre-emptively plan for conflict management techniques when you anticipate a headache-inducing event.

Infrequent tension headaches generally do not need to be treated with preventive prescription medication. However, if you have chronic tension headaches, you may benefit from these types of medications to help reduce the frequency and duration of your headaches.

Medications that may be effective in chronic tension headache prevention include Elavil (amitriptyline) ad Neurontin (gabapentin).

Behavioral therapies are also sometimes used on their own or in combination with preventative medication to reduce the occurrence of chronic or recurrent tension-type headaches. The data on the effectiveness of these therapies is not strong though.

Some examples of behavioral therapies that are occasionally used for tension headache prevention include:

• Acupuncture
• Biofeedback
• Cognitive-behavioral therapy (CBT)
• Massage Therapy
• Physical therapy

While tension headaches are common and can usually be effectively managed, you should be sure to speak with your doctor about your headaches so you can receive an accurate diagnosis and a safe treatment plan. This is especially important if you are experiencing new or different headaches or if your tension headaches are worsening.