Overview of Tension Headaches

Imagine a usual Monday morning filled with a seemingly endless "to-do" list. The last thing you need is a headache. While maybe not an incapacitating migraine, a tension headache can be burdensome in its own way. It often presents itself as a nagging "rubber-band around the head sensation" that frankly hurts and is disruptive.

A tension headache is the most common primary headache disorder, and it can occur once in awhile or chronically (more than 15 days per month). Studies are variable in how much of the population is affected by them, suggesting anywhere from 30 to 78 percent of people. In other words, tension headaches are quite common and the vast majority of children and adults have experienced one at some point in their life. 

Tension headaches are characterized by a dull tightening or pressure on both sides of the head. They typically starts at the forehead and radiates around to the back of the head and can last anywhere from 30 minutes to 7 days. Unlike a migraine, a tension headache is not associated with nausea or vomiting. People with tension headaches do sometimes report a loss of appetite.

Tension headaches are quite different from migraines, but they can co-exist, and sometimes it is still tricky (even for doctors) to distinguish between the two. For example, both migraines and tension headaches can share features like sensitivity to light or sound; although a person with a migraine can experience both light and sound sensitivity whereas a person with a tension headache only experiences one (or no sensitivity).

Another defining difference is that tension headaches do not occur with an aura like migraines can. Also, migraines tend to be one-sided, throbbing, and worse with physical activity whereas tension headaches feel more muscular in nature (like your temple muscles are contracting) and do not get worse with physical activity. Tension headaches also occur on both sides, whereas most migraines are localized to one side of the head—again, there can be overlap though.

Like migraines, there are a number of potential triggers for tension headaches, and these triggers are often unique for an individual. That being said, common triggers for tension headaches include:

• Stress
• Anxiety
• Sleep deprivation
• Cold and warm temperature changes
• Fasting or not eating on time

The good news is that tension headaches usually resolve with simple over-the-counter or home remedies like sleep, food, exercise, hydration, and caffeine. Classic examples of effective over-the-counter medications for tension headaches include:

• Tylenol (acetaminophen)
• 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 confer with your doctor before taking any medication, including over-the-counter therapies, to ensure it's safe for you. In addition, be sure to limit any medication for your tension headache to no more than twice a week, to prevent the occurrence of medication overuse headache, as well as undesirable side effects with organs like your stomach or kidney.

Behavioral therapies are also sometimes used alone or in combination with medication to prevent tension-type headaches, especially chronic ones. The data on the effectiveness of these therapies is not super strong though. Some examples of these are:

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

People with episodic tension headaches generally do not need to take a daily preventive medication. On the other hand, people who have chronic tension headaches often benefit from one to help reduce the number and duration of headaches. One medication that has been found to be effective in chronic tension headache prevention is Elavil (amitriptyline).

If you have tension headaches, try not to get frustrated. They are common and can usually be effectively managed. Even so, be sure to peak with your healthcare provider so you receive a proper diagnosis and treatment plan. This is especially important if you are experiencing new or different headaches or your presumed tension headaches are worsening. In this case, your doctor will want to rule out secondary causes of your headache, like medication over use or a structural brain problem.