What Is a Chronic Tension Headache?

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Most people have at one time or another experienced a tension-type headache. The pain is typically a dull tightening or pressure on both sides of the head, often described as having a tight rubber band around the head.

Tension headaches are typically caused by stress, anxiety, dehydration, fasting, or lack of sleep and usually resolve with over-the-counter medicine, like Tylenol (acetaminophen).

Some people experience these headaches frequently, a condition known as chronic tension-type headaches. A primary headache disorder that affects approximately 3% of the population, chronic tension headaches can occur daily and negatively impact one's quality of life and daily functioning.

Symptoms

Tension headaches are commonly referred to as "stress headaches" or "muscle contraction headaches." They are typically a dull, aching pain and may include tightness or pressure across the forehead, sides or back of your head. Some people experience tenderness on the scalp, neck, and shoulders as well.

Chronic tension headaches occur on 15 or more days per month on average for more than 3 months. The headache can last for several hours or be continuous for several days.

Causes

Tension-type headaches are typically caused by tight muscles in the shoulders, neck, scalp, and jaw.

Headaches can be due to stress, depression, or anxiety, and are more common in people who work long hours in stressful jobs, do not get enough sleep at night, skip meals, or regularly drink alcoholic beverages.

Diagnosis

If you are experiencing headaches that interfere with your daily life or you need to take medication for your headache more than twice a week, talk to your doctor.

Prior to your appointment, it can be helpful to keep a headache diary noting the days, times, description of the pain, intensity, and other symptoms. Some questions your doctor might ask include:

  • Does your pain pulsate, is it sharp or stabbing, or is it constant and dull?
  • Are you able to work?
  • Do your headaches interfere with your sleeping?
  • Where do you feel the pain? Is it all over your head, on only one side of your head, or just on your forehead or behind your eyes?

Your doctor will likely be able to diagnose you based on symptoms alone. However, if your headaches don't fit into a usual pattern, your doctor may order imaging tests, such as Magnetic resonance imaging (MRI) or Computerized tomography (CT) scans to rule out other diagnoses.

Chronic tension-type headaches can often be confused with other chronic daily headache disorders like chronic migraine, hemicrania continua, temporomandibular joint dysfunction (TMJ), or cluster headaches.

Treatment

Pharmacological therapy for sufferers of chronic tension headaches usually involves a preventive medication.

Amitriptyline (Elavil) is one medication that has been found to be beneficial in chronic tension headache prevention. Amitriptyline – a tricyclic antidepressant – is a sedating medication and is usually taken at bedtime.

According to a 2017 meta-analysis of 22 published studies on tricyclic antidepressants in the Journal of General Internal Medicine, these medications are superior to placebo in reducing headache frequency, with an average of 4.8 fewer headache days per month.

Additional preventive medications that your doctor may consider include other antidepressants—like Remeron (mirtazapine), or an anti-seizure medication—like Neurontin (gabapentin) or Topamax (topiramate).

Your doctor may also prescribe medication to treat headache episodes, such as:

  • Prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) including acetaminophen, naproxen, indomethacin, ketorolac, or naproxen
  • Opiates
  • Muscle relaxants
  • Benzodiazepines, such as Valium

Botox

Several clinical trials suggest that Botox (botulinum toxin) injections can help to prevent chronic tension headaches. The injections are given into muscles in different areas of the head, neck, and shoulders, and work to prevent the muscle tension and spasms that lead to chronic headaches.

A 2019 meta-analysis of 22 studies published in the journal Pain Practice found mixed results on the use of Botox for tension headache prevention, with most studies showing a reduction in pain scale scores and some evidence for its efficacy in reducing the frequency and severity of headaches.

Non-Drug Treatments

Behavioral therapies are sometimes used alone or in combination with medication to prevent chronic tension headaches. Examples of behavioral therapies include:

Acupuncture: Acupuncture is an alternative therapy that involves using needles to stimulate specific points on the body believed to connect with certain pathways (or "meridians") that carry vital energy (or "chi") throughout the body.

A 2016 literature review published in the journal Headache reports there is evidence to support acupuncture as an effective treatment for chronic tension-type headaches and other chronic headache conditions. In addition, the findings also suggest acupuncture may be a cost-effective therapy.

Biofeedback: In Electromyography (EMG) biofeedback, electrodes are placed on the scalp, neck and upper body to detect muscle contraction. The patient is then trained to control that muscle tension in hopes of preventing a headache.

The process, however, is costly and time-consuming, and there is a lack of evidence to support its effectiveness for treating or preventing tension headaches.

Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy involves learning how to identify headache triggers and cope with them in a more adaptive, less stressful manner. Many headache specialists will often recommend CBT in addition to medication when devising a treatment plan for their patients.

A 2017 study published in BMJ Open found CBT can boost the effectiveness of other self-management techniques for chronic tension headaches, such as mindfulness, for decreasing pain intensity, improving mood, and reducing headache-related disability.

Supplements

Some people with chronic tension headaches find relief using supplements. The American Academy of Neurology and the American Headache Society reports the following supplements are possibly effective:

  • Butterbur
  • Feverfew
  • Magnesium
  • Riboflavin 

A Word From Verywell

Chronic tension headache is an uncommon, debilitating form of a tension headache. It can interfere with work, relationships, and daily living. If you are affected by headaches that occur 15 or more days per month on average for more than 3 months, see your doctor, who can prescribe medication to help treat and prevent chronic tension-type headaches.

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Article Sources

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