Tension Headaches

Reviewed by: HU Medical Review Board | Last review date: December 2020

Tension headaches are the most common type of primary headache. “Primary” means the headache is not caused by an injury or other health condition. Tension headaches generally cause mild to moderate pain that feels like a tight band around the head.1,2

Tension headaches are very common. Studies show that anywhere from 30 percent to nearly 80 percent of people will have a tension headache sometime in their lives.1

Types of tension headaches

There are 3 types of tension headaches:1,2

  • Infrequent episodic (less than 1 headache a month)
  • Frequent episodic (10 or more headaches a month for 3 months or more)
  • Chronic (15 or more headaches a month for 3 months or more)

With episodic tension headaches, the pain may last from 30 minutes up to a week. The pain of chronic tension headaches can last hours, days, or never stop. People who have frequent tension headaches may go on to develop chronic headaches.1,2

What causes tension headaches?

Doctors do not know exactly what causes tension headaches. Research suggests there are physical changes in how the body senses pain in people who get tension headaches. Stress is a common trigger.1,2

Symptoms of tension headaches

The symptoms of a tension headache include:1,2

  • Dull, aching head pain
  • Feeling tightness or pressure around the head, across the forehead, or across the back of the head
  • Tenderness or pain of the neck, scalp and shoulder muscles

It is not common to have a sensitivity to light or sound with a tension headache, but it does sometimes happen.

Tension headache or migraine?

Some people confuse tension headaches with migraines. However, there are some key differences between the 2 conditions. While both are painful, migraines generally cause more extreme pain. Tension headaches do not cause nausea, vomiting, or changes in vision. Physical activity often makes migraine pain worse, but not tension headaches.3

That said, people can have both tension headaches and migraines.2

Treatments for tension headaches

Most tension headaches can be treated at home with rest, stress management, and over-the-counter (OTC) pain medicines. Chronic headaches should be treated by a doctor.2

The most effective treatments for tension headache include:2

  • OTC pain medicine, such as aspirin and ibuprofen
  • Drugs with a pain reliever and caffeine
  • Biofeedback and relaxation training
  • Amitriptyline, a type of antidepressant, for chronic tension headaches

Studies show that using pain relievers and stress management together work better than using either alone.2

Preventing tension headaches

Anything that helps you relax can help prevent a tension headache. This includes:2

  • Exercise
  • Cognitive-behavioral therapy
  • Meditation, yoga, deep breathing, and progressive muscle relaxation

Other recommendations include:2

  • Getting enough sleep
  • Eating regular meals
  • Drinking plenty of water
  • Quitting smoking
  • Limiting alcohol, caffeine, and sugar

When to see a doctor

Talk with your doctor if tension headaches interfere with your life or if you take medicine for headaches more than twice a week.2

Seek emergency help if you feel any of the following symptoms:

  • Sudden, severe head pain
  • Double vision
  • Seizure
  • Stiff neck
  • Weakness
  • Numbness
  • Trouble speaking

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