Tension Headaches

What is a tension headache?

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. They tend to affect both sides of the head. Tension headaches may be chronic, occurring often, or every day.

What causes a tension headache?

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.

What are the symptoms of a tension headache?

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.

How are tension headaches diagnosed?

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?

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.

How are tension headaches treated?

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.

How can I help prevent tension headaches?

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.

When should I call my healthcare provider?

A severe headache that is the “worst headache ever” may be a sign of a stroke. Get medical care right away. For your "usual" tension headache symptoms, check with your provider if your treatment doesn't work or if new symptoms develop.

Key points about tension headaches

Tension headaches are the most common type of headache.
Tension headaches typically don't cause nausea, vomiting, or sensitivity to light.
Tension headaches affect both sides of the head and come on slowly. They are described as a tight band or vice around the head.
Lifestyle changes. such as regular sleep, exercise, and meal schedules, can reduce or prevent headaches.
Talk with your healthcare provider about medicines to treat or prevent tension headaches.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.