Learn about tension headaches, their causes, symptoms, and effective relief methods. Trusted information at Meri Sehat.

Tension Headaches

Online Consultation

Ismail Munir

Overview

Tension headaches are commonly identified by a dull, uncomfortable pressure, or stiffness around the head. It is often described as a feeling of tightness around the head, akin to a band. 
Headaches are a common medical issue. Tension headaches, also known as stress headaches, are the most common type of primary headaches. 
&nbsp;

There are currently more than 100 different types of headaches<a href="#accordion">[2]</a>. Moreover, approximately 1-4% of all emergency department visits are due to headaches, making it the most common reason for a doctor&#39;s consult<a href="#accordion">[3]</a>.

Tension headaches are primary headaches, a type of headache that is not caused by another underlying condition<a href="#accordion">[1]</a>. People with tension headaches experience mild to intense pain in the head, neck, and behind the eyes. The headache may feel like a tight band across the forehead. Unlike <a href="https://merisehat.pk/disease/migraines-73">migraines</a>, it is generally not associated with any <a href="https://merisehat.pk/disease/nausea">nausea</a>, vomiting, or light sensitivity. Moreover, tension headaches tend to affect both sides of the head and can be chronic, occurring every day.

According to several studies, the lifetime prevalence of tension-type headaches (TTH) in the general population ranges from 30% to 78%3 i.e. Roughly 1.4 billion people&nbsp; or almost 20.8% of the world&#39;s population is impacted<a href="#accordion">[3]</a>. 
&nbsp;

There are three women for every two males who experience tension-type headaches, which frequently begin during the adolescent years. The incidence of tension headaches typically increases in the fourth decade<a href="#accordion">[3]</a>. However, investigations conducted in Europe reveal that these&nbsp;headaches continue to occur well into the sixth decade of life<a href="#accordion">[3]</a>. 
&nbsp;

The International Headache Society (IHS) has established two categories for tension headaches: episodic and chronic. The classification is based on how often and how many headaches the person experiences. 
&nbsp;

<ul>
	<li>Episodic Tension Headache - The headaches occur less than 15 days a month. They often start in the middle of the day and typically start slowly. 
	&nbsp;</li>
</ul>

<ol>
	<li>Infrequent Episodic Headache - This headache is experienced for less than 1 day in a month. It could be as short as 30 minutes or last up to a week. It is not commonly associated with vomiting and nausea.</li>
	<li>Frequent Episodic Tension Headache - A person will experience no less than 10 headaches in a month which can last between 1-14 days per month, for 3 or more months. These headaches may last for 30 mins to a week. Light and sound sensitivity may accompany the headaches. 
	&nbsp;</li>
</ol>

<ul>
	<li>Chronic Tension-Type Headache - This is characterized by a headache that lasts for at least 15 days or more, for three months or longer. The pain may continue for hours, days, or even weeks. Other symptoms include minor nausea, light sensitivity, and sound sensitivity<a href="#accordion">[1]</a>. 
	&nbsp;</li>
</ul>

Signs and Symptoms

The signs and symptoms of a tension headache are: 
&nbsp;

<ul>
	<li>Mild to moderate pressure or pain in the top, both sides, or front of the head</li>
	<li>Pain is usually dull and may feel like a band around the head</li>
	<li>Pain can be constant but not throbbing</li>
	<li>Tenderness around the scalp or forehead</li>
	<li>The headache starts later in the day</li>
	<li>Fatigue or irritability</li>
	<li>Slight sensitivity to sound or light</li>
	<li>Muscles in the jaw, neck, and shoulders may feel sore and tight</li>
	<li>Trouble focusing</li>
</ul>

Pain typically does not get worse with physical activity. Moreover, vomiting or nausea does not accompany the above symptoms. 
&nbsp;
<quillbot-extension-portal></quillbot-extension-portal>

Migraines may often be confused with tension headaches. However, they have certain distinct features that can help differentiate the two.

Unlike tension headaches, migraines are moderate to severe in intensity and the pain mostly occurs on one side. The migraine headache is pulsating and worsens with physical activity. Moreover, it is associated with nausea, vomiting, visual disturbances (e.g., blind spots, flashing lights, colored spots), and sensitivity to light or sound. 
&nbsp;

In rare cases, tension headaches can also lead to light or sound sensitivity, and nausea or vomiting. Furthermore, tension headaches create discomfort, but they are not usually as severe as migraine headaches. 
&nbsp;

Causes

Researchers<a href="#accordion">[1]</a> have yet to find a single cause of tension headaches. Some medical professionals believe tense neck or back muscles might cause or contribute to tension headaches<a href="#accordion">[2]</a>.

While it is not an inherited condition, genetic factors seem to influence a person&rsquo;s susceptibility to tension headaches. Moreover, abnormalities in central pain processing and increased pain sensitivity are possible causes. 
&nbsp;

According to the National Health Services (NHS), the following may trigger tension headaches

<ul>
	<li>Anxiety</li>
	<li>Stress</li>
	<li>Emotional stress</li>
	<li>Lack of physical activity</li>
	<li>Squinting or strain on the eyes</li>
	<li>Fatigue</li>
	<li>Skipping meals</li>
	<li>Dehydration</li>
	<li>Regular exposure to loud noises</li>
	<li>Strong sunlight</li>
	<li>Bad posture</li>
	<li>Low iron</li>
	<li>Smoking</li>
	<li>Flu, cold, or a sinus infection</li>
	<li>Alcohol</li>
	<li>Caffeine</li>
	<li>Lack of sleep</li>
	<li>Certain smells, such as perfumes</li>
	<li>Depression, anxiety, or stress can cause jaw clenching which can worsen the headache</li>
	<li>An overuse of painkillers can cause rebound headaches 
	&nbsp;</li>
</ul>

There is currently no screening test for tension headaches. 
&nbsp;
<quillbot-extension-portal></quillbot-extension-portal>

Diagnosis

There are no specific diagnostic tests for tension headaches. A medical practitioner will inquire about the frequency and severity of the headaches, as well as the patient&rsquo;s general health and lifestyle aspects to identify tension headaches. 
&nbsp;

Some common questions asked are:

<ol>
	<li>How long do the headaches last and when do they occur?</li>
	<li>Where does the pain occur?</li>
	<li>Are there any other symptoms apart from the headache?</li>
	<li>Does it cause any difficulty in sleeping?</li>
	<li>Have you experienced stress before?</li>
	<li>Have you ever sustained a head injury?</li>
	<li>Has there been a change in behavior or personality?</li>
	<li>Does shifting positions cause the occurrence of headaches?</li>
	<li>Do certain foods trigger the headache? 
	&nbsp;</li>
</ol>

<h5>Imaging Tests</h5>

In case of a complicated or unusual headache, the doctor will rule out serious causes like a tumor. A CT or MRI scan may be used to obtain a detailed view of the brain. 
&nbsp;

<h5>Blood Tests</h5>

These help rule out underlying conditions, such as anemia. 
&nbsp;

<h5>Sinus X-ray</h5>

This can help check for infection, congestion, or other problems.

Tip: It is very helpful to keep and maintain a headache diary which can help link and identify triggers and patterns of the headache. 
&nbsp;

As per the IHS diagnostic criteria, at least two of the following characteristics must be present for a diagnosis of tension headaches.

<ul>
	<li>Pain is not aggravated by physical activity</li>
	<li>Mild to moderate bilateral pain</li>
	<li>Pain located in the front-occipital area</li>
	<li>Non Pulsating pain with a pressing or tightening character 
	&nbsp;</li>
</ul>

Treatment

Treatment aims to stop the occurrence of headaches. 
&nbsp;

<ol>
	<li>Over-The-Counter Drugs: Medications such as ibuprofen, acetaminophen, or aspirin may be used as pain relievers. However, they cannot be used frequently as they can lead to rebound headaches and pain that occur after the medication wears off. 
	&nbsp;</li>
	<li>Prescription Drugs: When over-the-counter drugs are not effective in relieving pain, the doctor may prescribe<a href="#accordian">[4]</a>:</li>
</ol>

<ul>
	<li>Beta-blockers</li>
	<li>Tricyclic antidepressants</li>
	<li>Divalproex sodium</li>
	<li>Indomethacin</li>
	<li>Naproxen</li>
	<li>Ketorolac</li>
	<li>The prescription of an antidepressant, such as a selective serotonin reuptake inhibitor (SSRI), by a medical expert,&nbsp;is another option. SSRIs stabilize serotonin levels in the brain and also aid in stress management.</li>
	<li>Muscle relaxants can also help prevent muscle contractions. Cyclobenzaprine and methocarbamol are two examples of muscle relaxants. 
	&nbsp;</li>
</ul>

<ol start="3">
	<li>Headache Diary: The patient is asked to make a note every day they experience a stress headache. It can take a few weeks or months before a link can be established. For instance, if the patient record reveals that they experienced headaches on days when they consumed a specific food, that food may be a trigger<a href="#accordian">[4]</a>. 
	&nbsp;</li>
	<li>Meditation : According to headache parameters, relaxation methods like meditation are useful for treating chronic headaches. Low levels of cortisol were found in patients with persistent headaches, and these levels gradually returned to normal when meditation was practiced<a href="#accordion">[3]</a>. 
	&nbsp;</li>
	<li>Acupuncture : Those who suffer from chronic or recurrent TTH may benefit from acupuncture. Evidence supporting acupuncture as a useful, non-pharmacologic treatment for episodic or chronic TTH was discovered in an analysis of eleven studies comprising 2,317 individuals<a href="#accordion">[3]</a>. 
	&nbsp;</li>
	<li>Massage: Several studies suggest that massage may also be a useful treatment for people with TTH. Massage may loosen up tense shoulders, back, and neck muscles, which may help with headache pain<a href="#accordion">[3]</a>. 
	&nbsp;</li>
	<li>CBT: Those who experience recurring tension headaches as a result of stress may benefit from counseling, including cognitive behavioral therapy (CBT). 
	&nbsp;</li>
	<li>Home Remedies And Alternative Therapies:</li>
</ol>

<ul>
	<li>Reduce the intake of caffeine</li>
	<li>Place an ice pack or heat on the aching parts of the head and neck</li>
	<li>Yoga</li>
	<li>Head massage</li>
	<li>Acupuncture</li>
	<li>Biofeedback</li>
	<li>Relaxation training</li>
	<li>Aromatherapy 
	&nbsp;</li>
</ul>

Note: Always consult a doctor before starting any medication or home and alternative remedy. 
&nbsp;

Because tension headaches are so frequent, they have a significant impact on quality of life and work performance, especially if they are chronic. Persistent pain can prevent people from participating in activities. Individuals might not be able to go to work, or if they do, their performance might be compromised. 
&nbsp;

The following factors can increase one&rsquo;s risk of tension headaches:

<ul>
	<li>Gender - Women are more likely to get tension headaches than men.</li>
	<li>Stress</li>
	<li>Eye strain</li>
	<li>Sleep disturbances, such as insomnia</li>
	<li>Missed meals</li>
	<li>Fatigue</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression </a>and <a href="https://merisehat.pk/disease/anxiety">anxiety</a></li>
	<li>Temporomandibular disorders causing pain in other parts of the head and neck</li>
	<li>Caffeine withdrawal</li>
</ul>

Moreover, the causative factors of tension headaches also serve as risk factors. 
&nbsp;

Following a healthy lifestyle can help prevent tension headaches. The following tips should be followed:

<ul>
	<li>Reduce caffeine intake</li>
	<li>Get the right amount of sleep</li>
	<li>Manage stress levels</li>
	<li>Maintaining a good posture throughout the day</li>
	<li>Take frequent breaks when working behind a desk</li>
	<li>Do stretches regularly while exercising the shoulder and neck muscles during work hours</li>
	<li>Use the correct glasses and get regular eye exams</li>
	<li>Stay hydrated</li>
	<li>Wear sunglasses on days with heavy sunlight</li>
	<li>Eat regular meals and avoiding foods that trigger the headache</li>
	<li>Avoid the use of perfumed products</li>
	<li>Monitor for any side effects after taking medications</li>
	<li>Massage therapy</li>
	<li>Supplements&nbsp;: Studies have shown that since supplements can prevent migraine headaches, they may also be able to prevent tension headaches<a href="#accordion">[5]</a>. 
	&nbsp;</li>
</ul>
<quillbot-extension-portal></quillbot-extension-portal>

Key Points

<ul>
	<li>Tension headaches are commonly identified by a dull, uncomfortable pressure, or stiffness around the head.</li>
	<li>Tension headaches, also known as stress headaches, are the most common type of primary headache.</li>
	<li>The International Headache Society (IHS) has established two categories for tension headaches: episodic and chronic.</li>
	<li>People with tension headaches experience mild to intense pain in the head, neck, and behind the eyes. The headache may feel like a tight band across the forehead.</li>
	<li>Unlike migraines, it is generally not associated with any nausea, vomiting, or light sensitivity. Moreover, tension headaches tend to affect both sides of the head and can be chronic, occurring every day.</li>
	<li>Those who experience recurring tension headaches as a result of stress may benefit from counseling, including cognitive behavioral therapy (CBT). 
	&nbsp;</li>
</ul>

[1] Tension headaches: Symptoms, treatments, and causes. Medical News Today.

[2] Tension headaches: Symptoms, causes, & treatments. Cleveland Clinic.

[3] Michelle Blanda MD. Tension headache treatment & management. Medical Care, Alternative Medicine

[4] Higuera V. Tension headaches. Healthline.

[5] Tension headache: Symptoms, causes, treatment, and prevention. WebMD.

[6] Cumplido-Trasmonte C, Fernández-González P, Alguacil-Diego IM, Molina-Rueda F. Manual therapy in adults with tension-type headache: A systematic review. Neurologia (Engl Ed). 2021;36(7):537-547. doi:10.1016/j.nrleng.2017.12.005

[7] Cho SJ, Song TJ, Chu MK. Sleep and Tension-Type Headache. Curr Neurol Neurosci Rep. 2019;19(7):44. Published 2019 May 30. doi:10.1007/s11910-019-0953-8