Definition

A tension headache is generally a diffuse, mild to moderate pain in your head that's often
described as feeling like a tight band around your head. A tension headache (tension-type
headache) is the most common type of headache, and yet its causes aren't well understood.
Treatments for tension headaches are available. Managing a tension headache is often a balance
between fostering healthy habits, finding effective nondrug treatments and using medications
appropriately.
Symptoms
Signs and symptoms of a tension headache include:
Dull, aching head pain
Sensation of tightness or pressure across your forehead or on the sides and back of your head
Tenderness on your scalp, neck and shoulder muscles
Tension headaches are divided into two main categories episodic and chronic.
Episodic tension headaches
Episodic tension headaches can last from 30 minutes to a week. Frequent episodic tension
headaches occur less than 15 days a month for at least three months. Frequent episodic tension
headaches may become chronic.
Chronic tension headaches
This type of tension headache lasts hours and may be continuous. If your headaches occur 15 or
more days a month for at least three months, they're considered chronic.
Tension headaches vs. migraines
Tension headaches can be difficult to distinguish from migraines. Plus, if you have frequent
episodic tension headaches, you can also have migraines.
Unlike some forms of migraine, tension headache usually isn't associated with visual
disturbances, nausea or vomiting. Although physical activity typically aggravates migraine pain,
it doesn't make tension headache pain worse. An increased sensitivity to either light or sound can
occur with a tension headache, but these aren't common symptoms.
When to see a doctor
Make an appointment with your doctor
If tension headache disrupts your life or you need to take medication for your headaches more
than twice a week, see your doctor.
Even if you have a history of headaches, see your doctor if the pattern changes or your headaches
suddenly feel different. Occasionally, headaches may indicate a serious medical condition, such
as a brain tumor or rupture of a weakened blood vessel (aneurysm).
When to seek emergency help
If you have any of these signs or symptoms, seek emergency care:
Abrupt, severe headache
Headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness,
numbness or speaking difficulties
Headache after a head injury, especially if the headache gets worse
Causes
The cause of tension headache is not known. Experts used to think tension headaches stemmed
from muscle contractions in the face, neck and scalp, perhaps as a result of heightened emotions,
tension or stress. But research suggests muscle contractions aren't the cause.
The most common theories support a heightened sensitivity to pain in people who have tension
headaches and possibly a heightened sensitivity to stress. Increased muscle tenderness, a
common symptom of tension headache, may result from a sensitized pain system.
Triggers
Stress is the most commonly reported trigger for tension headaches.
Risk factors
Risk factors for tension headache include:
Being a woman. One study found that almost 90 percent of women and about 70 percent
of men experience tension headaches during their lifetimes.
Being middle-aged. The incidence of tension headaches appears to peak in the 40s,
though people of all ages can get this type of headache.

Complications
Because tension headaches are so common, their effect on job productivity and overall quality of
life is considerable, particularly if they're chronic. The frequent pain may render you unable to
attend activities. You might need to stay home from work, or if you do go to your job, your
ability to function is impaired.
Preparing for your appointment
By Mayo Clinic Staff
You're likely to start by seeing your family doctor. You then may be referred to a doctor who
specializes in treating nervous system disorders, such as headache (neurologist).
Here's some information to help you get ready for your appointment and to know what to expect
from your doctor.
What you can do
Write down any symptoms you're experiencing, including any that may seem unrelated to your
headaches.
Write down key personal information, including major stresses or recent life changes.
Make a list of all medications, vitamins or supplements you're taking, and share this
information with your doctor.
Write down questions to ask your doctor.
For tension headaches, some basic questions to ask your doctor include:
What type of headache do you think I'm experiencing?
What tests do I need? What will these tests rule out?
Is my condition likely temporary or chronic?
What treatments are available? Which do you recommend?
What are the alternatives to the primary approach you're suggesting?
I have other health conditions. How can I best manage them together?
Are there restrictions I need to follow?
Do I need to see a specialist?
Is there a generic alternative to the medicine you're prescribing?
What are common side effects of the medications you're prescribing?
Do you have brochures or other printed material I can take home? What websites do you
recommend?
Don't hesitate to ask other questions, as well.
What to expect from your doctor
Your doctor will likely ask you questions, such as:
When did you begin experiencing symptoms?
Have you noticed any common triggers, such as stress or hunger?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
How often do you have headaches?
How long does each headache last?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
What you can do in the meantime
While you're waiting to see your doctor, you can take an over-the-counter painkiller, such as
ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) to temporarily relieve
the pain.
Keep a headache diary. To gather information about your headaches that will help your doctor,
keep a headache diary. For each headache, jot down:
Date. Charting the date and time of each headache can help you recognize patterns.
Duration. How long did your headache last?
Intensity. Rate your headache pain on a scale from 1 to 10, with 10 being the worst.
Triggers. List possible triggers of your headache, such as certain foods, physical activities, noise,
stress, smoke, bright lights or changes in weather.
Symptoms. Did you have symptoms before you got the headache?
Medications. What medications have you taken? List any, including dosage, even if they're
unrelated to your headache.
Relief. Have you experienced any pain relief and from what?
Tests and diagnosis
If you have chronic or recurrent headaches, your doctor may conduct physical and neurological
exams, then try to pinpoint the type and cause of your headaches using these approaches:
Your pain description
Your doctor can learn a lot about your headaches from a description of your pain. Be sure to
include these details:
Pain characteristics. Does your pain pulsate? Or is it constant and dull? Sharp or stabbing?
Pain intensity. A good indicator of the severity of your headache is how much you're able to
function while you have it. Are you able to work? Do your headaches wake you or prevent you
from sleeping?
Pain location. Do you feel pain all over your head, on only one side of your head, or just on your
forehead or behind your eyes?

Treatments and drugs
Some people with tension headaches don't seek medical attention and try to treat the pain on
their own. Unfortunately, repeated use of over-the-counter (OTC) pain relievers can actually
cause overuse headaches.
A variety of medications, both OTC and prescription, are available to reduce the pain of a
headache, including:
Pain relievers. Simple OTC pain relievers are usually the first line of treatment for reducing
headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and
naproxen (Aleve). Prescription medications include naproxen (Naprosyn), indomethacin
(Indocin) and ketorolac (Ketorolac Tromethamine).
Combination medications. Aspirin or acetaminophen or both are often combined with caffeine
or a sedative drug in a single medication. Combination drugs may be more effective than are
single-ingredient pain relievers. Many combination drugs are available OTC.
Triptans and narcotics. For people who experience both migraines and episodic tension
headaches, a triptan can effectively relieve the pain of both headaches. Opiates, or narcotics,
are rarely used because of their side effects and potential for dependency.
Preventive medications
Your doctor may prescribe medications to reduce the frequency and severity of attacks,
especially if you have frequent or chronic headaches that aren't relieved by pain medication and
other therapies.
Preventive medications may include:
Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and nortriptyline
(Pamelor), are the most commonly used medications to prevent tension headache. Side effects
of these medications may include weight gain, drowsiness and dry mouth.
Other antidepressants. There also is some evidence to support the use of the antidepressants
venlafaxine (Effexor XR) and mirtazapine (Remeron) in people who don't also have depression.
Anticonvulsants and muscle relaxants. Other medications that may prevent tension headache
include anticonvulsants, such as topiramate (Topamax). More study is needed.
Preventive medications may require several weeks or more to build u
p in your system before they take effect. So don't get frustrated if you haven't seen improvements
shortly after you begin taking the drug.
Your doctor will monitor your treatment to see how the preventive medication is working. In the
meantime, overuse of pain relievers for your headaches may interfere with the effects of the
preventive drugs.

Imaging tests
If you have unusual or complicated headaches, your doctor may order tests to rule out serious
causes of head pain, such as a tumor. Two common tests used to image your brain include:
Computerized tomography (CT). A CT scan is a diagnostic imaging procedure that uses a series
of computer-directed X-rays to provide a comprehensive view of your brain.
Magnetic resonance imaging (MRI). An MRI scan combines a magnetic field, radio waves and
computer technology to produce clear images.
Lifestyle and home remedies
Rest, ice packs or a long, hot shower may be all you need to relieve a tension headache. A
variety of strategies can help reduce the severity and frequency of chronic tension headaches
without using medicine. Try some of the following:
Manage your stress level. One way to help reduce stress is by planning ahead and
organizing your day. Another way is to allow more time to relax. And if you're caught in
a stressful situation, consider stepping back.
Go hot or cold. Applying heat or ice whichever you prefer to sore muscles, may
ease a tension headache. For heat, use a heating pad set on low, a hot-water bottle, a
warm compress or a hot towel. A hot bath or shower also may help. For cold, wrap ice,
an ice pack or frozen vegetables in a cloth to protect your skin.
Perfect your posture. Good posture can help keep your muscles from tensing. When
standing, hold your shoulders back and your head level. Pull in your abdomen and
buttocks. When sitting, make sure your thighs are parallel to the ground and your head
isn't slumped forward.
Prevention
In addition to regular exercise, techniques such as biofeedback training and relaxation therapy
can help reduce stress.
Biofeedback training. This technique teaches you to control certain body responses that
help reduce pain. During a biofeedback session, you're connected to devices that monitor
and give you feedback on body functions such as muscle tension, heart rate and blood
pressure. You then learn how to reduce muscle tension and slow your heart rate and
breathing yourself.
Cognitive behavioral therapy. This type of talk therapy may help you learn to manage
stress and may help reduce the frequency and severity of your headaches.
Other relaxation techniques. Anything that helps you relax, including deep breathing,
yoga, meditation and progressive muscle relaxation, may help your headaches. You can
learn relaxation techniques in classes or at home using books or tapes.
Using medications in conjunction with stress management techniques may be more effective
than is either treatment alone in reducing your tension headaches.
Additionally, living a healthy lifestyle may help prevent headaches:
Get enough, but not too much sleep.
Don't smoke.
Exercise regularly.
Eat regular, balanced meals.
Drink plenty of water.
Limit alcohol, caffeine and sugar.