(Muscle Contraction Headache; Tension-Type Headache)
DefinitionTension headache refers to radiating, steady pain in the head, neck, or eyes that can be mild or intense. Tension headaches may be occasional or chronic.
|Tension Headache: Areas of Pain|
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CausesTension headaches may occur when muscles in the neck, face, and scalp contract. In some cases, muscle contraction is the result of teeth grinding and jaw clenching. In others, it may be unknown.
Risk FactorsTension headaches are more common in women. Other factors that may increase your risk of getting a tension headache include:
- History of teeth grinding or jaw clenching
- Sleep apnea or sleep disruption
- Poor posture
- Injuries or arthritis of the neck area
- Temporomandibular joint disease (TMJ)
- Low physical activity
SymptomsSome tension headaches are nearly constant, with daily pain that may vary in intensity. Other tension headaches only occur once in a while. Symptoms usually start slowly and build.Tension headache may cause:
- Constant, steady pain and pressure
- Dull and achy pain
- Pain which may be felt on both sides of the head, in the forehead, temples, and the back of the head
- Pressure may feel like a tight band around the head
- Intensity ranges from mild to severe and can vary during the day
- Tightness in head and neck muscles
DiagnosisYou will be asked about your symptoms and medical history. A physical exam will be done. Diagnosis can be made on exam, based on specific features. The cause of the headaches however, may be more difficult to determine. A neurological exam may be done. Imaging is not usually needed, but if pain is unusual or severe it may be done to look for other causes of the headache. Imaging tests include:
TreatmentThere are no specific cures for tension headaches, but they can be managed. Therapies aim to stop the headache and reduce the frequency of future episodes. Treatment may include:
MedicationsFor occasional headaches, the following medication may be recommended to relieve pain:
- Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
- Prescription pain relievers
- Muscle relaxers
- Botulinum toxin injections (Botox)
- Anti-seizure medication
- Beta blocker medication
Self-care During the HeadacheSelf-care may include:
- Rest if needed
- An ice pack or heat pack on your head or neck to ease discomfort
- A warm shower, with water running over tense muscles
Lifestyle ChangesLifestyle changes may include:
- Regular exercise
- Improving your posture
- Adequate sleep
- Regular breaks from tasks
- Stress management and relaxation techniques
- Counseling to:
- Develop new coping skills
- Identify events that trigger the headaches and work toward resolution
Additional TherapiesAdditional therapies may include:
- Acupuncture—to have more headache-free days and lessen the intensity of headaches when they do occur
- Physical therapy—to develop a home exercise program
- Massage therapy
PreventionTo help reduce your chances of getting a tension headache, try the following strategies:
- Keep a diary, marking when headaches occur and what you were doing before they started.
- Learn to recognize what provokes a tension headache.
- Avoid or minimize stressful situations.
- Take frequent breaks to walk or move around.
- Make time for pleasurable activities.
- Practice relaxation techniques, such as deep breathing and focusing on something pleasant.
- Learn techniques for coping with difficult or stressful situations.
- Make time for friends and build a strong support system.
- Go to bed early and get a good night's sleep.
- Exercise regularly.
- Do not slouch.
- Hold the phone, rather than cradling it on your shoulder, or use a headset.
American Headache Society
National Headache Foundation
Headache Network Canada
Help for Headaches
Melchart D, Streng A, Hoppe A, et al. Acupuncture in patients with tension-type headache: randomized controlled trial. Brit Med J. 2005;331:376-379.
NINDS headache information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/headache/headache.htm. Updated September 26, 2014. Accessed January 15, 2015.
Tension-type headache. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 6, 2015. Accessed January 15, 2015.
Tension-type headache. National Headache Foundation website. Available at: http://www.headaches.org/education/Headache%5FTopic%5FSheets/Tension-Type%5FHeadache. Accessed January 15, 2015.
12/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN. Acupuncture in patients with headache. Cephalalgia. 2008;28:969-979.
8/27/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA. An unfavorable lifestyle and recurrent headaches among adolescents: The HUNT Study. Neurology. 2010;75(8):712-717.
5/12/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Yancey JR, Sheridan R, et al. Chronic daily headache: diagnosis and management. Am Fam Physician. 2014 Apr 15;89(8):642-8.
- Reviewer: Rimas Lukas, MD
- Review Date: 01/2015
- Update Date: 05/12/2014