Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, a head injury, and anxiety.
They may occur at any age, but are most common in adults and adolescents.
If a headache occurs two or more times a week for several months or longer, the condition is considered chronic. Chronic daily headaches can result from the under- or over-treatment of a primary headache.
Rebound headaches are headaches that keep coming back. They may occur when pain medicines are overused.
Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.
Tension headaches can occur when you also have a migraine. Tension headaches are not associated with brain diseases.
The headache pain may be described as:
Dull, pressure-like (not throbbing)
A tight band or vise on the head
All over (not just in one point or one side)
Worse in the scalp, temples, or back of the neck, and possibly in the shoulders
The pain may occur once, constantly, or daily. Pain may last for 30 minutes to 7 days. It may be triggered by or get worse with stress, fatigue, noise, or glare.
There may be difficulty sleeping. Tension headaches usually do not cause nausea or vomiting.
People with tension headaches try to relieve pain by massaging their scalp, temples, or the bottom of the neck.
Exams and Tests
If your headache is mild to moderate, without other symptoms, and responds to home treatment within a few hours, you may not need further examination or testing.
With a tension headache, there are usually no problems with the nervous system. But tender points (trigger points) in the muscles are often found in the neck and shoulder areas.
The goal is to treat your headache symptoms right away, and to prevent headaches by avoiding or changing your triggers. A key step in doing this involves learning to manage your tension headaches at home by:
Keeping a headache diary to help you identify your headache triggers so that you and your doctor can make changes in your lifestyle to reduce the number of headaches you get
Learning what to do to relieve a headache when it starts
Learning how to take your headache medicines the correct way
Medicines that may relieve a tension headache include:
Over-the-counter pain medicines such as aspirin, ibuprofen, or acetaminophen
Taking medicines more than 3 days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine.
Taking too much acetaminophen can damage your liver.
Too much ibuprofen or aspirin can irritate your stomach.
If these medicines do not help, talk to your doctor about prescription medicines.
Other treatments that you can discuss with your doctor include relaxation or stress-management training, biofeedback, cognitive behavioral therapy, acupuncture, or botulinum toxin type A (Botox ®).
Tension headaches often respond well to treatment. But if the headaches are chronic, they can interfere with life and work.
When to Contact a Medical Professional
Call 911 if:
You are experiencing "the worst headache of your life"
You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before
The headache starts very suddenly
The headache occurs with repeated vomiting
You have a high fever
Also, call your doctor if:
Your headache patterns or pain change
Treatments that once worked are no longer helpful
You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
You are pregnant or could become pregnant -- some medicines should not be taken when pregnant
Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for chronic tension headache.
Tips to prevent tension headaches:
Keep warm if the headache is associated with cold
Use a different pillow or change sleeping positions
Practice good posture when reading, working, or doing other activities
Exercise the neck and shoulders frequently when working on computers, or doing other close work
Get plenty of sleep and rest
Massaging sore muscles may also help.
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Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis. JAMA. 2012;307:1736-1745.
Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, et al. Tricyclic antidepressants and headaches: systematic review and meta-analysis. BMJ. 2010. 341:c5222. doi: 10.1136/bmj.c5222.
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009;(1):CD007587.
Joseph V. Campellone, M.D., Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.