What is tension headache?

Most headaches are tension headaches. This kind of headache may cause pain or pressure on both sides of your head. You may feel tightness around your forehead that feels like a "vise grip."

If you get a lot of these kind of headaches, one way to reduce them is to find out what's causing them. Things that can cause headaches are called triggers. To find your triggers, you can:

• Use a headache diary to keep track of what you do each day—what you eat and drink, the stress you feel, the weather, and other things.
• Pay attention to your daily routines, like how much exercise and sleep you get.

With this information, you may start to see patterns to what triggers your headaches. Then you can make changes to avoid or manage those triggers.

Tension headaches may come on suddenly or slowly. They can last from 30 minutes to 7 days. They tend to come back, especially if a person is under stress.

If a person has a headache on 15 or more days each month over a 3-month period, they may have chronic tension headaches. This type of headache can lead to stress and depression, which in turn can lead to more headaches.

But there is treatment for tension headaches. Most can be treated with over-the-counter pain medicines. Prescription medicines may help if headaches keep coming back or if the headaches are very bad.

Symptoms of tension headaches include:

• A constant headache that doesn't throb or pulse. The pain or pressure is usually on both sides of the head.
• Tightness around the forehead that may feel like a "vise grip."
• Aching pain at the temples or the back of the head and neck.

Unlike migraines, tension headaches usually don't occur with nausea, vomiting, or feeling sensitive to both light and noise. But light or noise could make the headache worse. Pain from a tension headache usually isn't severe and doesn't get in the way of a person's school, work, or social life. But for some people, the pain is very bad or lasts a long time.

Tension-type headaches are classified as:

Infrequent episodic.

You may have this type of headache if you get a headache less often than 1 day a month (or fewer than 12 days a year). The pain is mild to moderate. You may feel pressure or tightening across your forehead (like a "vise grip") and at your temples, back of your head, or neck. You may have pain on both sides of your head. You also may feel sensitive to light or noise (but not both). This type of headache doesn't cause nausea or vomiting. These headaches don't get worse with physical activity.

Frequent episodic.

You may have this type of headache if you have a headache on more than 1 day but fewer than 14 days each month (or more than 12 but fewer than 180 days a year). The pain is mild to moderate. You may feel pressure or tightening across your forehead (like a "vise grip") and at your temples, back of your head, or neck. You may have pain on both sides of your head. You also may feel sensitive to light or noise (but not both). These headaches don't cause nausea or vomiting, and they don't get worse with physical activity.

Chronic.

You may have chronic tension headaches if you have a headache on 15 or more days each month for at least 3 months (or more than 180 days a year). The location of pain and pressure is the same as an episodic tension headache. But with chronic tension headaches, you may feel nausea (but without vomiting). You also may be sensitive to light or noise. These headaches can sometimes be confused with migraine headaches. Chronic tension headaches may last for days at a time and usually do not get better when you use pain relievers. Although the pain may be mild to moderate, the constant pain can become disabling. People who have anxiety or depression may get these headaches often.

You can treat most tension headaches yourself. You can take over-the-counter medicines, avoid things that trigger your headaches, and reduce your stress. If you keep having headaches or your headaches are very bad, your doctor may give you prescription medicines.

In some cases, your doctor may prescribe stronger pain medicine if over-the-counter drugs don't stop your headaches.

You may want to try medicine to prevent getting a headache if:

• You use medicines to stop your headaches more than 3 times a week.
• Medicines to stop headaches aren't working well for you.

Even with treatment, you will most likely still get some tension headaches. But you probably will get them less often. And they may hurt less when you do get them.

To help prevent tension headaches:

• Find healthy ways to cope with stress.
• Get regular exercise.
• Keep a regular schedule for sleeping and eating.
• Use good posture, and try to keep your neck and shoulders relaxed.
• Take medicine that prevents headaches, if your doctor prescribed it.

A doctor can usually diagnose tension headaches by doing a physical exam and asking questions, such as how often the headaches happen and what the symptoms are. The doctor will also ask about your overall health and lifestyle.

It can be hard to know which type of headache you have. That's because different types can have the same symptoms. But the treatments may be different, so it's important to find out which type you have.

In some cases, your doctor may order tests to find out if a health problem is causing them. These tests may include an MRI or a CT scan.

In very rare cases, headaches can be caused by more serious health problems (such as brain tumors or aneurysms). But most headaches aren't caused by anything serious. So you probably won't need to have tests.

Your doctor may recommend medicine to stop or to prevent tension headaches.

The type of tension headache you have may help your doctor decide which drug to prescribe. You may have to try several different drugs or types of drugs before you find the one that is right for you. Make sure to tell your doctor how well a drug stops your headaches.

You might need to take only an over-the-counter medicine for pain. They usually have fewer side effects than prescription drugs. Always be safe with medicines. Read and follow all instructions on the label.

The medicine that you take may cause side effects. Some side effects may last for a few weeks. Others may last for as long as you take the medicine. Certain pain medicines can cause a bad reaction if you take them with other medicines. Before you start to take pain medicines, be sure to let your doctor know about all of the drugs you take. This includes over-the-counter medicines and complementary treatments (such as herbs).

Over-the-counter drugs to stop headaches

Medicines to stop a headache after it starts include:

• Acetaminophen.
• Aspirin.
• Ibuprofen.
• Naproxen.
• Medicine that combines aspirin, acetaminophen, and caffeine.

Talk to your doctor if you are taking medicine more than 2 days a week to stop a headache. Taking too much pain medicine can lead to more headaches. These are called medicine-overuse headaches.

Prescription drugs to prevent headaches

Your doctor may recommend that you take a prescription medicine every day to prevent headaches. You may want to take this medicine if:

• Over-the-counter medicines don't work to stop your headaches.
• You take over-the-counter medicines to stop headaches more than 3 times a week.
• You get a headache more than 15 days a month.

Medicines used to prevent tension headaches include:

• Antidepressants, such as amitriptyline.
• Seizure medicines, such as topiramate.
• Medicines that relax muscles, such as tizanidine.
• Antianxiety medicines, such as buspirone.

There are things you can do that may help you have fewer headaches—and less pain when you do get them. Some self-care ideas include:

• Finding and avoiding things that trigger your headaches. Triggers may include stress, hunger, and lack of sleep.
• Keeping a headache diary to find out what triggers your headaches.
• Taking over-the-counter medicines to stop a headache.
• Taking medicine as your doctor advises to stop or prevent a headache.
• Reducing stress with relaxation and positive-thinking methods.

The most common triggers for tension headaches are physical and emotional stress.

Sometimes stress is caused by conditions such as anxiety and depression. If you think you may have anxiety or depression, talk with your doctor. If you treat these conditions, you may get tension headaches less often.

If you have tension headaches, ask yourself if you are:

• Having conflicts within your family or at work or school.
• Not getting enough sleep or relaxation.
• Hungry.

Other possible tension headache triggers include:

• Eyestrain from working at a computer.
• Neck strain from poor posture, your work environment, or injury.
• Strain in the chewing muscles of your jaw. This can happen if you grind or clench your teeth.
• Muscle tension in your shoulders and upper back.

Some people find that some non-medicine treatments can help stop a tension headache or prevent one.

If you decide to try one or more of these treatments, make sure that your doctor knows. He or she may have advice on how to use them safely. Some non-medicine treatments for headaches include:

• Acupuncture. This involves putting very thin needles into the skin at certain points on the body. Studies show that acupuncture can help prevent tension headaches.
• Biofeedback. This is a relaxation method to help you learn to control a body function that you normally don't control, such as muscle tension.
• Cognitive behavioral therapy or problem-solving therapy. Counseling with these methods can help with tension headaches.
• Meditation. This can produce a state of relaxation that reduces heart rate, slows breathing, and lowers blood pressure.
• Peppermint oil. Some research shows that peppermint oil rubbed on your temples or on the tight muscles in your head, neck, and shoulders may help relieve tension headaches.
• Transcutaneous electrical nerve stimulation (TENS). This treatment uses mild electrical current to treat pain. It may help reduce headache pain.
• Yoga. Hatha yoga includes meditation and exercises to help you improve flexibility and breathing, decrease stress, and maintain health.

The cause of tension headaches isn't clear. In the past, doctors believed that tension or spasms of the muscles of the neck, face, jaw, head, or scalp played a role in causing these headaches. Now they think a change in brain chemistry may also help cause them.

Tension headaches can be brought on—or triggered—by things such as stress, depression, hunger, and muscle strain. They may come on suddenly or slowly.

Chronic tension headaches are headaches that keep coming back. They often occur along with other health problems such as anxiety or depression.

Tension headaches are the most common headaches. They cause aching, tightness, pressure, and pain around the forehead, temples, or back of the head and neck. They tend to happen again and again, especially if a person is under stress. They usually aren't a sign of something serious. But they can be very painful.