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Tension headaches are the most common type of primary headache, often caused by stress and muscle tension. They are characterised by a steady ache, rather than a throbbing pain, and typically do not cause nausea, vomiting, or sensitivity to light. While the exact cause of tension headaches is unknown, muscle contractions in the head and neck are considered a major factor. This contraction of muscles can be a response to stress, depression, head injury, or anxiety, and can lead to a build-up of waste products that irritate nerve fibres and cause pain. This pain can manifest as a mild to moderate intensity headache, often described as a tight band or vice around the head. While tension headaches usually do not require medical attention, severe cases may warrant a check-up to rule out other health problems.
| Characteristics | Values |
|---|---|
| Type | Tension-type headache (TTH) is the most common type of primary headache |
| Other Names | Muscle contraction headache, stress headache, psychomyogenic headache |
| Occurrence | Episodic (frequent and infrequent subtypes) and chronic |
| Diagnosis | At least 10 episodes lasting 30 minutes to 7 days (average 4-6 hours) are required for a diagnosis of TTH |
| Pain | Mild to moderate, dull, pressing, or band-like tightening |
| Aggravating Factors | Not aggravated by routine physical activity; may be triggered or worsened by stress, fatigue, noise, or glare |
| Associated Symptoms | No nausea, vomiting, or sensitivity to light; may have mild nausea; sleep disturbances |
| Treatment | Over-the-counter medications (e.g., acetaminophen, ibuprofen, naproxen), lifestyle changes (regular sleep, exercise, meal schedules), relaxation techniques, biofeedback, cognitive-behavioral therapy |
| Prevention | Identify and avoid triggers, manage stress, improve posture, regular exercise, heat therapy |
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What You'll Learn
Tension headache characteristics
Tension-type headache (TTH) is the most common type of primary headache. It is often linked to stress, poor posture, and muscle tension. TTH occurs repetitively and may be categorized into episodic TTH, with frequent and infrequent subtypes, and chronic TTH. The differentiating factor for these types is the frequency of headache episodes.
Tension headaches typically don't cause nausea, vomiting, or sensitivity to light. They do, however, cause a steady ache, and patients often report significant muscle tenderness with increasing headache frequency and intensity. The pain is usually described as a constant, mild to moderate pressure, like someone is squeezing or tightening the sides of the head together. The headaches are often bilateral in location, affecting both sides of the head, and are not aggravated by routine physical activity such as walking or climbing stairs.
The average duration of a tension headache is about 4 to 6 hours, but they can last anywhere from 30 minutes to 7 days. They usually feel better in the morning and worse in the evening. Patients may also experience neck and shoulder muscle tightness, sleep disturbances, and sensitivity to sound.
While the exact cause of tension headaches is not known, muscle contractions in the head and neck region are thought to be a major factor. Researchers believe that the pathogenesis involves heightened sensitivity of the central nervous system, particularly the trigeminal system.
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Causes of tension headaches
Tension-type headache (TTH) is the most common type of primary headache. TTH is often linked to stress, poor posture, and muscle tension, with a multifactorial etiology involving both peripheral and central mechanisms. The pathogenesis is thought to involve heightened sensitivity of the central nervous system, particularly in the trigeminal system, and muscle contraction in the head and neck region.
TTH may be distinguished from other primary and secondary headaches using the International Headache Society (IHS) definition and diagnostic criteria. The IHS requires at least 10 headache episodes lasting 30 minutes to 7 days for a diagnosis of TTH. The average duration is about 4 to 6 hours. TTH is characterized as recurrent, mild to moderate, bilateral, band-like, pressing or tightening, and not aggravated by routine physical activity or minor exertional activity.
Patients with TTH often report significant muscle tenderness with increasing headache frequency and intensity. The muscle tenderness may involve the neck, leading patients and physicians to assume that a disorder of the neck is the cause of the headache. In addition, psychological tension is associated with and can aggravate TTH, but it is not clear if it is the cause.
Lifestyle changes such as maintaining a regular sleep, exercise, and meal schedule can help reduce or prevent tension headaches. Over-the-counter medications such as acetaminophen, ibuprofen, or naproxen can also be effective in treating TTH. However, using these medications too frequently can lead to medication overuse headaches, so it is important to use them carefully. If tension headaches occur often, therapies such as cognitive-behavioral therapy, relaxation therapy, or biofeedback may be recommended.
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Treatment options
Tension headaches are often treated with over-the-counter medications such as acetaminophen, ibuprofen, or naproxen. However, these should be used carefully, as overuse can lead to more headaches. Identifying and avoiding triggers is an important preventative measure. Keeping a regular sleep, exercise, and meal schedule can also help. For chronic tension headaches, therapies such as cognitive-behavioral therapy, relaxation therapy, or biofeedback may be beneficial.
If tension headaches are interfering with your life and work, it is important to seek medical advice. Healthcare providers may recommend prescription medication or physical therapy. They may also suggest blood tests, sinus X-rays, MRIs, or CT scans to rule out other health problems.
Some lifestyle changes that may help in managing tension headaches include:
- Maintaining a regular sleep schedule, including sleeping and waking at the same time each day.
- Getting enough sleep and rest.
- Practicing good posture when reading, working, or doing other activities.
- Exercising regularly, especially the neck and shoulders when working on computers or doing close work.
- Managing stress through relaxation exercises, meditation, or biofeedback.
- Keeping warm if headaches are associated with cold temperatures.
- Using a different pillow or changing sleeping positions.
- Massaging sore muscles.
Keeping a headache diary can be a useful tool to help identify triggers and make the necessary lifestyle changes to reduce the frequency of tension headaches.
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Diagnosis
Tension headaches are the most common type of headache. They are often linked to stress, poor posture, and muscle tension. The exact cause of a tension headache is not known, but muscle contractions in the head and neck are thought to be a major factor.
Tension headaches are diagnosed based on symptoms and a physical exam. It is important to track and share information about your headaches with your healthcare provider to help make an accurate diagnosis. Keeping a headache diary can be useful for this, noting the frequency, duration, severity, and aggravating and relieving factors. The IHS requires at least 10 headache episodes lasting 30 minutes to 7 days, with an average duration of 4 to 6 hours, for a diagnosis of Tension-Type Headache (TTH).
Tension headaches usually do not cause nausea, vomiting, or sensitivity to light. They are described as a tight band or vice around the head and are typically bilateral. They are also of mild or moderate intensity and are not aggravated by routine physical activity. People with tension headaches often try to relieve pain by massaging their scalp, temples, or the bottom of neck.
Your healthcare provider may also recommend additional tests to rule out other health problems that may be causing your symptoms. These may include blood tests and other lab tests to check for underlying conditions. In some cases, a CT scan may be performed to create detailed images of the head and neck region.
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Prevention
Tension-type headaches (TTH) are the most common type of primary headache. They are often referred to as "muscle contraction headaches" or "stress headaches". TTH causes pain that radiates bilaterally from the forehead to the neck and is described as tightness, pressure, or a dull ache. While TTH is not aggravated by routine physical activity, it is often linked to stress, poor posture, and muscle tension.
To prevent tension headaches, the following steps can be taken:
Minimize Stress
Work pressures, relationship stress, and other life challenges can cause tension headaches. Avoiding or limiting stressful events and situations can help prevent TTH. If stress cannot be avoided, examining the psychological stress in your life and seeking help through therapy or counseling can help to reduce it.
Take Breaks
Limit the time spent looking down at your phone or computer, as this can contribute to poor posture and neck strain, which may lead to tension headaches. Take breaks on long drives and adjust your sleeping position to ensure your neck is in a neutral posture.
Exercise and Stretch
Engaging in regular exercise of at least 30 minutes a day and stretching the neck and shoulder muscles can help prevent tension headaches. Using a therapy cane or a hard therapy ball to massage the neck and shoulder area may also provide relief.
Maintain Regular Sleep, Exercise, and Meal Schedules
Sticking to a consistent sleep schedule, including going to bed and waking up at the same time each day, can help prevent tension headaches. Additionally, maintaining a regular exercise and meal routine can also be beneficial.
Use Over-the-Counter Medicines
Medicines such as aspirin, ibuprofen, acetaminophen, or naproxen can be effective in preventing and treating episodic tension headaches. However, it is important to use these medicines carefully, as overuse can lead to more frequent headaches and the development of chronic daily headaches.
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Frequently asked questions
Tension headaches are the most common type of headache. They occur when neck and scalp muscles become tense or contract, often due to stress and muscle tension. They are typically mild to moderate in intensity and are not aggravated by routine physical activity.
Tension headaches can often be treated with over-the-counter medications such as acetaminophen, ibuprofen, or naproxen. However, these should be used carefully as overuse can lead to rebound headaches. Lifestyle changes such as regular sleep, exercise, and meal schedules can also help reduce or prevent tension headaches.
While there is no direct mention of tension headaches causing muscle spasms, tension headaches are associated with muscle tenderness, tightness, and contractions in the head and neck region. Therefore, it is possible that the muscle spasms could be related to the tension headache, but further medical advice should be sought for a definitive answer.
