"Tension-type" headaches are the most common type of headaches among adults. They are commonly referred to as muscle contraction headaches or stress headaches.
A tension-type or tension headache may appear periodically ("episodic," less than 15 days per month) or daily ("chronic," more than 15 days per month). An episodic tension headache may be described as a mild to moderate constant band-like pain or pressure. These headaches may last from 30 minutes to several days. Episodic tension headaches usually begin gradually, and often occur in the middle of the day.
The "severity" of a tension headache increases significantly with its frequency. Chronic tension headaches come and go over a prolonged period of time. The pain is usually throbbing and affects the front, top or sides of the head. Although the pain may vary in intensity throughout the day, the pain is almost always present. Chronic tension headaches do not affect vision, balance or strength.
Causes
There is no single cause for tension headaches. This type of headache is not an inherited trait that runs in families. In some people, tension headaches are caused by tightened muscles in the back of the neck and scalp. This muscle tension may be caused by:
Inadequate rest
Poor posture
Emotional or mental stress, including depression
In others, tightened muscles are not part of tension headaches, and the cause is unknown.
Tension headaches are usually triggered by some type of environmental or internal stress. The most common sources of stress include family, social relationships, friends, work and school. Examples of stressors include:
Having problems at home/difficult family life
Having a new child
Having no close friends
Returning to school or training; preparing for tests or exams
Going on a vacation
Starting a new job
Losing a job
Being overweight
Deadlines at work
Competing in sports or other activities
Being a perfectionist
Not getting enough sleep
Being over-extended (involved in too many activities/organizations)
Episodic tension headaches are usually triggered by an isolated stressful situation or a build-up of stress. Daily stress, such as from a high-pressured job, can lead to chronic tension headaches.
Symptoms
People with tension headaches commonly report these symptoms:
Severity/Intensity of Pain: The pain of episodic tension headaches is described as mild to moderate, constant band-like pain, pressure or throbbing. The "severity" of a tension headache increases significantly with its frequency. Chronic tension headaches may vary in intensity throughout the day, but the pain is almost always present.
Location of Pain: Tension headaches affect the front, top or sides of the head.
Duration of Pain: Episodic tension headaches usually begin gradually, and often occur in the middle of the day. These headaches may last from 30 minutes to several days. Chronic tension headaches come and go over a prolonged period of time.
Frequency of Headaches: A tension-type headache may appear periodically (episodic, less than 15 days per month) or daily (chronic, more than 15 days per month).
Associated symptoms include:
Headache upon awakening
Difficulty falling asleep and staying asleep
Chronic fatigue
Irritability
Disturbed concentration
Mild sensitivity to light or noise
General muscle aching
There are no associated neurological symptoms (such as muscle weakness, or blurred vision) in people with tension headaches. In addition, severe sensitivity to light or noise, stomach pain, nausea and vomiting are not symptoms usually associated with tension headaches.
Treatment
Tension headaches are treated using several strategies, including: stress management/relaxation training, counseling, biofeedback, medications, and self-care treatments. Treatment for chronic tension headaches usually involves stress management, counseling, biofeedback, and possibly the use of antidepressant or anxiety-reducing medications.
Over-the-counter (OTC) medications are recommended for tension headaches. Ask your doctor or pharmacist about using acetaminophen (Tylenol), ibuprofen (Advil, Motrin), aspirin or naproxen sodium (Aleve) to relieve your headaches.
Take these medications only when necessary. If you do take them, use the smallest dose needed to relieve your pain. Overusing pain medications can actually cause rebound headaches. In addition, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can have serious side effects, including stomach or intestinal pain or bleeding and ulcers.
If OTC pain relievers don't help, your doctor may prescribe a prescription medication to reduce the severity and frequency of your headaches. The most effective drug for treating tension-type headaches is often the antidepressant Elavil, which provides some relief for about 65% of people.
For relief of chronic tension headaches, preventive medications may be prescribed that are aimed at reducing both the frequency and severity of the headaches. These medications may include antidepressants with a sedating effect, such as Elavil; and NSAIDs, such as naproxen sodium (Aleve). These medications are not habit-forming.
Benzodiazepines, butalbital combinations and narcotics (such as codeine, oxycodone) are not recommended because these medications could become habit-forming or addictive. Overuse of these medications or the daily use of OTC pain-relieving medications are not recommended.
Keep in mind that medications don't cure headaches and that, over time, pain-relievers and other medications may lose their effectiveness. In addition, all medications have side effects. If you take medication regularly, including products you buy over-the-counter, discuss the risks and benefits with your doctor. Also, remember that pain medications are not a substitute for recognizing and dealing with the stressors that may be causing your headaches.
Regardless of the treatment, tension headaches are best treated when the symptoms first begin and are mild, before they become more frequent and painful.
