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Tension-Type Headaches

by Stephen D. Silberstein, MD

A tension-type headache is usually mild to moderate pain that feels like a band tightening around the head.

  • Pain in other parts of the head and neck may trigger these headaches.

  • Headaches may occur several or many days each month.

  • Doctors base the diagnosis on symptoms and results of a physical examination and sometimes do imaging tests to rule out other disorders.

  • Pain relievers may help, as may relaxation and stress management.

Many people occasionally have tension-type headaches. The cause is not well-understood but may be related to a lower-than-normal threshold for pain. Stress may be involved. However, how stress is involved is not clearly understood, and it is not the only explanation for the symptoms. Other problems may contribute to or trigger the headaches. For example, sleep disturbances, a problem with the joint of the jaw (temporomandibular joint disorder), neck pain, or eyestrain may trigger a tension-type headache.

Symptoms

Tension-type headaches feel like tightening of a band around the head, making the whole head ache. These headaches may be episodic or chronic.

Episodic headaches occur fewer than 15 days a month. The pain is usually mild to moderate. It may last 30 minutes to several days. These headaches typically start several hours after waking and worsen as the day progresses. They rarely awaken people from sleep.

Chronic headaches occur 15 or more days a month. Severity may increase as more headaches occur. The pain may vary in intensity throughout the day but is almost always present.

Tension-type headaches are rarely severe and usually do not interfere with daily activities.

Unlike migraine headaches, tension-type headaches are not accompanied by nausea and vomiting and are not made worse by physical activity, light, sounds, or odors.

Some mild migraines resemble tension-type headaches.

Diagnosis

  • A doctor's evaluation

  • Sometimes computed tomography or magnetic resonance imaging to rule out other possible causes

The diagnosis is based on the person’s description of the headache and the results of a physical examination. Doctors ask the person about problems that may trigger the headaches.

No specific procedures can confirm the diagnosis. Sometimes computed tomography (CT) or magnetic resonance imaging (MRI) of the head is done to rule out other disorders that may be causing the headache, particularly if headaches have developed recently.

Treatment

  • Pain relievers

  • Behavioral and psychologic interventions

  • For chronic headaches, certain drugs used to treat migraines

For most mild to moderate tension-type headaches, almost any over-the-counter (OTC) pain reliever (analgesic), such as aspirin, acetaminophen, or ibuprofen (see Over-the-Counter Drugs and Nonopioid Analgesics : Nonsteroidal Anti-Inflammatory Drugs), can provide relief. Massaging the affected area may help relieve the pain. Most people with mild to moderate episodic headaches do not go to a health care practitioner.

If OTC analgesics are ineffective and the headaches are severe, the headache is probably not a tension-type headache. It may be a migraine (see Migraines : Treatment).

For some people, caffeine, an ingredient of some headache preparations, enhances the effect of analgesics. However, overuse of analgesics, caffeine (in headache preparations or caffeinated beverages), triptans, or opioids can lead to daily headaches. Such headaches, called medication overuse headaches, can be present when a person awakens in the morning. Headaches can also worsen or occur when the drugs being used to treat the headache are suddenly stopped. Thus, people need to work closely with their doctor to change the drugs and to use behavioral and psychologic interventions when possible.

Behavioral and psychologic interventions are often effective, especially when drugs are also used. These interventions include relaxation and stress management techniques.

If tension-type headaches are chronic, some drugs used to prevent migraine, particularly amitriptyline (a tricyclic antidepressant—see Table: Drugs Used to Treat Migraines), can help.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • ADVIL, MOTRIN IB
  • No US brand name
  • TYLENOL