Migraines and Headaches - Tension Headaches

June 6, 2010

Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time.

Tension headaches are the most common type of headaches among adults. They are commonly referred to as stress headaches.

A 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, tightness, or pressure around the forehead or back of the head and neck.

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.

Tension headaches usually don't keep a person from performing daily tasks.

Who Gets Tension Headaches?

About 30%-80% of the adult U.S. population suffers from occasional tension headaches; approximately 3% suffer from chronic daily tension headaches. Women are twice as likely to suffer from tension-type headaches as men.

Most people with episodic tension headaches have them no more than once or twice a month, but the headaches can occur more frequently.

Chronic tension headaches tend to be more common in females. Many people with chronic tension headaches have usually had the headaches for more than 60-90 days.

What Causes Tension Headaches?

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
• Anxiety
• Fatigue
• Hunger
• Overexertion

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 can lead to chronic tension headaches.

What Are the Symptoms of Tension Headaches?

People with tension headaches commonly report these symptoms:

• Mild to moderate pain or pressure affecting the front, top or sides of the head
• Headache occurring later in the day
• Difficulty falling asleep and staying asleep
• Chronic fatigue
• Irritability
• Disturbed concentration
• Mild sensitivity to light or noise
• General muscle aching

A tension headache may appear periodically (episodic, less than 15 days per month) or daily (chronic, more than 15 days per month). Chronic tension headaches may vary in intensity throughout the day, but the pain is almost always present.

Unlike migraine headaches, 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.

How Are Tension Headaches Treated?

The goals of treatment for tension headaches are to prevent further attacks and relieve any current pain. Prevention includes:

• Taking the medications recommended by your doctor
• Pain relievers
• Muscle relaxants
• Antidepressants
• Others
• Avoiding or minimizing the causes or triggers
• Stress management/relaxation training
• Biofeedback
• Home treatments

Treating the Headache

Over-the-counter (OTC) painkiller medications are often the first treatments recommended for tension headaches. Some of these painkillers can also be used to prevent headaches in people with chronic tension headaches.

If OTC pain relievers don't help, your doctor may recommend a prescription strength pain reliever or a muscle relaxant.

Preventive treatments are drugs used to keep you from getting a tension headache. These include drugs like antidepressants, blood pressure medications, and anti-seizure medications. They are used daily even if you don’t have a headache, so that the overall amount of medication you end up using to treat headaches are diminished.

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.