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Tension headaches, also known as stress headaches, are among the most common types of headaches experienced by adult populations across the world.
Although this condition affects both genders, women tend to be more susceptible to tension headaches than men.
The degree of pain may range from mild to moderate, but tension headaches almost always give rise to a characteristic feeling of increased tightness or pressure across your forehead, on your temples, and at the back of your head.
The jury is still out on what exactly causes these headaches, but excessive contraction of the head and neck muscles may have a role to play.
The pain associated with a tension headache typically sets in at the back of the head or above the eyebrows and then gradually progresses to engulf your entire head as well as your neck.
Although a tension headache can inflict a considerable amount of pain, most individuals are able to carry out their regular activities when it strikes, unlike during a migraine headache that causes debilitating pain.
Types of Tension Headache
Tension headaches fall under the following categories:
- Infrequent episodic tension headaches: Can occur less than 12 times in a year with each episode lasting from 30 minutes to 1 week.
- Frequent episodic tension headaches: May occur often, about 1-14 times a month, lasting for a period of 30 minutes to 1 week.
- Chronic tension headaches: May occur about 15 times a month, lasting for hours. This type of headache may be accompanied by mild nausea.
Here are the types, triggers, and symptoms of tension headache and treatment methods.
Causes of Tension Headache
Some common triggers of tension headache are stress, anxiety, depression, impaired sleep, poor posture, and skipping meals.
Some cases of tension headaches may result from overexertion, but they are rarely aggravated by physical activity. (1)
Instead, these headaches usually stem from some sort of emotional stress, which can make your facial, head, and neck muscles increasingly tense.
Moreover, you may also experience such headaches in the wake of a head injury.
Other factors that may cause a tension headache include: (1)
- Vision problems
- Excessive caffeine intake
- Teeth grinding or jaw clenching problems
- Sinus infection
- Menstruation in rare cases
Signs and Symptoms of Tension Headache
The hallmark symptom of a tension headache is a feeling of a tight band clenched around your head, also termed as the “tight hatband” or “vise grip” sensation.
Your skull will feel heavy and compressed, due to the clenching of the head and neck muscles.
The muscle stress is often brought on by emotional triggers and gives rise to a dull pain that radiates from the back of your head or top of your eyebrows to your entire skull.
The pain maybe mild to moderate and the duration depends on the type of tension headache. The characteristic pain may be accompanied by:
- Tenderness in neck, scalp, and shoulder muscles
- Trouble sleeping
- Difficulty falling asleep
- Inability to concentrate
- Heightened sensitivity to loud sounds and light
Not only are tension headaches caused by heightened emotional strain, but they can also add to your stress and anxiety to make matter worse. (2)
Diagnosing Tension Headache
There are no diagnostic tests, as of now, to determine if your headache originates from tension. Your doctor is likely to review your case based on your medical history and family history after analyzing your symptoms.
Because tension-type headaches may mimic the symptoms of secondary headaches, there is a possibility of misdiagnosis if you do not convey your symptoms properly, such as the intensity or duration of the headache.
Secondary headaches can be caused by overuse of medications or a structural difference in the brain.
A CT scan or MRI of the head may be prescribed if your headache is accompanied by some unusual symptoms to rule out any underlying problem.
Standard Treatment for Tension Headache
The medical treatment for a tension headache depends on its symptoms, frequency, duration, and causative factors.
- Infrequent tension headaches can be treated per individual episode using analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), or a combination of an analgesic and codeine.
However, it is recommended not to take combination medications on a regular basis, as doing so can trigger rebound headaches and can cause side effects on the kidneys, liver, and other body parts.
Medication overuse can also lead to addiction and can compromise your overall health. It is, therefore, in your best interest to consult a doctor for the appropriate dosage rather than to self-medicate.
- Tricyclic antidepressants are the standard drug of choice for the treatment of chronic tension-type headache.
Individuals with a chronic or frequent tension headache may be prescribed amitriptyline to relieve the pain and advised to adopt some preventive strategies to stop an incoming headache.
Tips to Deal with a Tension Headache
Here are various alternative ways and home remedies that may help you manage tension headaches.
1. Self-Care Measures
- Apply an ice pack to your head. This can help relieve your headache by soothing the sore muscles responsible for it.
Most cases of tension headaches are brought on by increased muscle tension in the face, head, and neck. The blood vessels in the affected area tend to expand due to the heightened degree of muscular strain and exert greater pressure on the nerves that lie underneath them.
Cold therapy may work to constrict the swollen blood vessels to bring down the pressure in your head and thereby relieve the pulsating ache. (4)Note: Never apply ice directly to your skin as it can lead to frostbite.
- Maintain a journal and write down the details of every episode of headache: date, duration, the intensity of the pain, and symptoms. This helps you keep track of your symptoms and avoid a headache in the near future.
- Be mindful of your dietary choices as tension headaches can often be triggered by what you eat. Identify potential triggers and exclude them from your diet.
Although triggers may vary from person to person, some of the commonly reported food culprits responsible for tension headaches include aged cheese, chocolate, and foods that contain preservatives and nitrates.
- Adhere to a regular eating schedule to make sure that you don’t go hungry for too long nor overeat.
- Follow a consistent sleep routine. Getting sufficient sleep does not imply that you should spend most of your time in a state of slumber.
It may seem like an easy way to cope with a headache, but oversleeping only worsens your condition by making you groggier.Improved quality of sleep may help regulate your body’s stress response and bring down the level of cortisol (stress hormone).
- Certain dietary habits can also help promote better sleep. For starters, you must avoid consuming anything that contains caffeine when you are nearing your bedtime.
Caffeine is a certified stimulant that can make it harder for you to doze off. Even if sleep does come to you after having caffeine, it is more likely to be disturbed than restorative. (3)
- As it is especially difficult to fall asleep with a throbbing headache; it may help to make your room sleep-friendly. Make sure that your sleeping space is devoid of any noise or disturbance while being comfortably cool and dark.
- If you are a smoker, it is in your best interest to quit the habit. Tobacco smoke can act as a major trigger for tension headaches, which makes it necessary for those who suffer from this condition to steer clear of both active and passive smoking.
- Cut back on your consumption of alcohol, caffeine, and sugar.
- Maintain optimal fluid intake to keep your body adequately hydrated.
Instead of flooding your system with abundant amounts of water at once, it is recommended to spread your fluid consumption throughout the day.
You can also derive your daily fill of hydration from succulent fruits and vegetables, in both juice and whole form.
- Change your sleeping position if disturbed sleep is a trigger for your headache.
- Take a cool shower to get some relief from the headache.
- Sitting in one position for extended periods can cause your muscles in your back, neck, and shoulders to tighten, which can lead to the onset of tension headaches.
Thus, people with desk jobs are advised to stretch out their body from time to time.
- Nowadays, most people are used to spending long hours in front of the computer or other digital screens, making them increasingly prone to eyestrain. Eyestrain is regarded as one of the prime contributors to tension headaches.
One way to comfort your tired eyes is to massage them gently for a minute. You must also take occasional breaks when working on the computer to give your eyes some rest.
- Be mindful of your body posture while standing, sitting, or lying down.
Incorrect posture can put extra strain on your already tense muscles and can aggravate the damage.It is important not to slouch while standing or sitting. Push your shoulders back, so your spine remains erect.
2. Manage Your Stress
Stress management is of paramount importance when it comes to treating or preventing tension headaches.
Controlling your stress levels not only reduces the frequency of a headache but also stops the pain from worsening.
Here are some of the things you can do to manage your stress:
- Fix yourself a therapeutic bath, and spend some quality time by yourself.
- Soft and soothing music can help calm your mind by temporarily blocking out the noise of the world.
- Recreational hobbies such as gardening or painting can offer you a much-needed respite from the constant drudgery of everyday life.
- Read inspirational texts to keep your spirits high.
- Venture outdoors for a nice relaxing walk every now and again, preferably in an area with abundant greenery so you can breathe in the fresh air.
- A number of restorative techniques,including deep breathing, yoga, meditation, guided imagery, visualization, and progressive muscle relaxation, can help you manage your stress levels better.
- Exercise works as an excellent stress buster and should be done regularly for best results.
3. Practice Mindfulness Meditation
Mindfulness meditation helps in stress management and improves both your physical and mental health. The idea behind mindful meditation is to be attentive to your thoughts, emotions, and perceptions and accept them as they are.
Mindfulness-based stress reduction (MBSR) may help address a number of pain-related conditions, including tension headaches.
One 2014 randomized controlled clinical trial found this new-age psychotherapy to be an effective treatment tool for reducing the pain severity and improving the mindful awareness in patients with tension headache. (6)
Another study published in Behavioural and Cognitive Psychotherapy suggested that practicing mindful meditation for brief periods can help reduce the frequency of chronic tension headaches. (7)
The study utilized three meditation practices, namely, the body scan meditation, formal sitting meditation, and 3-minute breathing space.
On the other hand, a systematic review and meta-analysis that took into account five randomized controlled trials with a total of 185 subjects concluded that mindfulness-based stress reduction may not improve the symptoms and frequency of chronic headaches.
There are, however, certain research-related limitations that one must keep in mind while interpreting these contradictory results. To begin with, there weren’t a sizeable number of studies included in the review to present a complete picture.
The ones that were included were conducted on relatively small sample size and, therefore, cannot be considered truly representative of the general population at large. To conclusively establish these results, they have to be validated by more rigorous and large-scale studies. (8)
Mindfulness-based therapy (MBT) helps you concentrate your energies in the present. This can be accomplished through your body, breathing, and thought process.
This meditation practice allows you to focus on your breath and enables you to embrace each and every aspect of your life through your thoughts.
4. Get a Massage
Massage, if done correctly, can help release the tension trapped in your muscles. Gently rubbing your head, neck, and back may even stimulate blood flow to the area and further relieve your muscle soreness.
A 2016 randomized, single-blinded, controlled clinical trial performed on 105 patients with tension-type headache found that massage therapy in conjunction with either postural techniques, gentle stretching exercises, or trigger point therapies may help relieve muscle tension and improve the range of motion in the neck region. (10)(5)
Pay special attention to massaging the temples and the back of the head for maximum pain relief.
You can also dab a few drops of diluted peppermint oil on to the skin before massaging it.
Peppermint oil is well-known for its soothing properties, which explains why it may work as a muscle relaxant when applied topically. Peppermint oil can also promote blood flow to the area of application.
5. Consider Acupressure
Acupressure is an alternative technique that works with the same principle as acupuncture, minus the use of needles.
This treatment modality involves stimulating specific pressure points on the body with the simple power of touch.
In acupressure, physical pressure is applied to the cup points with the aim of clearing any blockages in the flow of your life energy.
It helps trigger your body’s innate healing response against a wide array of ailments and may even help in alleviating headaches and neck pain.
A study published in Human Kinetics highlighted the use of acupressure points called joining of the valleys LI4 and gates of consciousness GB20 to manage a tension headache. (9)
It was demonstrated that a gentle massage in these areas reduced the headache in the patients.
6. Try Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is a type of talk therapy that can help you manage your stress. CBT gives you an insight into the possible causes of your stress and anxiety that lead to a tension headache.
Standard practice involves multiple sessions with a mental health specialist who will speak to you on a one-on-one basis to unearth various mental blocks that may be keeping you from getting better.
This therapy guides you to get a perspective about things and challenge your stress. As you become self-aware, the stress is controlled and the frequency and severity of the tension headaches are reduced to a large extent.
One 2014 RCT study conducted on 120 adult participants who suffer from migraine or tension-type headache demonstrated the positive impact of CBT on the improvement of their condition. (13)
Such behavioral interventions, however, need to be explored and advanced further to yield better results.
CBT may be especially beneficial for children and adolescents with tension headaches, not only in terms of reducing the pain intensity but also by pushing them to take their pharmacological treatment seriously.
Moreover, this kind of psychological support therapy may help maximize and prolong the therapeutic effects of your treatment strategy in general. (14)
7. Use Biofeedback
Tension headaches often result when the mind-body symbiosis gets disrupted due to stress, anxiety, depression, or other psychological triggers.
Biofeedback is a non-pharmacological technique that involves using electronic or electromechanical devices to record visual and auditory feedback from the body.
This alternative therapy can help you monitor and manipulate your body’s involuntarily physiological functions such as heart rate, blood pressure, body temperature, blood flow, perspiration, and muscle pain, among others.
The information received through biofeedback can help you understand the internal workings of your body, so you can modify your physiology in the interest of better health.
With regard to tension headaches, biofeedback devices are used to register the body tension that inadvertently leads to muscle pain and eventually induces tension headaches.
By keeping track of your tension levels and the resulting muscle strain, you gradually learn to circumvent or mitigate tension headaches by keeping your tension under control and your muscles relaxed.
This claim is supported by multiple published studies that favor the use of biofeedback as an effective means to reduce the frequency and severity of headaches while decreasing the patient’s medicinal dependence. (14)
One 2010 review suggested that various types of biofeedback techniques may help improve treatment outcomes when used in conjunction with prescribed headache medication, but there is a good chance that this treatment tool may not provide any significant relief as was observed in a sizeable number of patients. (15)
8. Submit to Chiropractic Care
Poor body posture can misalign your spine and exert great pressure on your muscles. The more tense your muscles are, the more likely you are to experience tension headaches.
As your spine is a sensitive and complex part of your body, it may be better to seek the trained expertise of a chiropractor to bring your body into proper alignment and ease the undue muscle strain.
Chiropractic care involves an eclectic mix of lifestyle changes, physical manipulation, and massage therapy to correct your posture and relax the tense muscles.
This noninvasive technique may help provide considerable relief from tension headaches when employed as part of a more holistic treatment strategy that includes medication and the avoidance of food and lifestyle triggers.
Risk Factors Associated with Tension Headache
It has been noted that tension headaches have a higher incidence in women than in men. The average age of occurrence in women lies between 30 and 39 years.
However, with progression in age, the risk of getting a tension headache decreases in women.
Several other factors can increase your risk of getting a tension headache. These include:
- Sleep apnea or sleep disorders
- An injury or arthritis in the neck region
- Temporomandibular joint disease (TMJ)
- Certain medications
- Decreased physical activity
- Hormonal changes in women during the premenstrual syndrome phase and menopause
Complications with Tension Headache
When not attended to, tension headaches can last for days or weeks.
A tension headache can hamper your productivity and performance because of the pain and associated discomfort. (1)
Although tension headaches are not the debilitating type, seek medical attention if you experience unusual symptoms.
When to See a Doctor
Seek immediate medical attention if you experience:
- A headache that is accompanied by vomiting and fever
- A headache that brings loss of consciousness
- A headache right after an injury to your head
- A change in the pattern, frequency, or duration of the pain
- A headache not relieved by medications or taking medications more than 3 days a week
- A headache that worsens when lying down
Tension headaches, commonly known as stress headaches, are manifested in the form of squeezing pain around the neck and forehead region.
Although without a definitive cure, tension headaches can be tended to by implementing changes in your lifestyle, keeping track of the triggers, and following alternative therapies that can help deal with a tension headache.
Living with pain can be physically debilitating and emotionally distressing. Coping with persistent headaches can be made easier with professional assistance. It is important to get professional help.
There are neurologists that subspecialize in headaches and are very well versed in nontraditional treatments.
Expert Answers (Q&A)
Answered by Dr. Martin M. Mortazavi, MD (Neurosurgeon)
It is variable and depends on the reason causing it, such as stress or too much work that leads to stress.
Yes, it is very normal.
The fastest way to get relief from a tension headache is to avoid the cause of stress.
Temporarily, massage and pain killers, as well as muscle relaxant medication, can help.
Tension headaches are usually caused by tension in the muscles attached to the skull, particularly those present at the back of the skull.
Care needs to be taken if the patient has a massage. Also, avoid pushing too much on the neck as excessive pressure can cause injury in the deep-seated arteries in the neck that bring blood to the brain. Any injury in these arteries can cause a stroke.
If you identify a certain cause such as work overload or familial stress, please make every effort to reduce them. Engage in running or swimming every day for almost an hour.
Get soft massage around your neck and shoulder. Read a book to learn how to deal with stress
In worse cases, get a mild pain killer and muscle relaxants while you are practicing the above advice.
About Dr. Martin M. Mortazavi, MD: Dr. Mortazavi is the Founding Chairman of the National Skull Base Center. He is also the Founding Chairman of the California Institute of Neuroscience and the Director of its Cerebrovascular, Skull Base and Tumor program.
Dr. Mortazavi pursued a postdoctoral research fellowship in neurotrauma and regeneration at Barrow Neurological Institute. In addition to treating the full panorama of Brain and Spine diseases, Dr. Mortazavi treats complex tumors and vascular lesions of the brain and the spinal cord.