What Is a Tension Headache?

A tension headache is a primary headache disorder and the most common type of headache that people experience. In fact, the condition affects more than 33% of people assigned male at birth and 50% of people assigned female at birth worldwide.

Common triggers for these headaches include stress, a lack of sleep, depression, anxiety, and sometimes, drinking too much caffeine. While tension headaches aren’t usually severe, symptoms can be frustrating and painful.

The good news is that you can treat a tension headache with over-the-counter (OTC) pain relievers. However, if your tension headaches become chronic, they can interfere with your daily life and may require prescription medication.

Types of Tension Headaches

In general, tension headaches are split into two different categories based on how frequently they occur: episodic and chronic. The symptoms are the same for both types, but how you treat your tension headaches may depend on how often you get them.

• Episodic tension headache: This type of tension headache occurs in episodes—whether infrequently or frequently. If you have one or fewer tension headaches per month, you likely have infrequent episodic tension headaches. However, if you have between one and 14 tension headaches per month, you are likely experiencing frequent episodic tension headaches.
• Chronic tension headache: If you have 15 or more headache days per month, for at least three months in a row, you might be experiencing chronic tension headaches. 

Signs and Symptoms of Headache

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Symptoms 

Whether you have episodic or chronic tension headaches, you’ll generally experience the same symptoms. Some people may have all of these symptoms, while others only have one or two. Likewise, these sensations can vary from person to person—where one person feels pressure, another may feel a dull ache, for example.

The most common tension headache symptoms include:

• Mild to moderate pain
• Pain on both sides of your head
• A tender scalp
• Dull, aching pain
• Soreness in your neck and/or shoulder muscles
• A feeling of pressure or fullness on your head
• The sensation that a tight band is wrapped around your head 

Most people with tension headaches don’t experience nausea or vomiting. However, some people with chronic tension headache episodes can occasionally have mild nausea during some or all of their episodes.

Causes

Experts don’t know the exact cause of tension headaches. However, researchers believe that a combination of genetic and environmental factors can trigger the onset of headache symptoms. These factors include:

• Fatigue or lack of sleep
• Stress, depression, or anxiety
• Alcohol, tobacco, or excessive caffeine use 
• Infections such as the cold or flu
• Eye strain or too much screen time

Aside from these environmental factors, you may be at an increased risk of having frequent or chronic tension headaches if you were assigned female at birth, are over the age of 60, or are white.

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Diagnosis  

There are no specific tests that healthcare providers use to diagnose tension headaches. The most common way to receive an accurate diagnosis for a tension headache is by learning about your medical history and performing a physical exam.

Tension headache is usually a diagnosis of exclusion—meaning that your provider will first try to rule out other health conditions that may be causing your symptoms. For example, if you report that your headaches are not severe, don’t become worse with physical activity, and don’t include any vomiting or sensitivities to light or sound, your provider can use that information to rule out other primary headache disorders such as migraine.

Most of the time, a basic neurological exam is all your provider needs to diagnose tension headaches. If there is any concern about the possible cause of your symptoms, your provider may order an MRI or CT scan only to rule out more serious conditions, such as a concussion or brain tumor. Keep in mind: these tests cannot confirm whether you have a primary headache disorder.

Treatment

Like all primary headache disorders, the goals of treatment are to improve symptoms when you are actively experiencing an episode and reduce the number of future headache episodes. 

If your tension headaches are infrequent, over-the-counter (OTC) pain relievers such as Tylenol (acetaminophen), Bayer (aspirin), and Advil/Motrin (ibuprofen) can help reduce symptoms. If your tension headaches are episodic or chronic, you’ll likely need to combine OTC pain relief with other treatment strategies. In some cases, your provider can also prescribe you a stronger medication.  
Other treatment options for tension headaches include:

• Amitriptyline: This is an antidepressant medication that shows strong evidence for reducing symptoms of tension headaches and migraine.
• Physical therapy: If muscle tenderness is contributing to your tension headaches, exercises that promote muscle relaxation, stretching, and correct posture can help relieve symptoms.
• Behavioral therapy: Cognitive behavioral therapy, relaxation therapy, and biofeedback are all types of behavioral therapies that can alleviate some of the stress that triggers tension headaches and treat symptoms of anxiety and depression that may be causing your headaches.
• Acupuncture: While more research on acupuncture is needed, some studies suggest that acupuncture can help relieve some symptoms of tension headaches.

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How to Prevent Tension Headache Episodes

There might not be much you can do to prevent ever having a tension headache—mostly because they’re common among all age groups and genders, and are often triggered by normal things like stress, fatigue, illness, and muscle overuse. 

If you’re prone to tension headaches and experience more than a few per month, there are some ways you can proactively reduce the number of episodes and severity of your headaches. While the best prevention for future headaches is to follow your treatment plan, you can also try the following strategies:

• Keeping a headache diary: When you get a tension headache, write down the date and time, what you were doing when the headache began, and whether you ate or drank anything prior to the onset of symptoms. Over time, you may be able to recognize some patterns in your headache episodes and figure out your personal triggers, so you know what to avoid in the future.
• Avoiding triggers: Speaking of triggers, once you know what yours are, a key prevention strategy is to avoid your triggers as much as possible. For example, if you know you get a tension headache every time you get less than six hours of sleep, make an effort to get to bed early enough. If headaches happen every time you sit at your work-from-home desk, you may need to check your posture or make ergonomic changes to your setup.

It can be difficult to figure out what exactly is triggering your symptoms. Sometimes it can take time to recognize headache patterns—and while that can be frustrating, it’s OK if you can’t figure out the cause right away. The important thing is to find prevention and treatment strategies that are right for you, even if it takes a bit of trial and error to figure them out.

Related Conditions   

There isn’t a lot of research on the relationship between tension headaches and other conditions. However, some evidence points to other conditions that can co-occur alongside primary headache disorder, including tension headaches.

If you have tension headaches, you might also experience:

• Obesity
• Hypertension (high blood pressure)
• Diabetes 
• Depression
• Anxiety
• Sleep disorders 
• Epilepsy (seizures)
• Stroke 

It’s important to note that tension headaches don't cause these other conditions in most cases. Instead, people with these conditions may be more likely to experience tension headaches alongside other symptoms. 

Living With Tension Headaches 

The good news is that tension headaches aren’t life-threatening and won’t cause any permanent damage to your brain. The bad news is that they can be pretty painful and it’s not always easy to pinpoint what’s triggering your episodes. There also tends to be more headache research focused on migraines, leaving people with tension headaches less informed about what causes them and how they can manage symptoms.

If your tension headaches are infrequent, find an OTC pain reliever that works quickly to relieve your symptoms and have it on hand—such as keeping it in your home, car, or your desk at work. If your tension headaches are frequent or episodic, it’s important to talk to a healthcare professional. Not only can they rule out other potential causes of your symptoms, but they can also help you create a headache management plan that combines pain relief with other treatments to reduce the number of tension headaches you experience.