Tension headaches are very common, unfortunately, they're also among the most neglected and difficult headaches to treat.
With a tension headache, the pain often starts at the back of your head and moves forward, so that it eventually includes your neck, scalp, and head. It’s often described as feeling like you have a tight band across your head.
It may be caused by staying in one position for a long time, such as in reading, using a computer, or playing video games. It may also be caused by stress, but sometimes there is no obvious cause.
If your headaches happen 15 or more days in a month for several months, they are considered chronic tension headaches. If they occur less frequently, they are called episodic tension headaches.
Although tension headaches can be painful, they are rarely a sign of a more serious illness. A combination of lifestyle changes, relaxation techniques, and traditional and complementary therapies can help reduce the number of tension headaches you have.
Researchers aren't clear what causes a tension headache. For years, scientists thought that it was caused by tightening the muscles in your shoulders, neck, scalp, and jaw when you are tense. But new tests that measure muscle tension show that the muscles of people with tension headaches aren’t any tighter. Newer theories suggest tension headaches are caused by changes in brain chemicals called neurotransmitters (including serotonin), similar to what happens with a migraine. Scientists don’t know why the levels of neurotransmitters go up and down, but they think it activates pain pathways in the brain. Tight muscles may help trigger the changes in neurotransmitters, or muscle tightness may be a result of changing levels of brain chemicals.
Triggers may include:
Certain foods or food additives may also be a trigger for some people (see Nutrition and Dietary Supplements section)
Pain that originates from other areas, such as your sinuses, can also trigger tension headaches, or a combined sinus-tension headache
Your doctor will take a detailed history to distinguish tension headaches from other headaches, such as migraines. Your doctor will ask questions about when your headaches occur, how long they last, how frequently they come on, the location of the pain, and any symptoms that accompany the headaches. Sometimes it helps to keep a diary about your headaches before seeing the doctor, so you have an accurate recording of how often they happen.
Your doctor will examine your head, neck, eyes, and sinuses, and do a neurologic examination. Your doctor may ask you some questions to test your short-term memory, and examine your neck and scalp to determine if they are tender.
If you have unusual symptoms, your doctor may order these tests:
A comprehensive treatment plan, including relaxation, exercise, lifestyle changes, and occasional medication can be very effective in reducing the frequency and intensity of tension headaches.
Biofeedback, yoga, and relaxation techniques, for example, can help relieve pain and lower the number of headaches you have. Regular exercise helps, too.
Keeping a headache diary can help identify the source of your tension headaches and how you can change your environment and habits to avoid them. When a headache starts, write down the date and time it began. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.
Good health habits may help reduce stress and tension headaches:
Medications are used both to relieve pain and to prevent headaches if you have chronic tension headaches.
To relieve pain:
Over-the-counter (OTC) analgesics -- are usually effective. Do not take these medications for more than a few days without calling your doctor, and take only the amount recommended on the package. Talk to your doctor about which of these is best for you.
Prescription analgesics -- may be needed if your headaches don't respond to OTC medications. They include
In some cases, your physician may recommend botulinum toxin A (Botox) injections to relieve tension headaches. Preliminary studies suggest that botulinum toxin A relieves neuromuscular pain. Repeat injections may be required. More research is needed.
Rarely, if your headaches are very severe and nothing else relieves the pain, your physician may consider prescribing narcotics such as codeine plus acetaminophen (Tylenol with Codeine No. 3) or hydrocodone with acetaminophen (Vicodin).
To prevent chronic tension headaches:
Tricyclic antidepressants -- Tricyclic antidepressants are helpful in preventing all kinds of headaches, including migraines and tension headaches. Tricyclic antidepressants include:
Selective serotonin reuptake inhibitors (SSRIs) -- another type of antidepressant that may not work as well as tricyclics in preventing headaches, but tend to have fewer side effects. They include:
Anticonvulsants -- Some anti-seizure drugs help prevent migraines and tension headaches, although researchers aren't sure why:
Certain foods can trigger tension headaches, including:
If you suspect that any of these foods cause your headaches, you could follow an elimination diet, eliminating all the items on this list from your diet and then reintroducing them one at a time. Pay close attention to whether the number of headaches increases after eating particular foods. Then you know which trigger foods to avoid.
5-hydroxytryptophan (5-HTP, 400 to 600 mg per day) -- Your body makes the amino acid 5-HTP and converts it into serotonin, an important brain chemical. Researchers think changes in brain chemicals may be related to tension headaches, and some of the drugs used to treat headaches work by affecting serotonin. Based on that thinking, 5-HTP has been proposed as a treatment for tension headaches. Several studies indicate that 5-HTP may be effective for migraines. But the evidence is mixed for tension headaches. One study found that 5-HTP did not reduce the number of headaches people had. But it did allow them to reduce their use of other painkillers. More studies are needed to tell whether 5-HTP helps treat tension headaches. If you take an antidepressant, sedatives, psychotropic medications, sleep aids, cough medicine that contains dextromethorphan, pain medications, or supplements, such as St. John's wort or SAMe, you should not take 5-HTP unless closely supervised by your physician. If you are pregnant or breastfeeding, do not take 5-HTP without first asking your doctor. People with Down Syndrome may have an increased risk of seizures with the use of 5-HTP.
The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
Although there are no scientific studies showing that these herbs work, they are sometimes suggested to treat tension headaches and other types of headaches. People who take blood-thinning medications or who have bleeding disorders should not take these herbs:
Scientific studies investigating the use of acupuncture to treat tension headaches have found mixed results. Researchers agree that acupuncture appears safe and that it may be effective for some people. Acupuncturists diagnose tension headaches by paying careful attention to the kidney and its associated meridians (energy pathways in the body), as well as liver and gallbladder meridians. The physical location of the headache also helps the acupuncturist create a treatment plan, which may include lifestyle/dietary changes or herbal remedies. Other studies suggest acupuncture is best used as a preventive treatment for tension headaches, and that electro-acupuncture is more effective than manual acupuncture.
Several clinical trials indicate that spinal manipulation therapy may help treat tension headaches, especially ones that start in the neck. One study compared spinal manipulation to Elavil and found that people in both groups got better, while those in the spinal manipulation group had less side effects. The benefits of spinal manipulation lasted longer: One month after treatment, the chiropractic group still showed improvement, while the Elavil group did not. Another study found a 50% reduction of headache severity after a single 10-minute spinal manipulation session. However, other studies comparing chiropractic to a sham treatment plus massage found no benefit.
Regular massage may help relieve stress and pain in people with chronic tension headaches, according to one preliminary study. Doing stretches for your head and neck (taught by a physical therapist) may also help. Practicing proper posture is another important factor in reducing the number of headaches. A physical therapist can teach you.
Reflexology is a technique that places pressure on specific "reflex points" on the hands and feet that are believed to correspond to areas throughout the body. Some early studies suggest it may relieve pain and allow people with migraines to take less pain medication. However, more research is needed. Practitioners believe reflexology helps you become more aware of your own body signals, which might help you sense the subtle signals that indicate a migraine is about to occur (before pain starts). They also believe reflexology helps improve general well-being and energy level.
Studies indicate that homeopathy may be no more effective than placebo in relieving tension headaches. Interestingly, one of the most common reasons people seek homeopathic care is to relieve the pain associated with chronic headaches. Many homeopaths report that homeopathy helps treat and prevent recurrent tension headaches. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
The following remedies are commonly prescribed for tension headaches:
You can do many things to avoid tension headaches or relieve the pain:
Other relaxation techniques that may be helpful include:
Some women who are prone to headaches may get them more often when they are pregnant. However, other women may have fewer headaches during pregnancy, especially during the second trimester.
Use medications only as directed. Using some medications on a regular basis can cause rebound headaches.
Call your doctor if you have a new headache, a change in quality of a previous headache or headache pattern, or if a medication that usually takes away the pain no longer works.
It's rare to have a serious underlying condition due to headaches, like a tumor or a stroke. You should go to the emergency room if you experience the following:
More than 90% of people with tension headaches can get significant relief from a combination of lifestyle changes, relaxation, and medication.
Abdoli S, Rahzani K, Safaie M, Sattari A. A randomized control trial: the effect of guided imagery with tape and perceived happy memory on chronic tension type headache. Scand J Caring Sci. 2012; 26(2):254-61.
Ahmadi A, Schwebel DC, Rezaei M. The efficacy of wet-cupping in the treatment of tension and migraine headache. Am J Chin Med. 2008;36(1):37-44.
Alonso-Blanco C, de-la-Llave-Rincon AI, Fernandez-de-las-Penas C. Muscle trigger point therapy in tesnion-type headache. Expert Reve Neurother. 2012; 12(3):315-22.
Annequin D, Tourniaire B, Massiou H. Migraine and headache in childhood and adolescence. Pediatr Clin North Am. 2000;47(3):617-631.
Astin JA., Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalagia. 2002;22(8):617-623
Barrows KA, Jacobs BP. Mind-body medicine: an introduction and review of the literature. Med Clin North Am. 2002;86(1):11-31.
Bendtsen L, Jensen R. Tension-type headache. Neurol Clin. 2009;27(2):525-535.
Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001;24(7):457-466.
Dagenais S. Haldeman S. Chiropractic. Prim Care. 2002;29(2):419-437.
Endres HG, Böwing G, Diener HC, Lange S, Maier C, Molsberger A, et al. Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial. J Headache Pain. 2007 Oct;8(5):306-14.
Ezra Y, Gotkine M, Goldman S, Adahan HM, Ben-Hur T. Hypnotic relaxation vs amitriptyline for tension-type headache: let the patient choose. Headache. 2012; 52(5): 785-91.
Freitag F. Managing and Treating Tension-type Headache. Medical Clinics of North America. Philadelphia, PA: W.B. Saunders Company. 2013; 97(2).
Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurology. 2008;7(1):70-83.
Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001;285(17):2208-2215.
Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med. 2002;136(5):374-383.
Karst M, Reinhard M, Thum P, Wiese B, Rollnik J, Fink M. Needle acupuncture in tension-type headache: a randomized, placebo-controlled study. Cephalagia. 2001;21(6):637-642.
Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician. 2007 Apr 1;75(7):1027-30. Review.
Linde K, Melchart D, Fisher P et al. Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane Library, Issue 3, 2001. Oxford: Update Software.
Lipchik GL, Nash JM. Cognitive-behavioral issues in the treatment and management of chronic daily headache. Curr Pain Headache Rep. 2002;6(6):473-479.
Long L, Huntley A, Ernst E. Which complementary and alternative therapies benefit which conditions? A survey of the opinions of 223 professional organizations. Complement Ther Med. 2001;9(3):178-185.
Manias P, Tagaris G, Karageorgiou K. Acupuncture in headache: a critical review. Clin J Pain. 2000;16(4):334-339.
Marcus DA. Estrogen and tension-type headache. Curr Pain Headache Rep. 2001;5(5):449-453.
Mauskop A. Alternative therapies in headache. Is there a role? [Review] Med Clin North Am. 2001;85(4):1077-1084.
McCrory DC, Penzien DB, Hasselblad V, Gray RN. Evidence report: behavioral and physical treatments for tension-type and cervicogenic headache. Des Moines (IA): Foundation for Chiropractic Education and Research; 2001. Product No. 2085.
Melchart D, Linde K, Fischer P, et al. Acupuncture for idiopathic headache. Cochrane Database Syst Rev. 2001;(1):CD001218.
Mueller L. Tension-type, the forgotten headache. How to recognize this common but undertreated condition. Postgrad Med. 2002;111(4):25-26, 31-32, 37-38.
Nestoriuc Y, Rief W, Martin A. Meta-analysis of biofeedback for tension type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol. 2008;76(3):379-96.
Penzien DB, Rains JC, Andrasik F. Behavioral management of recurrent headache: three decades of experience and empiricism. Appl Psychophysiol Biofeedback. 2002;27(20:163-181.
Powers SW, Mitchell MJ, Byars KC, Bentti AL, LeCates SL, Hershey AD. A pilot study of one-session biofeedback training in pediatric headache. Neurology. 2001;56(1):133.
Quinn C, Chandler C, Moraska A. massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002;92(10):1657-1661.
Rains JC. Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache. Headache. 2008;48(5):735-6.
Rakel D. Rakel:Integrative Medicine, 2nd ed. Philadelphia, PA: Saunders Elsevier, Inc. 2007.
Ribeiro CA. L-5-Hydroxytryptophan in the prophylaxis of chronic tension-type headache: a double-blind, randomized, placebo-controlled study. Headache. 2000;40:451-6.
Savi L, Rainero I, Valfre W, Gentile S, Lo Giudice R, Pinessi L. A comparison of patients with migraine and tension-type headache. Panminerva Med. 2002;44(1):27-31.
Silberstein SD, Rosenberg J. Multispecialty consensus on diagnosis and treatment of headache. Neurology. 2000;54(8):1553.
Silver N. Headache (chronic tension-type). Am Fam Physician. 2007 Jul 1;76(1):114-6. Review.
Solomon GD. Chronic tension-type headache: advice for the viselike-headache patient. Cleve Clin J Med. 2002;69(2):167-172.
Solomon S. Posttraumatic headache. Med Clin North Am. 2001;85(4):987-996.
Sun-Edelstein C, Mauskop A. Complementary and alternative approaches to the treatment of tension-type headache. Curr Pain Headache Rep. 2012; 16(6):539-44.
Vithoulkas G. Homeopathic treatment of chronic headache: a critique. Homeopathy. 2002;91(1):32-34.
Walach H, Lowes T, Mussbach D et al. The long-term effects of homeopathic treatment of chronic headaches: 1 year follow up. Cephalalgia. 2000;20:835-837.
Walach H, Lowes T, Mussbach D et al. The long-term effects of homeopathic treatment of chronic headaches: one year follow-up and single case time series analysis. Br Homeopath J. 2001;90(2):63-72.
Wang K, Svensson P, Arendt-Nielsen L. Effect of acupuncture-like electrical stimulation on chronic tension-type headache: a randomized, double-blinded, placebo-controlled trial. Clin J Pain. 2007 May;23(4):316-22.
White AR, Resch K-L, Chan JCK et al. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia. 2000;20:632-637.
Yucal B, Kora K, Ozyalcin S, Alcalar N, Ozdemir O, Yucel A. Depression, automatic thoughts, alexithymia, and assertiveness in patients with tension-type headache. Headache. 2002;69(2):167-172.
Reviewed By: Steven D. Ehrlich, N.M.D., Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2022 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.