Signs and symptoms of a tension headache include:
- Dull, aching head pain
- Sensation of tightness or pressure across your forehead or on the sides and back of your head
- Tenderness on your scalp, neck and shoulder muscles
Tension headaches are divided into two main categories — episodic and chronic.
Episodic tension headaches
Episodic tension headaches can last from 30 minutes to a week. Frequent episodic tension headaches occur less than 15 days a month for at least three months. Frequent episodic tension headaches may become chronic.
Chronic tension headaches
This type of tension headache lasts hours and may be continuous. If your headaches occur 15 or more days a month for at least three months, they're considered chronic.
Tension headaches vs. migraines
Tension headaches can be difficult to distinguish from migraines. Plus, if you have frequent episodic tension headaches, you can also have migraines.
Unlike some forms of migraine, tension headache usually isn't associated with visual disturbances, nausea or vomiting. Although physical activity typically aggravates migraine pain, it doesn't make tension headache pain worse. An increased sensitivity to either light or sound can occur with a tension headache, but these aren't common symptoms.
When to see a doctor
Make an appointment with your doctor
If tension headache disrupts your life or you need to take medication for your headaches more than twice a week, see your doctor.
Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different. Occasionally, headaches may indicate a serious medical condition, such as a brain tumor or rupture of a weakened blood vessel (aneurysm).
When to seek emergency help
If you have any of these signs or symptoms, seek emergency care:
- Abrupt, severe headache
- Headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties
- Headache after a head injury, especially if the headache gets worse
The cause of tension headache is not known. Experts used to think tension headaches stemmed from muscle contractions in the face, neck and scalp, perhaps as a result of heightened emotions, tension or stress. But research suggests muscle contractions aren't the cause.
The most common theories support a heightened sensitivity to pain in people who have tension headaches and possibly a heightened sensitivity to stress. Increased muscle tenderness, a common symptom of tension headache, may result from a sensitized pain system.
Stress is the most commonly reported trigger for tension headaches.
Risk factors for tension headache include:
- Being a woman. One study found that almost 90 percent of women and about 70 percent of men experience tension headaches during their lifetimes.
- Being middle-aged. The incidence of tension headaches appears to peak in the 40s, though people of all ages can get this type of headache.
Because tension headaches are so common, their effect on job productivity and overall quality of life is considerable, particularly if they're chronic. The frequent pain may render you unable to attend activities. You might need to stay home from work, or if you do go to your job, your ability to function is impaired.
In addition to regular exercise, techniques such as biofeedback training and relaxation therapy can help reduce stress.
- Biofeedback training. This technique teaches you to control certain body responses that help reduce pain. During a biofeedback session, you're connected to devices that monitor and give you feedback on body functions such as muscle tension, heart rate and blood pressure. You then learn how to reduce muscle tension and slow your heart rate and breathing yourself.
- Cognitive behavioral therapy. This type of talk therapy may help you learn to manage stress and may help reduce the frequency and severity of your headaches.
- Other relaxation techniques. Anything that helps you relax, including deep breathing, yoga, meditation and progressive muscle relaxation, may help your headaches. You can learn relaxation techniques in classes or at home using books or tapes.
Using medications in conjunction with stress management techniques may be more effective than is either treatment alone in reducing your tension headaches.
Additionally, living a healthy lifestyle may help prevent headaches:
- Get enough, but not too much sleep.
- Don't smoke.
- Exercise regularly.
- Eat regular, balanced meals.
- Drink plenty of water.
- Limit alcohol, caffeine and sugar.