Tension headache refers to radiating, steady pain in the head, neck, or eyes that can be mild or intense. Tension headaches may be occasional or chronic.
Tension Headache: Areas of Pain
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Tension headaches may occur when muscles in the neck, face, and scalp contract. In some cases, muscle contraction is the result of teeth grinding and jaw clenching. In others, it may be unknown.
Tension headaches are more common in women.
Other factors that may increase your risk of getting a tension headache include:
Some tension headaches are nearly constant, with daily pain that may vary in intensity. Other tension headaches only occur once in a while. Symptoms usually start slowly and build.
Tension headache may cause:
- Constant, steady pain and pressure
- Dull and achy pain
- Pain which may be felt on both sides of the head, in the forehead, temples, and the back of the head
- Pressure may feel like a tight band around the head
- Intensity that ranges from mild to severe and can vary during the day
- Tightness in the head and neck muscles
Headaches can become so severe and constant that they interfere with normal activities and sleep.
You will be asked about your symptoms and medical history. A physical exam will be done. Diagnosis can be made on exam, based on specific features. The cause of the headaches however, may be more difficult to determine. A neurological exam may be done.
Imaging is not usually needed, but if pain is unusual or severe it may be done to look for other causes of the headache. Imaging tests include:
There are no specific cures for tension headaches, but they can be managed. Therapies aim to stop the headache and reduce the frequency of future episodes.
Treatment may include:
For occasional headaches, the following medication may be recommended to relieve pain:
- Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
- Prescription pain relievers
Note: Pain medications are most effective when taken at the first sign of pain and before it becomes severe. Overusing some over-the-counter medications may actually cause headaches. Continuous use of medications may create rebound pain when you stop taking the drug.
Taking a caffeine supplement with your pain reliever may improve pain relief.
The following medications may also be recommended to treat or prevent headaches:
- Muscle relaxants
- Botulinum toxin injections (Botox)
- Anti-seizure medication
- Beta blocker medication
Self-care may include:
- Rest if needed
- An ice pack or heat pack on your head or neck to ease discomfort
- A warm shower, with water running over tense muscles
Lifestyle changes may include:
- Improving your posture
- Adequate sleep
- Regular breaks from tasks
- Stress management
and relaxation techniques
- Develop new coping skills
- Identify events that trigger the headaches and work toward resolution
Additional therapies may include:
- Acupuncture—to have more headache-free days and lessen the intensity of headaches when they do occur
- Physical therapy—to develop a home exercise program
- Massage therapy
To help reduce your chances of getting a tension headache, try the following strategies:
- Keep a diary, marking when headaches occur and what you were doing before they started.
- Learn to recognize what provokes a tension headache.
- Avoid or minimize stressful situations.
- Take frequent breaks to walk or move around.
- Make time for pleasurable activities.
- Practice relaxation techniques, such as deep breathing and focusing on something pleasant.
- Learn techniques for coping with difficult or stressful situations.
- Make time for friends and build a strong support system.
- Go to bed early and get a good night's sleep.
- Exercise regularly.
- Do not slouch.
- Hold the phone, rather than cradling it on your shoulder, or use a headset.
Melchart D, Streng A, Hoppe A, et al. Acupuncture in patients with tension-type headache: randomized controlled trial.
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https://www.ninds.nih.gov/Disorders/All-Disorders/Headache-Information-Page. Accessed February 15, 2018.
Tension-type headache. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114522/Tension-type-headache. Updated February 8, 2017. Accessed February 15, 2018.
National Headache Foundation website. Available at:
http://www.headaches.org/2007/10/25/tension-type-headache/. Updated October 25, 2007. Accessed February 15, 2018.
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Last reviewed February 2018 by EBSCO Medical Review Board
Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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