A tension headache is generally a diffuse, mild to moderate pain that’s often described as feeling like a tight band around your head. A tension headache — or tension-type headache as it’s medically known — is the most common type of headache, and yet its causes aren’t well understood.
Tension headaches are very common, affecting up to 78% of people. Unfortunately, they’re also among the most neglected and difficult types of 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.
The causes are unknown. Anxiety, depression, and emotional conflicts are often associated with tension headaches. Headaches may also result from muscle strain associated with injury to the neck muscles. An abnormality in the bones at the back of the neck (cervical vertebrae) or in the area where the mouth opens and closes (temporomandibular joint) may also put tension on the surrounding muscles and lead to a tension headache. On occasion, a child who has been incorrectly fitted with glasses may suffer from a tension headache due to eye muscle strain.
The causes of tension-type headache are still uncertain. Although tension-type headaches were once thought to be primarily due to muscle contractions, this theory has largely been discounted. Instead, researchers think that tension-type headaches occur due to an interaction of different factors that involve pain sensitivity and perception, as well as the role of brain chemicals (neurotransmitters). Genetic factors are likely be involved in chronic tension-type headache, whereas environmental factors (physical and psychological stress) may play a role in the physiologic processes involved with episodic tension-type headache.
Tension headaches are considered chronic if they occur 15 or more days a month for at least three months. They’re considered epidsodic if they occur fewer than 15 times a month.
Tension headaches differ from migraines in that they’re not associated with abdominal pain, nausea and vomiting, slurred speech, visual disturbances such as blind spots or flashing lights, and weakness or numbness on one side of the body. Physical activity typically doesn’t aggravate the pain like it does migraines. Increased sensitivity to light or sound can occur, although it’s not common.
Management of tension-type headaches focuses in the short term on treating acute attacks, and in the long term on preventing recurrent episodes of headache. In general, short-term treatment of tension-type headache involves drugs (mainly pain relievers) while long-term preventive measures include both drug and non-drug approaches. With medications, relaxation training, lifestyle changes, and other therapies, nearly all patients can be helped.
To relieve Tension Headache 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.
- Acetaminophen (Tylenol) — can cause liver damage if used in high doses or over a long period of time
- Aspirin — can cause stomach upset and bleeding
- Ibuprofen (Advil, Motrin) — can cause stomach upset and bleeding, and raise risk of heart problems
- Naproxen (Aleve) — can cause stomach upset and bleeding, and raise risk of heart problems
- A combination of acetaminophen, aspirin, and caffeine (Excedrin, other brands) — can cause liver damage if use in high doses or over a long period of time; may increase the risk of bleeding
Prescription analgesics — may be needed if your headaches don’t respond to OTC medications. They include
- Naproxen (Naprosyn) — can cause stomach upset and bleeding, and raise risk of heart problems
- Indomethacin (Indocin) — can cause stomach upset and bleeding, and raise risk of heart problems
- Piroxicam (Feldene) — can cause stomach upset and bleeding, and raise risk of heart problems
- Fioricet (Butalbital apap caffeine) – can cause vomiting and the risk of liver problems.
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:
- Amitriptyline (Elavil)
- Nortriptyline (Pamelor)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
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:
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Sertraline (Zoloft)
Anticonvulsants — Some anti-seizure drugs help prevent migraines and tension headaches, although researchers aren’t sure why:
- Divalproex sodium (Depakote)
- Gabapentin (Neurontin)
- Topiramate (Topamax)
