Tension headache

Answer 1

Definition

A tension headache is pain or discomfort in the head, scalp, or neck, usually associated with muscle tightness in these areas.

See also:

• Cluster headache
• Headache
• Migraine headache
• Mixed tension migraine

Alternative Names

Muscle contraction headache; Headache - benign; Headache - tension; Chronic headaches - tension; Rebound headaches - tension

Causes, incidence, and risk factors

Tension headaches are one of the most common forms of headaches. They may occur at any age, but are most common in adults and adolescents.

If a headache occurs two or more times a week for several months or longer, the condition is considered chronic. Chronic daily headaches can result from the under- or over-treatment of a primary headache. For example, patients who take pain medication more than 3 days a week on an regular basis can develop rebound headaches.

Tension headaches can occur when the patient also has a migraine.

Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, a head injury, or anxiety.

Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.

Other triggers of tension headaches include:

• Alcohol use
• Caffeine (too much or withdrawal)
• Colds and the flu
• Dental problems such as jaw clenching or teeth grinding
• Eye strain
• Excessive smoking
• Fatigue
• Nasal congestion
• Overexertion
• Sinus infection

Tension headaches are not associated with structural changes in the brain.

Symptoms

The headache pain may be described as:

• Dull, pressure-like (not throbbing)
• A tight band or vise on the head
• All over (not just in one point or one side)
• Worse in the scalp, temples, or back of the neck, and possibly in the shoulders

The pain may occur as an insolated event, constantly, or daily. Pain may last for 30 minutes to 7 days. It may be triggered by or get worse with stress, fatigue, noise, or glare.

There may be difficulty sleeping. Tension headaches usually do not cause nausea or vomiting.

People with tension headaches tend to try relieve pain by massaging their scalp, temples, or the bottom of the neck.

Signs and tests

A headache that is mild to moderate, not accompanied by other symptoms, and responds to home treatment within a few hours may not need further examination or testing, especially if it has occurred in the past. A tension headache reveals no abnormal findings on a neurological exam. However, tender points (trigger points) in the muscles are often seen in the neck and shoulder areas.

The health care provider should be consulted -- to rule out other disorders that can cause headache -- if the headache is severe, persistent (does not go away), or if other symptoms are present with the headache.

Headaches that disturb sleep, occur whenever you are active, or that are recurrent or chronic may require examination and treatment by a health care provider.

Treatment

Understanding your headache triggers can help you avoid situations that cause your headaches. A headache diary can help you identify your headache triggers. When you get a headache, write down the day and time the pain began. The diary should include notes about what you ate and drank in the last 24 hours, how much you slept and when, and what was going on in your life immediately before the pain started. For example, were you under any unusual stress? Also include information about how long the headache lasted, and what made it stop.

Hot or cold showers or baths may relieve a headache for some people. You may need to make lifestyle changes if you have chronic tension headaches. This may include changing your sleep habits (usually to get more sleep), increasing exercise, and stretching the neck and back muscles. In some situations, you may need to change your job or recreational habits.

Over-the-counter painkillers such as aspirin, ibuprofen, or acetaminophen may relieve pain if relaxation techniques do not work. If you are planning to take part in an activity that you know will trigger a headache, taking one of these painkillers beforehand may be helpful.

Narcotic pain relievers are sometimes prescribed. Remember that pain medications only relieve headache symptoms for a short period of time. After a while, they do not work as well or the help they provide does not last as long. Regular, overuse of pain medications can lead to rebound headaches.

Other prescription treatments may include:

• Muscle relaxants such as tizanidine
• Selective serotonin-reuptake inhibitors (SSRIs) such as paroxetine (Paxil) or citalopram (Celexa) taken daily to help prevent or decrease the number of headaches
• Tricyclic antidepressants such as amitriptyline, nortriptyline, or doxepin taken daily to help prevent or decrease the number of headaches

Combining drug treatment with relaxation or stress-management training, biofeedback, cognitive behavioral therapy, or acupuncture may provide better relief for chronic headaches.

Botox (botulinum toxin) is becoming popular as a treatment for chronic daily headaches, including tension headaches. However, it is currently not approved for such use.

Expectations (prognosis)

Tension headaches usually respond well to treatment without residual effects.

Although they are not medically dangerous, chronic tension headaches can have a negative impact on the quality of life and work productivity.

Complications

Rebound headaches -- headaches that keep coming back -- may occur from overuse of painkillers.

It's important to see a doctor if you have chronic headaches. In some cases, the headache may be a symptom of a more serious disorder.

Calling your health care provider

Call 911 if:

• You are experiencing "the worst headache of your life"
• You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before
• Your headaches are more severe when lying down
• The headache starts very suddenly

Also, call your doctor if:

• Your headache patterns or pain change
• Treatments that once worked are no longer helpful
• You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
• You are pregnant or could become pregnant -- some medications should not be taken when pregnant

See the general article on headaches for more emergency headache symptoms

Prevention

Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may improve relaxation exercises and may be helpful for chronic tension headache.

Tips to prevent tension headaches:

• Keep warm if the headache is associated with cold.
• Use a different pillow or change sleeping positions.
• Practice good posture when reading, working, or doing other activities.
• Exercise the neck and shoulders frequently when typing, working on computers, or doing other close work.
• Get plenty of sleep and rest.

Massaging sore muscles may also help.

References

Silver N. Headache (chronic tension-type). Am Fam Physician. 2007:76(1):114-116.

Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008:7(1):70-83.

Naumann M, So Y, Argoff CE, Childers MK, Dykstra DD, Gronseth GS, et al Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008 May 6;70(19):1707-14.

Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587.

Answer 2

Definition

A tension headache is pain or discomfort in the head, scalp, or neck, usually associated with muscle tightness in these areas.

See also:

• Cluster headache
• Migraine headache

Alternative Names

Muscle contraction headache; Headache - benign; Headache - tension; Chronic headaches - tension; Rebound headaches - tension

Causes, incidence, and risk factors

Tension headaches are one of the most common forms of headaches. They may occur at any age, but are most common in adults and adolescents.

If a headache occurs two or more times a week for several months or longer, the condition is considered chronic. Chronic daily headaches can result from the under- or over-treatment of a primary headache.

Rebound headaches are headaches that keep coming back. They may occur if you overuse painkillers.

Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, a head injury, or anxiety.

Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.

Other triggers of tension headaches include:

• Alcohol use
• Caffeine (too much or withdrawal)
• Colds, the flu, or a sinus infection
• Dental problems such as jaw clenching or teeth grinding
• Eye strain
• Excessive smoking
• Fatigueor overexertion

Tension headaches can occur when you also have a migraine. Tension headaches are not associated with brain diseases.

Symptoms

The headache pain may be described as:

• Dull, pressure-like (not throbbing)
• A tight band or vise on the head
• All over (not just in one point or one side)
• Worse in the scalp, temples, or back of the neck, and possibly in the shoulders

The pain may occur as an isolated event, constantly, or daily. Pain may last for 30 minutes to 7 days. It may be triggered by or get worse with stress, fatigue, noise, or glare.

There may be difficulty sleeping. Tension headaches usually do not cause nausea or vomiting.

People with tension headaches tend to try to relieve pain by massaging their scalp, temples, or the bottom of the neck.

Signs and tests

A headache that is mild to moderate, not accompanied by other symptoms, and responds to home treatment within a few hours may not need further examination or testing, especially if it has occurred in the past. A tension headache reveals no abnormal findings on a neurological exam. However, tender points (trigger points) in the muscles are often seen in the neck and shoulder areas.

The health care provider should be consulted -- to rule out other disorders that can cause headache -- if the headache is severe, persistent (does not go away), or if other symptoms are present with the headache.

Headaches that disturb sleep, occur whenever you are active, or that are recurrent or chronic may require examination and treatment by a health care provider.

Treatment

The goal is to treat your headache symptoms right away, and to prevent headaches by avoiding or changing your triggers. A key step in doing this involves learning to manage your tension headaches at home by:

• Keeping a headache diary to help you identify your headache triggers. Then you and your doctor can make changes in your lifestyle to reduce the number of headaches you get.
• Learning what to do to relieve a headache when it starts
• Learning how to take your headache medicines the correct way

Medicines that may relieve a tension headache include:

• Over-the-counter painkillers such as aspirin, ibuprofen, or acetaminophen
• Narcotic pain relievers
• Muscle relaxants such as tizanidine

Remember that pain medications only relieve headache symptoms for a short period of time. After a while, they do not work as well or they do not relieve headaches for as long. Overuse of pain medications during most weeks can lead to rebound headaches -- headaches that keep coming back.

You may take some medicines daily to help prevent or decrease the number of headaches. These medicines are normally used to treat depression, but they can also help prevent tension headaches. They include:

• SSRIs such as paroxetine (Paxil) or citalopram (Celexa)
• Tricyclic antidepressants such as amitriptyline, nortriptyline, or doxepin

Ask your health care provider about relaxation or stress-management training, biofeedback, cognitive behavioral therapy, or acupuncture, which may help relieve chronic headaches.

Botox (botulinum toxin) is becoming popular as a treatment for chronic daily headaches, including tension headaches. However, it is currently not approved for such use.

Expectations (prognosis)

Tension headaches often respond well to treatment, and do not cause serious medical problems. However, chronic tension headaches can have a negative impact on the quality of life and work.

Calling your health care provider

Call 911 if:

• You are experiencing "the worst headache of your life"
• You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before
• The headache starts very suddenly
• The headache occurs with repeated vomiting
• You have a high fever

Also, call your doctor if:

• Your headache patterns or pain change
• Treatments that once worked are no longer helpful
• You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
• You are pregnant or could become pregnant -- some medications should not be taken when pregnant

Prevention

Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may improve relaxation exercises and may be helpful for chronic tension headache.

Tips to prevent tension headaches:

• Keep warm if the headache is associated with cold.
• Use a different pillow or change sleeping positions.
• Practice good posture when reading, working, or doing other activities.
• Exercise the neck and shoulders frequently when typing, working on computers, or doing other close work.
• Get plenty of sleep and rest.

Massaging sore muscles may also help.

References

Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008:7(1):70-83.

Naumann M, So Y, Argoff CE, Childers MK, Dykstra DD, Gronseth GS, et al. Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008;70(19):1707-1714.

Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, et al. Tricyclic antidepressants and headaches: systematic review and meta-analysis. BMJ. 2010. 341:c5222. doi: 10.1136/bmj.c5222.

Halker RB, Hastriter EV, Dodick DW. Chronic daily headache: an evidence-based and systematic approach to a challenging problem. Neurology. 2011;76(7 suppl 2):S37-S43.

Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009;(1):CD007587.

Reviewed By

Review Date: 12/14/2011

Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Do you often feel pain or discomfort in your head, scalp, or neck? Do your muscles get tight in these areas? If the answer is yes, you may suffer from tension headaches.

Tension headaches are one of the most common forms of headaches. You can get them at any age, but they mostly happen in adults and adolescents. Tension headaches occur when your neck and scalp muscles get tense, or contract. These muscle contractions can typically be a response to stress, depression, a head injury, or anxiety.

Often, you can get a tension headache when you hold your head in one position for a long time without moving it. Prime examples are typing at a computer, doing fine work with your hands, and using a microscope. You can even get a tension headache from sleeping in a cold room, from a cold, from drinking too much alcohol or caffeine, or from dental problems.

If you have tension headaches, you'd probably describe your pain as being Dull, pressure-like and not throbbing. You may say it feels like a tight band or vice around your head. It may be all over, not just in one point or on one side of your head or it could be worse in your scalp, temples, or the back of your head, and maybe even your shoulders.

Your doctor will ask you about what may be triggering your headaches. In fact, it's a good idea to keep a diary when you get headaches, and take it with you when you see your doctor. When you get a headache, write down the day and time the pain began. Include notes about what you ate and drank in the previous 24 hours, how much you slept and when, and what was going on in your life immediately before the pain started. Write down how long the headache lasted, and what made it stop.

For some people, taking hot or cold showers or baths may relieve a headache. You may need to make lifestyle changes if you have a lot of tension headaches. For example, you made need to change your sleep habits, usually you'll need more sleep, get more exercise, and stretch your neck and back muscles.

Your doctor may tell you to take over-the-counter painkillers, such as aspirin, ibuprofen, or acetaminophen if relaxation techniques do not work. If you plan to do something you KNOW will trigger a headache, taking one of these painkillers beforehand may help.

Your doctor MAY prescribe narcotic pain relievers, muscle relaxants, or other medicines, but after a while you may start getting rebound headaches BECAUSE you are taking medicines.

The best thing you can do if you get a lot of tension headaches is to lower your stress level, and the tension level in your head, neck, and shoulder muscles. Take breaks at the computer, learn to relax, avoid stressful situations, and make quiet time for yourself.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.