What Are Tension Headaches?
Tension headaches are marked by dull pain, tightness, or pressure that can feel like a clamp squeezing your skull. Also called stress headaches, they’re the most common type for adults.
Types of tension headaches
There are two types:
- Episodic tension headaches happen fewer than 15 days per month for at least 3 months
- Chronic tension headaches happen more than 15 days a month for at least 3 months
Tension headaches can last 30 minutes to a few days. The episodic kind usually starts slowly, often in the middle of the day.
Chronic ones come and go over a longer period. The pain may get stronger or ease up throughout the day, but it’s almost always there.
What does a tension headache feel like?
This type of headache can:
- Start in one area of your head and spread
- Become a band of dull pressure or squeezing pain around your entire head
- Affect both sides of your head equally
- Make the muscles in your neck, shoulders, and jaw feel tight and sore
Tension Headache Symptoms
Common symptoms include:
- Mild to moderate pain or pressure in the front, top, sides, or back of your head
- A headache that starts later in the day
- Feeling very tired
- Crankiness
- Trouble focusing
- Mild sensitivity to light or noise
- Muscle aches
- A tight band or vise (causing a squeezing pressure) on or around the head
- Tenderness of the scalp
Unlike migraine headaches, tension headaches don't cause other nerve symptoms, such as muscle weakness or blurred vision. They also don’t usually cause severe sensitivity to light or noise, stomach pain, nausea, or vomiting.
What does a hypertension headache feel like?
There's no strong evidence that headaches from high blood pressure feel different from regular headaches. It can be hard to figure out if a headache is causing high blood pressure or if high blood pressure is causing the headache, as it can be a "chicken and the egg" situation.
High blood pressure can cause other symptoms besides headaches, such as chest pain, blurred vision, nausea, and shortness of breath. While a spike in blood pressure alone may not require a hospital visit, you should see a doctor if you also have severe headache, chest pain, or shortness of breath.
Tension Headache Causes
There is no single cause of tension headaches, but they tend to run in families. Some people get them because of tight muscles in the back of the neck and scalp.
But, increased pain sensitivity, rather than muscle contractions, may be a key factor in causing tension headaches. This means that instead of muscle tension, the headache could be more related to how your brain processes pain signals. Muscle tenderness is a common sign of tension headache and might result from this sensitized pain system.
Tension headache triggers
Most of the time, stress from work, school, family, friends, or other relationships triggers tension headaches.
A single stressful situation or a buildup of stress can set off episodic tension headaches, while daily stress can lead to the chronic kind.
Tension headache triggers may include:
- Not enough rest
- Poor posture
- Emotional or mental stress, including depression
- Anxiety
- Fatigue
- Hunger
- Low iron levels
- Alcohol
- Jaw or dental problems
- Straining your eyes
- Dehydration
- Skipping meals
- Smoking
- A cold, the flu, or a sinus infection
- Caffeine (withdrawal or too much)
Tension Headache Risk Factors
Up to 80% of adults in the U.S. get them from time to time. About 3% have chronic daily tension headaches. Women are twice as likely to get them as men.
Most people with episodic tension headaches have them no more than once or twice a month, but they can happen more often.
Many people with the chronic type have usually had them for more than 60 to 90 days.
Also, age may be a factor. People in their 40s are likely to get tension headaches.
When to See Your Doctor
See your doctor if you have frequent or severe headaches or if they interfere with your daily life.
Call 911 for a sudden and severe headache that also causes your face to droop, causes weakness or numbness, or makes it hard to talk, see, or think.
Tension Headache Diagnosis
Your doctor may diagnose you based only on your symptoms. They might ask you things such as:
- Where does your head hurt?
- What does the pain feel like?
- When do you have headaches?
- How long do they last?
- Do your headaches get in the way of your daily life?
- Do they keep you from sleeping?
- Are you under a lot of stress?
- Have you had a head injury?
- Have you noticed any changes in your behavior or personality?
They can also do tests to rule out other conditions. These include:
- Blood tests
- Imaging tests such as X-rays, CT scans, or MRI exams to take pictures of the inside of your head
Tension Headache Treatment
It’s best to treat tension headaches soon after they begin when the symptoms are still mild. The goal is to ease your pain and keep them from happening again.
Tension headache medications
Over-the-counter (OTC) painkillers are often the first treatments for tension headaches. People with the chronic kind can use some of these drugs to prevent headaches. But if you take them a lot, they can lead to what’s called a medication overuse or rebound headache.
Common OTC treatments include:
- Acetaminophen
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen
If OTC pain relievers don't help, your doctor may prescribe a stronger medicine such as:
- Indomethacin (Indocin, Indochron E-R)
- Ketoprofen
- Ketorolac (Toradol)
- Naproxen (Naprelan, Naprosyn)
If you have both migraine and tension headaches, your doctor may prescribe triptans to ease pain.
They could also suggest a muscle relaxer such as:
- Cyclobenzaprine (Amrix, Fexmid)
- Methocarbamol (Robaxin)
Some other kinds of drugs can keep you from getting a tension headache. You take them every day, even if you aren’t in pain, so you end up using less medication over time. Your doctor may prescribe:
- Tricyclic antidepressants such as amitriptyline and protriptyline
- Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), paroxetine (Paxil), or venlafaxine (Effexor)
- Anti-seizure drugs such as topiramate (Topamax)
Keep in mind that medications don't cure tension headaches and that, over time, pain relievers and other medicines might not help as much as they did at first. Plus, all medicines have side effects. If you take one regularly, discuss the pros and cons with your doctor. You'll still need to identify and deal with the things that are causing your headaches.
Supplements
Some studies have found that certain dietary supplements are effective against migraine headaches. They may also help prevent tension headaches. These supplements include:
- Butterbur
- Feverfew
- Riboflavin
- Coenzyme Q10
Talk with your doctor before starting any supplements.
Tension Headache Relief
The most effective way to deal with tension headaches is to prevent them from happening in the first place. Try these treatments to make your tension headaches less severe or less frequent.
Find ways to relax and manage stress such as:
Biofeedback: This is where you control some of your body's functions, such as relaxing your muscles, to ease pain.
Cognitive behavioral therapy (CBT): It's a psychological treatment using thought- and action-based methods to treat diseases. Studies show that CBT for headaches can ease the symptoms of tension headaches.
Acupuncture. Placing needles in various pressure points on your head and neck releases endorphins and other hormones, stimulating your circulatory system and easing headache pain.
Physical therapy. Physical therapy can help with repeated headaches in two ways. First, physical therapists can pinpoint the source of your headache pain. And, if your headaches are linked to mechanical issues, they can create a treatment plan that includes movements to help improve them.
Deep breathing. Slow, deep breathing can help you feel more relaxed and ease headaches. You can practice it for 5-10 minutes, two or three times a day.
Meditation. Meditation, or a conscious state of relaxation, could improve headache symptoms by easing stress and boosting blood circulation to your head.
Yoga. Different yoga postures and breathing techniques could ease tension headaches by improving blood circulation and lowering anxiety.
Lifestyle changes may also help. Consider these:
Limit stress. Try to plan. Get and stay organized. Things that help you relax, such as massage or meditation, can also help.
Try to pace yourself. Take breaks. Set aside time to do things you enjoy. For some people, mindfulness — staying in the here and now instead of following thoughts of worry and fear — can help.
Build your support system. Spend time with people you love. You may also want to book some sessions with a therapist to find solutions and manage any anxiety or depression you may have.
Exercise regularly. At least 30 minutes of exercise five times a week is ideal. It eases stress and keeps you fit. It also helps to stretch. Pay close attention to your jaw, neck, and shoulders. These are areas where we tend to hold a lot of tension.
Get enough sleep. When you’re well-rested, dealing with daily stress is much easier.
Improve your posture. A strong stance can help keep your muscles from tensing. When you stand, hold your shoulders back and your head level. Tighten your belly and buttocks. When you sit, make sure your thighs are parallel to the floor, and your head and neck don’t slump forward.
Drink lots of water. You’re more likely to get a tension head if you're dehydrated. Drink several glasses of fresh water each day, even if you’re not thirsty. It also helps to eat foods naturally rich in water, such as most fruits and vegetables.
Eat regular, balanced meals. Skipping a meal can cause a throbbing headache. Try to eat at the same time every day. Include plenty of fruits, vegetables, and whole grains in your diet.
Limit caffeine and alcohol. There is caffeine in many OTC headache medicines, but it can also trigger headaches. Lower your intake of coffee, tea, and energy or soft drinks.
Limit how much pain-relieving medication you take. Use the smallest possible dose. Don't take painkillers more than one or two times a week.
Keep your sense of humor. It reduces tension.
Use a headache diary. This will help you spot triggers. It’ll also help your doctor come up with a treatment plan. When you get a tension headache, note things such as:
- The date and time
- Any warning signs or other symptoms
- The location and intensity of the pain
- What you were doing at that time
- Medications you’d taken
- Foods you had eaten
Tension Headaches vs. Migraines
How do you tell them apart?
Tension headaches
- What do they feel like? Steady, mild to moderate pain that doesn’t throb. It can ease or get worse over the course of the headache.
- Where do they hurt? It can hurt all over your head, but you’ll most likely feel a band of pain around your forehead, the base of your skull, or around your neck. The headache does not get worse with activity. Your jaw, shoulders, neck, and head may also be tender.
- Are there any other symptoms? This type of headache doesn’t come with the nausea, vomiting, light sensitivity, or aura that people with migraines have.
- Do you notice symptoms before the headache starts? You might feel stress or tension.
- Who gets them? Mostly adults.
- How often do you get them? It varies.
- How long do they last? Thirty minutes to 7 days.
Migraines
- What do they feel like? They come on slowly, but the pain gets intense over time. It can be moderate or severe. It might throb or pulse, and it will get worse with physical activity.
- Where do they hurt? Often, it affects only one side of your head, including your eye, temple, or the base of your skull.
- Are there other symptoms? Some people get a visual disturbance called an aura before the tension headache starts. During the headache, you might be extra sensitive to light and sound. You might get nauseated and throw up. Some people have trouble moving or speaking.
- Who gets them? Anyone. Boys get them more than girls before puberty, but afterward, women get them more than men.
- How often do you get them? It varies.
- How long do they last? Between 4 and 72 hours
Takeaways
Tension headaches are the most common type of headache for adults and can feel like dull, squeezing pain around your head. There are two types of tension headaches — episodic (happening fewer than 15 days a month) and chronic (happening more than 15 days a month). These headaches can last 30 minutes to several days. They can usually result from stress, poor posture, or a lack of sleep. Treatment includes over-the-counter or prescription painkillers, stress management techniques, and lifestyle changes such as regular exercise and drinking enough water. Unlike migraines, tension headaches don't cause serious sensitivity to light, nausea, or visual disturbances.
Tension Headache FAQs
What are the tension headache relief pressure points?
One pressure point is the skin between your thumb and pointer finger. Using your opposite hand, you can massage this part of your hand for 20 to 30 seconds or pinch and hold it until you feel better.
