What is a tension headache?

Tension headaches are the most common type of headache. Stress and muscle tension are often factors in these headaches. Tension headaches typically don't cause nausea, vomiting, or sensitivity to light. They do cause a steady ache, rather than a throbbing one, and tend to affect both sides of the head. Tension headaches may be chronic, occurring often, or every day.

What causes a tension headache?

The exact mechanism that causes a tension headache is not known. Several factors, such as genetics and environment, are thought to be involved. Muscle contractions in the head and neck are considered a major factor in the development of a tension headache. Some people get tension headaches in response to stressful events or hectic days.

What are the symptoms of a tension headache?

These are common symptoms of a tension headache:

• Slow onset of the headache
• Head usually hurts on both sides
• Pain is dull or feels like a band or vice around the head
• Pain may involve the back part of the head or neck
• Pain is usually mild to moderate, but not severe

The symptoms of tension headaches may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How are tension headaches diagnosed?

Tension headaches are mainly diagnosed based on the symptoms you report. A thorough medical exam, which may include other tests or procedures, may be used to rule out underlying diseases or conditions.

Tracking and sharing information about your headache with your healthcare provider helps make an accurate diagnosis.

Questions commonly asked during the exam may include:

• When do headaches occur?
• What is the location of the headache?
• What do the headaches feel like?
• How long do the headaches last?
• Have there been changes in behavior or personality?
• Do changes in position or sitting up cause the headache?
• Do you have trouble sleeping?
• Do you have a history of stress?
• Have you had a head injury?

If the history suggests tension headaches and the neurological exam is normal, no further testing may be needed. But, if the headache is not found to be the main problem, then other tests may be needed to determine the cause such as:

• Blood tests. Various blood and other lab tests may be run to check for underlying conditions.
• Sinus X-rays. An imaging test to check for congestion, infection, or other problems that may be corrected.
• Magnetic resonance imaging (MRI). A procedure that uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in the body.
• Computed tomography scan (also called a CT or CAT scan). An imaging procedure that uses X-rays and a computer to make horizontal images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.

How are tension headaches treated?

The goal of treatment is to stop headaches from occurring. Good headache management depends on reducing stress and tension. Some suggestions include:

• Going to sleep and waking at the same time each day
• Exercising regularly each day for at least 30 minutes
• Eating regular meals without skipping any, especially breakfast
• Avoiding headache triggers, such as certain foods and lack of sleep
• Resting in a quiet, dark environment as needed
• Stress management (yoga, massage, or other relaxation exercises)
• Medicine, as recommended by your healthcare provider

Can tension headaches be prevented?

Identifying and avoiding headache triggers may prevent a tension headache. Maintaining a regular sleep, exercise, and meal schedule is also helpful. If tension headaches occur regularly or frequently, therapies such as cognitive-behavioral therapy, relaxation therapy, or biofeedback may reduce or eliminate headaches. Talk to your healthcare provider about medicines to prevent tension headaches.

When should I call my healthcare provider?

A severe headache that is the "worst headache ever" requires immediate attention.

Key points about tension headaches

• Tension headaches are the most common type of headache.
• Tension headaches typically do not cause nausea, vomiting, or sensitivity to light.
• Tension headaches affect both sides of the head, come on slowly, and are described as a tight band or vice around the head.
• Lifestyle changes including regular sleep, exercise, and meal schedules can reduce or prevent headaches.
• Discuss medicines to treat or prevent tension headaches with your healthcare provider.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.