What Is a Tension Headache? Doctors Explain

Fact checked by Olga Sadouskaya, MD
Clinical Pharmacologist, Chief Medical Officer

A headache is, simply put, pain in the head. It is caused by the dilation of arteries in the head or the contraction of muscles around the head and neck. A headache could also be a drug reaction. There are several types of headaches, such as tension headaches, migraines, and sinus headaches. With nearly 80 percent of people having an episode at least once during their lifetime, tension headaches are the most typical type of headache. Most people start experiencing tension headaches between the ages of 15 and 40.

What is a tension headache?

Tension headaches are also called tension-type, muscle contraction, essential, stress, and psychomyogenic headaches. This type of headache typically involves recurrent episodes of head pain that can be traced to problems in muscles in the head and neck.

The exact medical explanation for tension headaches is not entirely clear.

Scientists have attributed it to autonomic nervous system malfunctions, including the muscle-related release of pain-causing neurochemicals. It has also been attributed to myofascial trigger points. These are hypersensitive areas that form within your muscles following muscle injury or overuse.

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Symptoms of a tension headache

Tension headaches are usually not severe enough to interfere with daily activities. They are typically described as dull, aching, diffuse headaches. They are generally experienced in a band-like distribution around the head. They are not commonly associated with nausea or vomiting and do not have prodromes or auras like migraine headaches. The defining features of tension headaches include the following:

  • Head pain: The head pain in tension headaches comes on gradually, slowly increasing in intensity until it reaches its peak.
  • Intensity: Tension headaches are usually mild to moderate in intensity. They are generally manageable and, in the absence of an underlying illness, not severe enough to disrupt physical activity.
  • Characteristic: Unlike temple headaches, a tension headache is non-throbbing. It is typically reported as a band-like, pressing, tightening, or full type of discomfort or pain.
  • Location: Tension headaches occur on both sides of the head, unlike one-sided cluster headaches. They typically manifest as pain in the forehead, in and around the eyes, and around the occiput, or at the back of your neck.
  • Duration: A tension headache may last between 30 minutes and several days. However, the average course of an episode is between 4 and 6 hours.
  • Time of day: Some people find that tension headaches are worse in the evening and improve in the morning.
  • Aggravating and relieving factors: Tension headaches do not worsen with activity but may improve with rest.
  • Other symptoms: People with tension headaches may also experience the following symptoms:

- Difficulty concentrating

- Stiffness or tightness of muscles in the neck or front or back of the head

- Reduced appetite

An older woman sitting in front of a laptop with a tension headache

How long do tension headaches usually last?

The frequency and duration of the symptoms of a tension headache vary widely and depend on associated risk factors and triggers. Tension headaches can be divided into two major types: episodic and chronic.

1. Episodic tension headaches: A person with an episodic type of tension headache will usually experience separate events of short but multiple headaches. Episodic tension headaches can be further divided into infrequent and frequent types.

Infrequent episodic tension headaches occur

  • Less than 10 times per month
  • Less than one day per month
  • Less than 12 times per year

Frequent episodic tension headaches occur

  • More than 10 times per month
  • Between one and 14 days per month for more than three months

2. Chronic tension headaches: They can arise on their own or be a progression from episodic types. When a person has headaches for more than 14 days monthly for over three months, they are said to have a chronic tension headache. These headaches occur commonly in people with vitamin deficiencies, particularly deficiencies of vitamins B6, B12, D, and E.

Risk factors and triggers for tension headaches

Although you are very likely to experience a tension-type headache at some point in your life, numerous factors can significantly increase your risk. Risk factors for tension headaches include the following:

  • Sex. Tension headaches are about six times more frequent among women than men. Female sex hormone levels tend to vary widely with menstruation, and this has been suggested to be the main culprit.
  • Insomnia and sleep-related problems like narcolepsy and sleep apnea. Sleep is regulated by a brain region known as the hypothalamus. The hypothalamus is also responsible for controlling pain and matching our sleeping habits with our exposure to daylight. Lack of sleep can disrupt the normal functioning of the hypothalamus and cause the release of pain chemicals around the eyes.
  • Depression and anxiety disorders. These are usually associated with poor sleep patterns.
  • Temporomandibular joint disorders. Pain in the joint connecting your jawbone to your skull can irritate nearby nerves and cause tension in surrounding muscles. A combination of these can amplify the pain signals around the head and cause headaches.
  • Vitamin deficiencies. Aside from the harmful effects on general body functions, vitamin deficiencies can have grave neurological implications. Inadequate consumption of vitamin D and B12 can lead to tension headaches, especially chronic ones.
A woman drinking water to prevent a tension headache

Falling into any of the above categories only implies a higher chance of developing headaches in the presence of triggers. Triggers are conditions and situations that set off disease in the presence of risk factors. For tension headaches, these triggers include:

  • Dehydration. This occurs when your body lacks sufficient water to function normally. Your body’s meticulous regulation of fluid and electrolyte balance can sometimes be disrupted when you don’t drink enough or lose too much water. When fluid is insufficient within your body, your brain tissue shrinks temporarily. This shrinking stretches small blood vessels and nerve fibers, causing pain that you experience as a headache.
  • Hunger. You experience hunger when your blood sugar falls below 250 mg/dL. This reduction, known as hypoglycemia, can lead to tension headaches if it occurs too rapidly or the blood sugar drops too low.
  • Poor posture. Bad posture while working or sleeping can strain your muscles and cause them to ache. If excessive stretching occurs in your back and neck muscles, it can manifest as tension-type headaches.
  • Other triggers of tension headaches include sleep deprivation, excessive exposure to noise, and stressful situations.

How to get rid of a tension headache

Most cases of tension headaches resolve without intervention. You may find rest helpful. However, if your symptoms persist for longer than usual, you may need expert management and should contact your physician.

People with episodic tension headaches usually find relief from acetaminophen, caffeine, and nonsteroidal anti-inflammatory drugs like ibuprofen.

Chronic tension headaches may require tricyclic antidepressants like amitriptyline or cognitive behavioral therapy.

Ways to prevent tension headaches

Tension headaches can reduce your productivity even though they rarely interfere with daily activities. Preventing them requires you to identify and avoid risk factors and triggers. Although some triggers can be specific to you, here are some ways to avoid tension headaches:

  • Avoid stressful situations.
  • Do not expose yourself to noise for too long.
  • Drink enough water. The World Health Organization advises that you drink 8–10 cups of water daily.
  • Sleep well. The Centers for Disease Control and Prevention recommend at least 7 hours of sleep per night for adults.
  • Maintain healthy posture. Use ergonomic desk setups at work. See a sleep therapist if you feel pain in your back or neck after sleep.
January 17, 2023