Tension headache

Overview

A tension headache causes pain or pressure in the head, scalp, or neck. It's thought to come from tight muscles in the shoulders, neck, scalp, and jaw, often as a response to stress, anxiety, or depression.

It can happen at any age, but it's most common in teens and adults, and slightly more common in women. Most tension headaches come and go. Some people get them almost every day, which is called chronic tension headache.

Symptoms

The pain is usually mild to moderate. It can start at the back of the head and spread forward.

• Dull, pressing headache, not throbbing
• A tight band or pressure around the head
• Pain on both sides, often in the forehead, temples, or back of the head
• Tight or sore neck and shoulder muscles

Less common

• Mild sensitivity to light or sound
• Trouble sleeping
• Feeling tired
• Tender spots in the neck and shoulders

How it usually goes

• Start: Pressure builds slowly, often later in the day or during stress.
• 30 minutes to hours: Most tension headaches ease with rest or a pain reliever.
• Ongoing: Headaches on 15 or more days a month are called chronic; see a healthcare professional.

When to get medical care

Causes

Tension headaches are linked to tight muscles in the shoulders, neck, scalp, and jaw. They're often related to stress, depression, anxiety, or holding your head and neck in one position for a long time.

Common triggers include stress, too little sleep, missed meals, alcohol, too much caffeine or caffeine withdrawal, eye strain, jaw clenching or teeth grinding, and colds or sinus infections.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.
• It can run in families. Tell your doctor if a parent, brother, or sister has it.

Who is more likely to get it

• Stress at work, school, or home
• Not getting enough sleep
• Working long hours or looking at screens
• Women, and people with a family history of tension headaches

Possible complications

• Medication-overuse headache: From taking pain medicine more than 3 days a week
• Chronic tension headache: Headaches on 15 or more days a month

Diagnosis

A healthcare professional can usually tell it's a tension headache from how you describe the pain. If your headache is mild and goes away with home care, you may not need a visit at all.

Questions you may be asked

• Where the pain is and what it feels like
• How often you get headaches, and how long they last
• What seems to bring them on, like stress, sleep, or screens
• How often you take pain medicine
• Whether you have nausea, vision changes, or other symptoms

The exam

They'll check your head, neck, and shoulders for tight or tender muscles and do a short nerve exam, checking your eyes, strength, balance, and reflexes.

Tests

Tests are usually not needed. Your healthcare professional may order a scan if something seems unusual:

• CT or MRI scan: Only if there are warning signs, like a sudden, severe, or changing headache, or problems with the nerve exam.

Treatment

The goal is to ease a headache when it starts and prevent new ones by finding and changing your triggers. Many people do well with relaxation and other home care.

Self-care

• Take a pain reliever early, when the headache starts
• Put heat or ice on your neck or shoulders, or take a hot shower
• Massage your scalp, temples, or the back of your neck
• Rest and relax your jaw, neck, and shoulders
• Keep a headache diary to find your triggers

Medicines

Over-the-counter pain relievers usually help. Use them only when you need them.

Medicine names link to drug information from the U.S. National Library of Medicine (MedlinePlus). OwieClear doesn't give doses: follow the label or your healthcare professional.

If you get headaches often, ask about relaxation training, biofeedback, cognitive behavioral therapy, or physical therapy. A healthcare professional may prescribe a daily medicine, like certain antidepressants, to prevent frequent headaches.

How it compares

Prevention

Healthy habits help prevent tension headaches:

• Learn ways to manage stress, like exercise, meditation, or relaxation
• Get enough sleep, and keep a regular schedule
• Don't skip meals, and drink enough water
• Take breaks from screens and check your posture
• Limit caffeine and alcohol, and don't smoke

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a neurologist (brain and nerve doctor).

Living with it

• Keep a simple diary of symptoms, triggers, and medicines to bring to visits.
• Bring a list of your medicines and questions to each visit.
• Stay active in ways that feel good to you.
• Get enough sleep and manage stress.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Back to school, work, or sports

• Most people can keep working or going to school.
• Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.

Children, pregnancy, and older adults

• Children and teens: Tension headaches are common in teens. Watch for stress, poor sleep, and skipped meals. Never give aspirin to children or teens.
• Pregnancy: Some pain medicines aren't safe during pregnancy. Ask your healthcare professional which one to use.
• Adults over 50: A new kind of headache that starts after age 50 should be checked by a healthcare professional.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Go to visits when you can and take notes.
• Keep a list of medicines, allergies, and doctors in one place.
• Learn the warning signs that need fast care.
• Take breaks and ask for help. Caregivers need care too.

Outlook

Tension headaches usually respond well to treatment. Frequent headaches can get in the way of work and life, but a healthcare professional can help find triggers and treatments that work.

Myths and facts

Getting ready for your visit

A headache diary is the most helpful thing to bring.

What to bring

• A headache diary: when each headache started, how long it lasted, and what you were doing
• Every medicine you take for headaches, and how often
• Your sleep, caffeine, and stress patterns

Questions to ask

• Is this a tension headache or something else?
• How often is it safe to take pain medicine?
• Would physical therapy, biofeedback, or counseling help?
• Should I take a daily medicine to prevent headaches?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Tension headache