Condition Basics

What are tension headaches?

Most headaches are tension headaches. Some people get them often, especially if they have a lot of stress in their lives.

This kind of headache may cause pain or a feeling of pressure all over your head. Sometimes it's hard to know where the centre of the pain is.

If you get a lot of these kind of headaches, the best way to reduce them is to find out what's causing them. Then you can make changes in those areas.

Where can they cause pain?

Tension headaches can cause pain:

• In your upper back and neck.
• At the base of your head.
• Around your ears.
• In your jaw.
• Above your eyes.

What causes tension headaches?

The cause of tension headaches isn't clear. Tension or spasms of the muscles of the neck, face, jaw, head, or scalp may play a role in causing these headaches. A change in brain chemistry may also help cause them. They can be brought on—or triggered—by stress, depression, hunger, and muscle strain.

What are the symptoms?

Symptoms of tension headaches include a constant headache, usually with pain or pressure on both sides of your head. You may feel tightness around your forehead that feels like a "vise grip." You may also have aching pain at your temples or the back of your head and neck. The pain usually isn't severe.

How are they diagnosed?

A doctor can usually diagnose tension headaches by doing a physical exam and asking questions about how often the headaches happen, what the symptoms are, and about your overall health and lifestyle. In some cases, imaging and other tests may be done to rule out other health problems. But this isn't common.

How are tension headaches treated?

You can treat most tension headaches by taking over-the-counter pain medicines. Prescription medicines may help if you keep having headaches or if your headaches are very bad. Avoiding the things that trigger your headaches can also help.

Cause

The cause of tension headaches isn't clear. In the past, doctors believed that tension or spasms of the muscles of the neck, face, jaw, head, or scalp played a role in causing these headaches. Now they think a change in brain chemistry may also help cause them.

Tension headaches can be brought on—or triggered—by things such as stress, depression, hunger, and muscle strain. They may come on suddenly or slowly.

Chronic tension headaches are headaches that keep coming back. They often occur along with other health problems such as anxiety or depression.

Tension headache triggers

The most common triggers for tension headaches are physical and emotional stress.

Sometimes stress is caused by conditions such as anxiety and depression. If you think you may have anxiety or depression, talk with your doctor. If you treat these conditions, you may get tension headaches less often.

If you have tension headaches, ask yourself if you are:

• Having conflicts within your family or at work or school.
• Not getting enough sleep or relaxation.
• Hungry.

Other possible tension headache triggers include:

• Eye strain from working at a computer.
• Neck strain from poor posture, your work environment, or injury.
• Strain in the chewing muscles of your jaw. This can happen if you grind or clench your teeth.
• Muscle tension in your shoulders and upper back.

Prevention

Here are some things you can do to help prevent tension headaches.

• Keep a headache diary. This can help you and your doctor figure out what is triggering your headaches. If you avoid your triggers, you may be able to prevent headaches.
• Find healthy ways to deal with stress. Headaches are most common during or right after stressful times.
• Get plenty of exercise every day. This can help with stress and muscle tension.
• Get regular sleep.
• Eat regularly and well. If you wait too long to eat, it can trigger a headache.
• Try to use good posture and keep the muscles of your jaw, face, neck, and shoulders relaxed.
• If you use a computer a lot, give your eyes a break by blinking more and sometimes looking away from the screen. Use glasses or contacts if you need them. And check that your monitor is about an arm's distance away.

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Symptoms

Symptoms of tension headaches include:

• A constant headache that doesn't throb or pulse. The pain or pressure is usually on both sides of the head.
• Tightness around the forehead that may feel like a "vise grip."
• Aching pain at the temples or the back of the head and neck.

Unlike migraines, tension headaches usually don't occur with nausea, vomiting, or feeling sensitive to both light and noise. But light or noise could make the headache worse. Pain from a tension headache usually isn't severe and doesn't get in the way of a person's school, work, or social life. But for some people, the pain is very bad or lasts a long time.

What Happens

Tension headaches may come on suddenly or slowly. They can last from 30 minutes to 7 days. They tend to come back, especially if a person is under stress.

If a person has a headache on 15 or more days each month over a 3-month period, they may have chronic tension headaches. This type of headache can lead to stress and depression, which in turn can lead to more headaches.

But there is treatment for tension headaches. Most can be treated with over-the-counter pain medicines. Prescription medicines may help if headaches keep coming back or if the headaches are very bad.

When to Call a Doctor

Call 911 or other emergency services if:

• You have symptoms of a stroke, such as:
  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.

Call your doctor now or go to the emergency room if:

• You have a fever and a stiff neck.
• You have new nausea and vomiting, or you cannot keep food or liquids down.

Watch closely for changes in your health, and be sure to contact your doctor if:

• Your headache wakes you up at night.
• Your headaches get worse or happen more often.
• You start to have new symptoms.
• You have any problems with your medicine.
• Your headaches occur after physical exercise, sexual activity, coughing, or sneezing.
• Your life is disrupted by your headaches (for example, you miss work or school regularly).

Watchful waiting

Watchful waiting is a wait-and-see approach. If your headache gets better on its own, you won't need treatment. If it gets worse or you get headaches often, you and your doctor will decide what to do next.

Watchful waiting and using over-the-counter pain medicines work well if your tension headaches don't keep you from doing the things you want to do. But if your headaches are disrupting your life, talk to your doctor about other treatments that you could try.

Examinations and Tests

A doctor can usually diagnose tension headaches by doing a physical exam and asking questions, such as how often the headaches happen and what the symptoms are. The doctor will also ask about your overall health and lifestyle.

It can be hard to know which type of headache you have. That's because different types can have the same symptoms. But the treatments may be different, so it's important to find out which type you have.

In some cases, your doctor may order tests to find out if a health problem is causing them. These tests may include an MRI or a CT scan.

In very rare cases, headaches can be caused by more serious health problems (such as brain tumours or aneurysms). But most headaches aren't caused by anything serious. So you probably won't need to have tests.

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Treatment Overview

You can treat most tension headaches yourself. You can take over-the-counter medicines, avoid things that trigger your headaches, and reduce your stress. If you keep having headaches or your headaches are very bad, your doctor may give you prescription medicines.

In some cases, your doctor may prescribe stronger pain medicine if over-the-counter drugs don't stop your headaches.

You may want to try medicine to prevent getting a headache if:

• You use medicines to stop your headaches more than 3 times a week.
• Medicines to stop headaches aren't working well for you.

Even with treatment, you will most likely still get some tension headaches. But you probably will get them less often. And they may hurt less when you do get them.

Self-Care

• Rest in a quiet, dark room. Put a cool cloth on your forehead. Close your eyes, and try to relax or go to sleep. Do not watch TV, read, or use the computer.
• Use a warm, moist towel or a heating pad set on low to relax tight shoulder and neck muscles.
• Have someone gently massage your neck and shoulders.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• Be careful not to take more pain medicine than the instructions say. This is because you may get worse or more frequent headaches when the medicine wears off.
• If you get a headache, stop what you are doing and sit quietly for a moment. Close your eyes and breathe slowly. Try to relax your head and neck muscles.
• Pay attention to any new symptoms you have when you have a headache. These include a fever, weakness or numbness, vision changes, or confusion. They may be signs of a more serious problem.

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Medicines

Your doctor may recommend medicine to stop or to prevent tension headaches.

The type of tension headache you have may help your doctor decide which drug to prescribe. You may have to try several different drugs or types of drugs before you find the one that is right for you. Make sure to tell your doctor how well a drug stops your headaches.

You might need to take only an over-the-counter medicine for pain. They usually have fewer side effects than prescription drugs. Always be safe with medicines. Read and follow all instructions on the label.

The medicine that you take may cause side effects. Some side effects may last for a few weeks. Others may last for as long as you take the medicine. Certain pain medicines can cause a bad reaction if you take them with other medicines. Before you start to take pain medicines, be sure to let your doctor know about all of the drugs you take. This includes over-the-counter medicines and complementary treatments (such as natural health products).

Over-the-counter drugs to stop headaches

Medicines to stop a headache after it starts include:

• Acetaminophen.
• Aspirin.
• Ibuprofen.
• Naproxen.
• Medicine that combines aspirin, acetaminophen, and caffeine.

Talk to your doctor if you are taking medicine more than 2 days a week to stop a headache. Taking too much pain medicine can lead to more headaches. These are called medicine-overuse headaches.

Prescription drugs to prevent headaches

Your doctor may recommend that you take a prescription medicine every day to prevent headaches. You may want to take this medicine if:

• Over-the-counter medicines don't work to stop your headaches.
• You take over-the-counter medicines to stop headaches more than 3 times a week.
• You get a headache more than 15 days a month.

Medicines used to prevent tension headaches include:

• Antidepressants, such as amitriptyline.
• Seizure medicines, such as topiramate.
• Medicines that relax muscles, such as tizanidine.
• Anti-anxiety medicines, such as buspirone.

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Complementary Treatments

Some people find that some non-medicine treatments can help stop a tension headache or prevent one.

If you decide to try one or more of these treatments, make sure that your doctor knows. He or she may have advice on how to use them safely. Some non-medicine treatments for headaches include:

• Acupuncture. This involves putting very thin needles into the skin at certain points on the body. Studies show that acupuncture can help prevent tension headaches.
• Biofeedback. This is a relaxation method to help you learn to control a body function that you normally don't control, such as muscle tension.
• Cognitive behavioural therapy or problem-solving therapy. Counselling with these methods can help with tension headaches.
• Meditation. This can produce a state of relaxation that reduces heart rate, slows breathing, and lowers blood pressure.
• Peppermint oil. Some research shows that peppermint oil rubbed on your temples or on the tight muscles in your head, neck, and shoulders may help relieve tension headaches.
• Transcutaneous electrical nerve stimulation (TENS). This treatment uses mild electrical current to treat pain. It may help reduce headache pain.
• Yoga. Hatha yoga includes meditation and exercises to help you improve flexibility and breathing, decrease stress, and maintain health.

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