Tension Headaches

Cause

The cause of tension headaches is not 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 a tension headache.

Tension headaches are the most common type of headache. They can be brought on—or triggered—by things such as stress, depression, hunger, and muscle strain. Tension headaches may come on suddenly or slowly.

Chronic tension headaches often occur along with other health problems such as anxiety or depression.

Symptoms

Symptoms of tension headaches include:

• A constant headache that does not throb or pulse. You usually feel the pain or pressure on both sides of your head.
• Tightness around your forehead that may feel like a "vise grip."
• Aching pain at your temples or the back of your 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 your headache worse. Tension headaches usually aren't bad enough to keep you from doing your daily activities.

Tension headaches can last from 30 minutes to 7 days.

If you have a headache on 15 or more days each month over a 3-month period, you may have chronic tension headaches.

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.

Who to see

Most health professionals can recognize and treat tension headaches. You may seek treatment from any of the following:

• General practitioner
• Family medicine physician
• Internist
• Nurse practitioner (NP)
• Physician assistant (PA)
• Neurologist, if your headaches are severe or do not get better with treatment

If you think that your headaches are caused by depression or anxiety, talk to your doctor. Treating these problems may help reduce how bad your headaches are and how often you get them.

Exams and Tests

Finding out the type of headache you have

A doctor can usually diagnose tension headaches by asking you questions about your health and lifestyle and by examining you.

It can be hard to know which type of headache you have, 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.

Finding other possible causes

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

Treatment Overview

You can treat most tension headaches with:

• Over-the-counter pain medicines.
• Prescription drugs if you have chronic or very bad headaches.
• Avoiding things that trigger your headaches.
• Meditation and other ways to lower your stress.

Over-the-counter medicines to stop headaches

Medicines can help you feel better. But they can also be dangerous, especially if you don't take them the right way. Be safe with medicines. Read and follow all instructions on the label.

• Try these drugs first. Most doctors recommend that you try over-the-counter drugs first if you have mild to moderate headaches. They may have fewer side effects than prescription drugs. These medicines include:
  • Acetaminophen, such as Tylenol.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (for example, Bayer) and ibuprofen (for example, Motrin).
  • Medicine that combines aspirin, acetaminophen, and caffeine, such as Excedrin.
• Don't take this medicine too often. Try not to take over-the-counter drugs more than 3 times a week, because you may get rebound headaches. These are different from tension headaches. They are usually triggered after pain medicine has worn off, prompting you to take another dose. After a while, you get a headache whenever you stop taking the medicine.

Prescription medicines to prevent headaches

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

• You are using over-the-counter medicines to stop headaches more than 3 times a week.
• Over-the-counter medicines to stop headaches aren't working well for you.

Your doctor may have you try one or more medicines, such as an antidepressant or a medicine that prevents seizures. These medicines can help prevent headaches even if you don't have depression or seizures.

Avoiding triggers

You may be able to prevent or reduce tension headaches by learning what causes your headaches and trying to avoid those triggers. For more information, see Living With Tension Headaches.

Reducing stress

How you think can affect how you feel. So finding ways to relax and stop negative thoughts may help prevent headaches.

You may want to try:

• Techniques to stop negative thoughts.
• Progressive muscle relaxation.
• Ways to manage your time.
• Breathing exercises.
• Guided imagery.
• Meditation.
• Yoga.

For more information, see Living With Tension Headaches.

Treatment if headaches get worse

If you continue to have tension headaches while you are getting treatment, you and your doctor may want to try another treatment.

You may have to try different drugs or doses. If you have already tried several medicines, your doctor may order tests (such as an MRI or CT scan) to find out if a health problem is causing your headaches.

Other things to think about

• 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.
• If you also have depression or anxiety, talk to your doctor. Treatment for these health problems also may help you have fewer headaches.

Prevention

Finding and avoiding the things—or triggers—that lead to tension headaches can reduce how often you get headaches and how bad they are when you do get them.

Headache triggers can include:

• Stress.
• Anxiety.
• Fatigue.
• Hunger.

Using a headache diary can help you find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you were doing before the headache started. This information can help you avoid things that bring on your headaches. And the diary also can help your doctor plan your treatment.

• Headaches: Finding and Avoiding Triggers.

If you have headaches caused by muscle tension in your neck, shoulders, and upper back, pay attention to your posture during your daily activities. You also can try muscle relaxation and other ways to reduce muscle tension.

Your doctor also may prescribe medicine to help prevent tension headaches.

Living With Tension Headaches

You may have fewer headaches—and less pain when you do get them—if you:

• Find and avoid triggers for your headaches.
• Keep a headache diary to find out what triggers your headaches.
• Take over-the-counter drugs to stop a headache.
• Take medicine as your doctor advises to stop or prevent a headache.
• Reduce stress with relaxation and positive-thinking methods.

• Headaches: Managing Headaches

Find and avoid triggers

You can reduce how many headaches you have by finding out what triggers them and avoiding those things. Triggers may include stress, hunger, and lack of sleep.

• Headaches: Finding and Avoiding Triggers

Use a headache diary

Use a headache diary to find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you were doing when the headache started. This information can help you avoid things that bring on your headaches. A diary also may help your doctor plan your treatment.

Take medicines as your doctor advises

If you have mild to moderate headaches, your doctor probably will want you to take over-the-counter medicines to stop your headaches. These include medicines like acetaminophen (such as Tylenol) and ibuprofen (such as Advil). Be safe with medicines. Read and follow all instructions on the label.

If over-the-counter medicines don't stop your headaches well enough—or you get a lot of headaches—your doctor may prescribe medicine to prevent headaches.

Don't take medicine too often. Talk to your doctor if you're taking medicine more than 3 days a week to stop a headache, or if you have a headache on more than 15 days a month. Taking too much over-the-counter pain medicine can lead to more headaches. These are called rebound headaches.

Reduce stress

Stress can cause tension headaches.

You can lower your stress with positive thinking and relaxation methods. Research shows that you can change how you think. And how you think affects how you feel. Try these techniques on your own or with help from a therapist or counselor trained in muscle relaxation, meditation, biofeedback, or cognitive-behavioral therapy.

You also can learn to stop thinking all the time about things that bother you.

• Stop Negative Thoughts: Getting Started

Seek help if you think that your tension headaches may be linked to depression or anxiety. Treating these health problems can reduce how often you get headaches.

Medications

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

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

Over-the-counter drugs to stop headaches

Over-the-counter medicines that you can use to stop a headache include:

• Acetaminophen (such as Tylenol).
• Aspirin (such as Bayer).
• Ibuprofen (such as Advil).
• Naproxen (such as Aleve).
• Medicine that combines aspirin, acetaminophen, and caffeine (such as Excedrin).

Try to avoid taking over-the-counter drugs more than 3 times a week, because you may get rebound headaches. These are different from tension headaches. They usually occur after headache medicine has worn off. This leads you to take another dose. After a while, you get a headache whenever you stop taking the medicine.

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're taking 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.
• Antianxiety medicines, such as buspirone.

Botulinum toxin type A (BTX-A) is sometimes injected into the muscles in the face and head to treat headaches. In the past, doctors thought that spasms caused tension headaches. But BTX-A injections do not seem to help with symptoms of tension headaches.^{footnote 1} And BTX-A may cause weakness of the facial muscles and may make it hard for you to swallow.

What to think about

• The type of tension headache you have may help your doctor decide which drug to prescribe.
• There are other things you can try besides daily medicine. For example, you could use cognitive-behavioral therapy or biofeedback.
• The medicine that you take may cause side effects. Some side effects may last for a few weeks or for as long as you take the medicine.
• 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.
• Certain pain medicines can cause a bad reaction if you take them with other medicines. Before you begin taking 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 herbs).

Other Treatment

Using other treatments along with medicines may help you stop a tension headache or prevent one.

If you decide to try one or more of these treatments, make sure your doctor knows. He or she may have advice on how to use other treatments safely. Other 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-behavioral therapy or problem-solving therapy. Counseling with these methods can help with tension headaches. For more information, see the topic Stop Negative Thoughts: Choosing a Healthier Way of Thinking.
• Meditation.
• 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). It may help reduce pain.
• Yoga.