Definition

Tension headache refers to head pain associated with stress and muscle contraction. These headaches may occur only occasionally in response to a stressful event. They may also be chronic, occurring frequently. Some tension headaches are nearly constant, with daily pain that may vary in intensity.

	Tension Headache: Areas of Pain
	© 2008 Nucleus Medical Art, Inc.

Causes

Tension headaches may occur when muscles in the neck, face, and scalp contract, which produce pain. The precise cause of this muscle contraction is unknown. Factors that may contribute to tension headache include:

• Stress
• Anxiety
• Depression
• Eyestrain
• Poor posture
• Injuries or arthritis of the neck area
• Temporomandibular joint disease (TMJ)
• Chemical imbalances in the brain

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Your risk of getting a tension headache increases with:

• Depression
• Anxiety
• Sex: female
• Teeth clenching or grinding
• Sleep apnea
• Medications
• Sleep disruption

Symptoms

Tension headache symptoms usually start slowly and build.

Symptoms include:

• Constant, steady pain and pressure
• Dull and achy pain
• Pain felt on both sides of the head, in the forehead, temples, and the back of the head
• Pressure may feel like a tight band around the head
• Intensity ranges from mild to severe and can vary during the day
• Tightness in head and neck muscles

Headaches can become so severe and constant that they interfere with normal activities and sleep.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The cause of a headache can be difficult to determine.

Tests may include:

• Neurological exam
• Blood tests
• Neck x-ray
• CT scan of the head —a type of x-ray that uses a computer to make pictures of structures inside the head
• MRI scan of the head —a type of machine that uses a magnetic field, radio waves, and a computer to make pictures of structures inside the head

Treatment

Tension headaches are managed, rather than cured. Therapies aim to stop the headache and reduce the frequency of future episodes.

Treatment may include:

Medications

Medications may include:

• Over-the-counter pain pills—Continuous use of some over-the-counter medication may create rebound pain when you stop taking the drug. Pain medications are most effective when taken at the first sign of pain and before it becomes severe.
• Prescription nonsteroidal anti-inflammatory drugs or muscle relaxants
• Drugs to prevent headaches, if you suffer from daily tension headaches
• Antidepressant medications, even if you are not clinically depressed
• Botulinum toxin injections

Self-care During the Headache

Self-care may include:

• Rest.
• Put an ice pack or heat pack on your head or neck to ease discomfort.
• Take a warm shower, with water running over tense muscles.
• Massage your temples and neck.
• Practice relaxation techniques.

Lifestyle Changes

Lifestyle changes may include:

• Exercise regularly.
• Improve your posture.
• Get plenty of sleep.
• Take breaks from tasks.
• Learn and practice stress management and relaxation techniques.
• Consider seeing a counselor to:
  • Develop new coping skills.
  • Identify events that trigger the headaches and work toward resolution.

Additional Therapies

Additional therapies may include:

• Acupuncture
• Physical therapy—Physical therapists can help you develop a home-exercise program.
• Massage therapy if the pain is in your neck and shoulders

Prevention

You may be able to reduce the chance of a tension headache by learning how to manage stress. Try the following strategies:

• Keep a diary, marking when headaches occur and what you were doing before they started.
• Learn to recognize what provokes a tension headache.
• Avoid or minimize stressful situations.
• Take frequent breaks to walk or move around.
• Make time for pleasurable activities.
• Practice relaxation techniques, such as deep breathing and focusing on something pleasant.
• Learn techniques for coping with difficult or stressful situations.
• Make time for friends and build a strong support system.
• Go to bed early and get a good night's sleep.
• Exercise regularly.
• Do not slouch.
• Hold the phone, rather than cradling it on your shoulder, or use a headset.

RESOURCES:

American Headache Society
http://ahsnet.org

National Headache Foundation
http://www.headaches.org

Radiological Society of North America, Inc (RSNA)
http://www.radiologyinfo.org/index.cfm?bhcp=1

CANADIAN RESOURCES:

Headache Network Canada
http://www.headachenetwork.ca/

Help for Headaches
http://www.headache-help.org/index.html

References:

American Medical Association website. Available at: http://www.ama-assn.org/ . Accessed October 12, 2005.

Dambro MR. Griffith's 5-Minute Clinical Consult . 1999 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.

Goetz CG. Textbook of Clinical Neurology . Philadelphia, PA: WB Saunders Co; 1999.

Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, et al. Acupuncture in patients with tension-type headache: randomized controlled trial. Brit Med J . 2005;331:376-379.

National Headache Foundation website. Available at: http://www.headaches.org . Accessed October 12, 2005.

National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/ . Accessed October 12, 2005.

Rakel RE, Bope ET. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Tension headache. Dynamed website. Available at: http://dynamed101.ebscohost.com/Detail.aspx?id=114522 . Accessed Oct. 20, 2007.

ThirdAge WWW