Tension headaches are one of the most common types of headaches, affecting almost everyone at some point in their lives. 

In many cases, tension headaches are mild, temporary, and go away without treatment. But in other cases, it can be a severe condition that is extremely painful and sometimes even disabling. 

This guide from HealthTap breaks down the causes of tension headaches, the signs and symptoms, and how they can be treated and prevented. 

What is a tension headache? 

Tension headaches are a type of primary headache, which means they aren’t caused by another medical condition. Other types of primary headaches include migraines, cluster headaches, and paroxysmal hemicrania. 

Tension headaches are the most common form of primary headache, affecting as much as 80% of the world’s population at some point in their lives. Women are almost twice as likely to get tension headaches than men. 

In many cases, a tension headache is a temporary condition that resolves on its own. However, for some people, tension headaches can be extremely painful, frequent, and persistent. This can cause serious disability in work or school and often affects a person’s quality of life. 

Tension headaches are known by various names, such as stress headache, essential headache, and psychogenic headache. This is partially due to the fact that doctors once thought tension headaches had a psychological cause. However, researchers now know that tension headaches result from dysfunction in the neck, jaw, or head muscles.

Tension headaches can be split up into three categories: 

1. Infrequent episodic tension headache
   This type of headache happens about once per month, if at all. It can last anywhere from 30 minutes to several days. It is generally not accompanied by other symptoms, such as nausea, vomiting, or dizziness. 

2. Frequent episodic tension headache
   This type of headache happens less than 10 times per month for three or more months. Each headache can last up to several days. While rare, the headaches can occur alongside other symptoms like light or sound sensitivity, fatigue, and nausea. 

3. Chronic tension-type headache
   This type of headache happens 15 or more times per month, and lasts for three or more months in total. The headaches may be accompanied by symptoms like light and sound sensitivity, fatigue, and nausea. 

What are the symptoms of tension headaches? 

A tension headache typically causes throbbing pain in the front of the head, which feels like it runs across the forehead in a tight band. Often, the pain radiates from the neck muscles to the head. It can be a mild, moderate, or severe headache and may have a dull aching quality, too. 

Unlike migraine headaches, a tension headache typically won’t cause symptoms like blurred vision, muscle weakness, and visual changes. However, other symptoms can be present, including:

• Fatigue.

• Mood changes like irritability.

• Trouble concentrating.

• Muscle tension or pain (especially in the neck).

• Sleep problems.

What causes tension headaches? 

There is no single cause of tension headaches. 

In many cases, tension headaches result from muscle tension in the neck, jaw, or scalp. This tension can lead to pain, potentially radiating to other parts of the head. While muscle tension can be caused by overexertion, it is also often caused by emotional stress from work, school, or relationships. 

There are a few other possible triggers of tension headaches, such as: 

• Sleep deprivation.

• Psychological conditions, like depression and anxiety.

• Fatigue.

• Hunger or dehydration.

• Smoking or drinking alcohol.

• Caffeine withdrawal.

• Poor posture. 

• Dental problems. 

• Eye strain.

• Sinus infection. 

In many cases, once the underlying cause has been addressed, the tension headache may go away. In most cases, it’s best to see a doctor to evaluate and confirm if the headaches are in fact tension headaches; then the doctor can work with the patient on solutions to get relief. 

How are tension headaches diagnosed?

There is no medical test that can “diagnose” tension headaches. Instead, a diagnosis is made based on the patient’s symptoms, while ruling out other medical conditions. 

The first step to getting diagnosed is to meet with a healthcare provider. They can ask questions about the headache symptoms experienced as well as questions about general medical history. 

These questions can include: 

• Where is the pain located?

• How intense is the pain?

• How long does the pain last?

• Have you had any injuries to the head?

• Have you noticed any changes in your thoughts or behaviors?

• Do you experience trouble falling or staying asleep?

• Is there anything that triggers your headaches? 

• Are your headaches accompanied by other symptoms, such as visual changes?

The above questions can help rule out an underlying medical condition (such as traumatic brain injury) and ensure that it’s a tension headache and not another headache type. 

To rule out other medical conditions, a doctor may choose to run other tests, which can include: 

• Blood tests
  A blood test can check for hormonal balance, electrolyte and fluid balance, glucose metabolism, and kidney function. All of these tests can help rule out another explanation for a tension headache. 

• Sinus X-ray
  In some cases, a sinus infection can cause extreme pressure on the sinuses, which can radiate to the head and manifest as a headache. If symptoms like congestion are present, a sinus infection could be a potential cause.  

• Magnetic resonance imaging (MRI)
  This type of imaging can provide a detailed picture of the brain. It can help rule out brain abnormalities that could be causing headache symptoms, such as a brain tumor. 

• Computed tomography scan (CT scan)
  This type of imaging is similar to an MRI, but slightly less detailed. It can point out structural issues in the brain that could be contributing to headache symptoms.

Once other, more serious health conditions are ruled out, a doctor may make the diagnosis of tension headache and begin treating the patient for it. 

How are tension headaches treated? 

Treatment options for a tension headache can include lifestyle changes and medications to control head pain. 

Lifestyle changes 

Lifestyle changes include sleep hygiene, physical exercise, and stress management. 

Sleep deprivation is common in people with tension headaches. Focusing not only on hours of sleep but also on quality is important. A cool, dark, quiet room free of distractions is most conducive to a good night’s sleep. 

If stress is a serious problem, relaxation techniques may help provide some relief. Popular options involve biofeedback (which teaches people to recognize how their bodies respond to stress), talking to a therapist, or spending time outdoors. 

Last, exercise can be an important part of any headache management plan. Exercise can help ease emotional stress and muscle tension, and works to release feel-good chemicals called endorphins that may help decrease headache frequency and severity. 

It might also be helpful to focus on relieving muscle tension in other ways. For example, applying a heating pad to the neck or back of the head can help with muscle relaxation. Working on improving posture can also reduce muscle strain in the long-run. 

Medications 

If lifestyle changes don’t work or the headache is especially intense, a doctor may recommend over-the-counter pain relievers to temporarily help manage symptoms. Some pain relief options include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), naproxen (Aleve) or aspirin, or acetaminophen. 

While these can be viable choices for relieving moderate pain, general guidelines suggest they should not be taken long-term. Long-term use of pain relievers may be associated with medication overuse headaches, which are generally relieved by stopping the medication.

If over-the-counter painkillers don’t relieve symptoms, a healthcare professional may write a prescription for stronger NSAIDs, muscle relaxants, beta blockers, or tricyclic antidepressants. These can either be used alone or in combination to provide headache pain relief. 

How can tension headaches be prevented?

Factors like sleep deprivation, muscle tension, and high levels of emotional stress can lead to tension headaches. This connection makes it important to keep track of potential triggers and avoid them as much as possible. 

Using a headache diary can be an effective way to identify triggers and better manage tension headaches. 

In a headache diary, a person with frequent headaches can track information related to when and where they feel headaches, and all of the factors that may be contributing to the headache, such as diet, exercise, and sleep. 

Over time, a pattern between triggers and headaches can become clear. Once these triggers have been identified, they can be avoided to prevent future tension headaches. 

When to see a doctor 

Tension headaches are generally not a serious medical condition because they don’t lead to further neurological damage. Plus, as a primary headache, they’re not caused by an underlying health problem that needs to be addressed.

This doesn’t mean that tension headaches are not disabling —  chronic tension headache sufferers may experience serious problems at work, school, or in relationships because of persistent pain. 

For this reason, it’s important to see a doctor if a tension headache begins to affect any aspect of daily living — even if it doesn’t seem “serious” at the moment. 

While a tension headache isn’t a medical emergency, it can sometimes be confused with a health problem that requires immediate medical attention.

It’s important to see a doctor if any of the following symptoms are present:

• Vision changes.

• Mental confusion.

• Loss of balance.

• Muscle weakness. 

• Numbness (especially on one side of the body).

• Slurred speech.

The above symptoms often indicate a medical emergency, such as a stroke or aneurysm. 

Getting tension headache relief with HealthTap

Tension headaches are one of the most common headache types, which affect most of the world’s population at some point in their lives. However, for some people, this condition can be painful, frequent, and disabling.

If you suffer from chronic tension headaches, talking with a doctor specializing in headaches can help bring you relief. HealthTap can connect you to a low-cost doctor through our virtual platform so you never have to leave home.

Make an appointment today and be on your way to tension headache relief.