(Muscle Contraction Headache; Tension-Type Headache)
Tension headache refers to radiating, steady pain in the head, neck, or eyes that can be mild or intense. Tension headaches may be occasional or chronic.
|Tension Headache: Areas of Pain
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Tension headaches may occur when muscles in the neck, face, and scalp contract. In some cases, muscle contraction is the result of teeth grinding and jaw clenching. In others, it may be unknown.
Tension headaches are more common in women.
Other factors that may increase your risk of getting a tension headache include:
Some tension headaches are nearly constant, with daily pain that may vary in intensity. Other tension headaches only occur once in a while. Symptoms usually start slowly and build.
Tension headache may cause:
- Constant, steady pain and pressure
- Dull and achy pain
- Pain which may be 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.
You will be asked about your symptoms and medical history. A physical exam will be done. Diagnosis can be made on exam, based on specific features. The cause of the headaches however, may be more difficult to determine. A neurological exam may be done.
Imaging is not usually needed, but if pain is unusual or severe it may be done to look for other causes of the headache. Imaging tests include:
There are no specific cures for tension headaches, but they can be managed. Therapies aim to stop the headache and reduce the frequency of future episodes.
Treatment may include:
For occasional headaches, the following medication may be recommended to relieve pain:
- Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
- Prescription pain relievers
Note: Pain medications are most effective when taken at the first sign of pain and before it becomes severe. Overusing some over-the-counter medications may actually cause headaches. Continuous use of medications may create rebound pain when you stop taking the drug.
Taking a caffeine supplement with your pain reliever may improve pain relief.
The following medications may also be recommended to treat or prevent headaches:
- Muscle relaxers
Botulinum toxin injections (Botox)
- Anti-seizure medication
- Beta blocker medication
Self-care During the Headache
Self-care may include:
- Rest if needed
- An ice pack or heat pack on your head or neck to ease discomfort
- A warm shower, with water running over tense muscles
Lifestyle changes may include:
- Improving your posture
- Adequate sleep
- Regular breaks from tasks
and relaxation techniques
- Develop new coping skills
- Identify events that trigger the headaches and work toward resolution
Additional therapies may include:
Acupuncture—to have more headache-free days and lessen the intensity of headaches when they do occur
- Physical therapy—to develop a home exercise program
- Massage therapy
To help reduce your chances of getting a tension headache, 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.
American Headache Society
National Headache Foundation
Headache Network Canada
Help for Headaches
Melchart D, Streng A, Hoppe A, et al. Acupuncture in patients with tension-type headache: randomized controlled trial.
Brit Med J. 2005;331:376-379.
NINDS headache information page. National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/disorders/headache/headache.htm. Updated September 26, 2014. Accessed January 15, 2015.
Tension-type headache. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T114522/Tension-type-headache. Updated July 1, 2016. Accessed September 14, 2016.
National Headache Foundation website. Available at:
http://www.headaches.org/education/Headache%5FTopic%5FSheets/Tension-Type%5FHeadache. Accessed January 15, 2015.
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http://www.ebscohost.com/dynamed: Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN. Acupuncture in patients with headache.
8/27/2010 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA. An unfavorable lifestyle and recurrent headaches among adolescents: The HUNT Study.
5/12/2014 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Yancey JR, Sheridan R, et al. Chronic daily headache: diagnosis and management. Am Fam Physician. 2014 Apr 15;89(8):642-8.
2/4/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Derry CJ, Derry S, et al. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database Syst Rev. 2012 Mar 14;3.
- Reviewer: EBSCO Medical Review Board
Rimas Lukas, MD
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