Tension Headache: Symptoms, Causes, Treatments

  • A tension headache usually feels like a tight band of pain that is wrapped around the head.
  • Tension headaches usually last from half an hour to several hours, but some can last much longer.
  • It’s unclear what causes tension headaches, but risk factors include stress and eye strain.
  • Visit Insider’s Health Reference Library for more advice.

Tension headaches are the most common type of headache, affecting an estimated 66% of adults in the United States at some point in their life.

They cause mild to moderate pain in the forehead or wrap around the sides and back of the head like a tight band.

Note: The pain of a tension headache is different from the throbbing, throbbing pain of a migraine. In addition, physical activity – like climbing stairs – does not increase the pain or intensity of tension headaches as it does with migraines.

While most tension headaches go away in 30 minutes to several hours, some can last much longer.

Here is information to help you determine if your pain is a tension headache and, if so, how to treat it.

How to tell if you have a tension headache

Tension headaches are divided into two main categories:

  • Episodicthat lasts between 30 minutes and a week and occurs less than 15 days a month.
  • Chronicthat occurs for at least three consecutive months on 15 or more days per month.

“Chronic headache problems mostly develop from episodic ones. People start out with the occasional headache, but over time it becomes a growing problem, “said Christopher H. Gottschalk, MD, FAHS, director of headache medicine and head of general neurology at Yale Medicine.

Regardless of the type of tension headache you have, you will have several symptoms including:

  • Tightness or pressure on the forehead or the sides and back of the head
  • Mild to moderate pain around the scalp, face, or neck and shoulder muscles

Note: If you have migraine symptoms such as nausea, vomiting, and fatigue in addition to the pain from tension headaches, you may sometimes have mixed headaches.

However, some researchers believe that the different types of headache – mainly tension vs. migraine – are not separate ailments, but rather a continuum of a health condition.

For example, the pain of a tension headache resembles the throbbing pain of a migraine as it worsens, and as the migraine becomes more frequent it resembles a chronic tension headache even more.

So the symptoms aren’t that clear-cut between the two, and that’s why some researchers disapprove of the different headache classifications.

Causes of tension headaches

The cause of tension headaches is little known. However, there are risk factors that can make you more susceptible to this, such as:

Recognizing and avoiding these risk factors will reduce the chances of headaches occurring later or worsening, says Gottschalk.

How to treat tension headaches

There are several ways to treat a tension headache, including:

  • Painkiller: In general, headaches are usually treated with over-the-counter pain relievers such as aspirin, ibuprofen (Advil or Motrin), naproxen sodium (Aleve), or acetaminophen (Tylenol). Combination drugs with two or more active ingredients (Excedrin) and prescription pain relievers used to treat more severe pain or chronic headaches such as naproxen (Naprosyn) or indomethacin (Indocin) can also help. Do not use pain relievers more than twice a week, as overuse of pain relievers can lead to what is known as drug overuse headaches.
  • Anti-nausea medication: Researchers have found that headaches can actually delay pain reliever absorption, but an anti-nausea medication can help. “Add an anti-nausea medication like Reglan or Compazine too [OTC pain medications] – even without nausea – can significantly improve the response, ”says Gottschalk.
  • Home remedies: Placing a cold compress on your forehead or over your neck and shoulders can relieve your symptoms. Dehydration and poor sleep also trigger headaches. So make sure you drink enough water and get a good night’s sleep.
  • Antidepressants: If pain medications do not relieve your symptoms or if you have chronic tension headaches, you may be prescribed tricyclic antidepressants such as amitriptyline (Elavil). Venlafaxine (Effexor XR) or mirtazapine (Remeron) are also effective. Antidepressants can reduce the duration and frequency of headaches because they increase serotonin levels in the brain, which contributes to its pain relieving properties.

You need to see a doctor if your symptoms affect your ability to function, Gottschalk says. Chronic headaches may require other treatments and preventive techniques such as cognitive behavioral therapy, biofeedback (using sensors to learn how to control key body functions), and healthy lifestyle habits such as getting enough sleep and regular exercise.

Important: Remember that sudden, severe headaches accompanied by fever, stiff neck, or confusion – especially after a head injury – require immediate emergency care as this may indicate a concussion or a more serious underlying health condition such as cerebral haemorrhage or bleeding, or meningitis (Inflammation of the brain and spinal cord tissue).

Insider tips

Tension headaches include mild to moderate pain in the forehead or sides and back of the head that can last anywhere from 30 minutes to several months.

Several factors such as vitamin deficiencies, eye strain, and lack of sleep can increase your risk of developing tension headaches.

If tension headaches are interfering with your daily life, you can try using OTC pain relievers to relieve the pain or schedule a visit to your GP for prescription medication.

Using treatments that don’t really work, like combining Tylenol and soda like Coca-Cola or Pepsi, can make headache symptoms worse over time, Gottschalk says.