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Tension headache

Tension-type headache; Episodic tension-type headache; Muscle contraction headache; Headache - benign; Headache - tension; Chronic headaches - tension; Rebound headaches - tension

A tension headache is the most common type of headache. It is pain or discomfort in the head, scalp, or neck, and is often associated with muscle tightness in these areas.

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Tension-type headache

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Causes

Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, head injury, or anxiety.

They may occur at any age, but are most common in adults and older teens. It is slightly more common in women and tends to run in families.

Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Activities may include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.

Other triggers of tension headaches include:

Tension headaches can occur when you also have a migraine. Tension headaches are not associated with brain diseases.

Symptoms

The headache pain may be described as:

The pain may occur once, constantly, or daily. Pain may last for 30 minutes to 7 days. It may be triggered by or get worse with stress, fatigue, noise, or glare.

There may be difficulty sleeping. Tension headaches usually do not cause nausea or vomiting.

People with tension headaches try to relieve pain by massaging their scalp, temples, or the bottom of the neck.

Exams and Tests

If your headache is mild to moderate, without other symptoms, and responds to home treatment within a few hours, you may not need further examination or testing.

With a tension headache, there are usually no problems with the nervous system. But tender points (trigger points) in the muscles are often found in the neck and shoulder areas.

Treatment

The goal is to treat your headache symptoms right away, and to prevent headaches by avoiding or changing your triggers. A key step in doing this involves learning to manage your tension headaches at home by:

Medicines that may relieve a tension headache include:

Be aware that:

If these medicines do not help, talk to your provider about prescription medicines.

Other treatments that you can discuss with your provider include relaxation or stress-management training, massage, biofeedback, cognitive behavioral therapy, or acupuncture.

Outlook (Prognosis)

Tension headaches often respond well to treatment. But if the headaches are long-term (chronic), they can interfere with life and work.

When to Contact a Medical Professional

Call 911 if:

Also, call your provider if:

Prevention

Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may help you improve the effect of doing relaxation exercises, and may be helpful for long-term (chronic) tension headache.

Tips to prevent tension headaches:

Massaging sore muscles may also help.

Related Information

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Headache - what to ask your doctor

References

Garza I, Schwedt TJ, Robertson CE, Smith JH. Headache and other craniofacial pain. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 103. 

Jensen RH. Tension-type headache - the normal and most prevalent headache. Headache. 2018;58(2):339-345. PMID: 28295304 www.ncbi.nlm.nih.gov/pubmed/28295304.

Silberstein SD. Headache management. In: Benzon HT, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW, eds. Practical Management of Pain. 5th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 30.

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Review Date: 11/22/2017  

Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Surgery at Providence Medical Center, Medford, OR; Department of Surgery at Ashland Community Hospital, Ashland, OR; Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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