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Tension Headache

What is a tension headache?
A tension headache is a headache caused by tense muscles in your face, neck, or scalp. It is also sometimes called a muscle-contraction headache. Tension headaches are very common.

How does it occur?
The muscles of your face, neck, and scalp may become tense because of:

  • anxiety or stress
  • staying in one position for a long time
  • injury, such as in a car accident
  • depression

Headaches can also be triggered by:

  • having too little or too much sleep
  • eating too little or too much
  • drinking too much alcohol
  • being somewhere that is noisy
  • working hard indoors or outdoors
  • some medical conditions.

What are the symptoms?
The symptoms may be:

  • a feeling like a tight band is around your head
  • dull and steady pain that worsens through the day, sometimes with a sore neck
  • trouble concentrating
  • trouble sleeping
  • pain that starts or gets worse with stress, fatigue, noise, or glare.

Your muscles might twitch or spasm. Sometimes your head may feel like it is throbbing.

How is it diagnosed?
Your health care provider will ask about your symptoms and examine you. No single test can confirm that a headache is a tension headache. The diagnosis is based on your symptoms, medical history, and a physical exam.

Your health care provider may ask:

  • When did the headache start?
  • How bad is it?
  • Where is the pain located?
  • What kind of pain is it?
  • Is it sharp, burning, or throbbing?
  • Do you have other symptoms, such as nerve tingling or weakness?
  • Do you have a fever?
  • Do you feel sick or vomit?
  • Do you have eye pain or vision changes?
  • Did you have an accident or injury before the pain started?
  • Did you take any drugs before the pain started? Have you had other headaches like this one?
  • What stresses are you having?
  • What is your family history for headaches?

Sometimes it is hard to know if a headache is a tension headache or a mild migraine headache.

How is it treated?
You can reduce muscle tightness and relieve pain with:

  • nonprescription pain medicine
  • relaxation exercises
  • regular physical exercise

If the pain continues, your health care provider might:

  • Refer you for physical therapy.
  • Recommend biofeedback therapy (use of a machine to help you learn to control muscle tension).
  • Prescribe a stronger pain reliever.

How long will the effects last?
Symptoms usually last a few hours to a day.

Taking pain medicine too often for headaches can cause headaches. These headaches are called rebound headaches or drug-induced headaches. It can create a bad cycle: You have a headache, so you take pain medicine. When the pain medicine wears off it causes another headache, which causes you to take more medicine, which causes another headache.

You are at risk for rebound headaches if you take pain medicine 3 or more days a week. Examples of nonprescription medicines that can cause rebound headaches are aspirin, acetaminophen, and ibuprofen. Some prescribed pain medicines can also cause this problem.

Talk to your health care provider if you are taking medicine for headaches more often than 2 or 3 times a week.

How can I take care of myself?

  • Rest in a quiet, dark room until symptoms lessen or go away.
  • Take a pain reliever such as aspirin, acetaminophen, ibuprofen, or other medicine your health care provider recommends or prescribes. Do this as soon as you notice symptoms. Recognizing early warning signs of headache and starting treatment right away is crucial to having less pain. Children under 18 years of age should not take aspirin or products containing salicylate (such as Pepto-Bismol) because of the risk of Reye's syndrome unless recommended by a health care provider.
  • Stretch and massage your neck, shoulders, and back. Put heat, an ice pack, or a cold washcloth on these areas.
  • See your health care provider right away if:
    • You have much more pain than your usual headaches and it does not go away.
    • You have repeated vomiting.
    • You have numbness or tingling in your face, arms, or legs.
    • Your arms or legs feel weak.
    • You have trouble seeing, thinking, talking, or walking.

What can be done to help prevent tension headaches?

  • Try to identify and avoid situations that cause tension or stress. Consider getting counseling to help you reduce the stress in your life.
  • Take breaks from tasks and learn to use relaxation techniques.
  • Exercise regularly.
  • Get enough sleep.
  • Try not to push yourself too hard.
  • Eat meals regularly.
  • Do not smoke.
  • Do not drink a lot of alcohol.
  • Keep your sense of humor. This reduces tension.