Tension headache

Alternative names
Muscle contraction headache; Benign headache; Headache - tension

A tension headache is a condition involving pain or discomfort in the head, scalp, or neck, usually associated with muscle tightness in these areas.

Causes, incidence, and risk factors
Tension headaches are one of the most common forms of headache. They may occur at any age, but are most common in adults and adolescents. If a headache occurs 2 or more times weekly for several months or longer, the condition is considered chronic.

Tension headaches result from the contraction of neck and scalp muscles. One cause of this muscle contraction is a response to stress, depression or anxiety. Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or use of computers, fine work with the hands, and use of a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger this type of headache.

Other causes include eye strain, fatigue, alcohol use, excessive smoking, excessive caffeine use, sinus infection, nasal congestion, overexertion, colds, and influenza. Tension headaches are not associated with structural lesions in the brain.


  • Headache       o Dull, pressure-like       o Generalized, worse in the scalp, temples or back of the neck       o Not one-sided       o Feels like a tight band or vise on the head       o Occurs as an isolated incident, or occurs constantly or daily       o Worsened or triggered by stress, fatigue, noise, glare  
  • Difficulty sleeping

Signs and tests

A headache that is mild to moderate, not accompanied by other symptoms, and which responds to home treatment within a few hours may not need further examination or testing. If a neurologic examination is performed, a tension headache causes no abnormal findings, but musculoskeletal tenderness is often present.

The health care provider should be consulted - to rule out other disorders that can cause head pain - if the headache is severe, persistent or if other symptoms accompany the headache.

Headaches that disturb sleep, occur whenever the person is active, or that are recurrent or chronic may also require examination and treatment by a health care provider.


The goal is to relieve symptoms and prevent future headaches. Prevention is the best treatment. If possible, remove or control precipitating factors.

Learn and practice stress management strategies. Some people find relaxation exercises or meditation helpful. Biofeedback (a means of providing information about certain body functions) may enhance relaxation exercises and may be helpful for chronic tension headache.

Other preventive measures may include keeping warm if the headache is associated with cold, using a different pillow, or changing sleeping positions. Use good posture when reading, working, or doing other activities that may cause headache. Exercise the neck and shoulders frequently when typing, working on computers, or doing close work.

Adequate sleep and rest or massage of sore muscles can help reduce the chance that a headache will occur. Hot or cold showers or baths may relieve a headache for some people.

Over-the-counter analgesics such as aspirin, ibruprofen, or acetominophen may relieve pain if the above measures are ineffective. An antidepressant or other medication may be advised for chronic headache. A nonsedating muscle relaxant like Skelaxin helps some patients.

A headache diary may help you identify the source of chronic headaches. When a headache occurs, write down the date and time the headache began. Note what you ate for the preceding 24 hours, sleep pattern and amount of sleep, what was being experienced immediately before the headache, unusual stress or other circumstances, how long the headache lasted, and what made it stop.

Lifestyle changes may be required for chronic tension headaches. This may include adequate rest and exercise, change in job or recreational habits, or other changes.

Expectations (prognosis)

Tension headaches usually respond well to treatment without residual effects. They are annoying, but not dangerous.


  • The headache may not be a tension headache, but it may be a symptom of another, more serious, disorder.  
  • Rebound headaches may occur from overuse of analgesic medications.

Calling your health care provider

See your health care provider if headaches are severe, persistent, recurrent, or are accompanied by other symptoms (drowsiness, vision changes, changes in movement or sensation, seizures, changes in alertness, nausea and vomiting).

Also call if headaches disturb sleep, occur whenever you are active, are recurrent or chronic, or if a headache does not respond to treatment.


Avoid situations that may cause a tension headache. This can include keeping warm if the headache is associated with cold, using a different pillow or sleeping position, or similar changes.

Use good posture when reading, working, or involved in activities that may cause a headache. Exercise the neck and shoulders frequently.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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