Tension-Type Headache

What Is It?

Tension-type headaches are the most common type of headache, affecting up to 40 percent of people at some time in their lives. These headaches are not caused by disease, and are often considered to be "normal" headaches. Tension-type headaches fall into two general categories:

• Episodic — Occurring less than 15 times per month
• Chronic — 15 or more headaches per month

Although people who have this type of headache often report a sense of muscular tension, there is no clear evidence that muscle strain or tension actually causes these headaches. Rather, these headaches probably are caused by changes in brain chemicals, which trigger pain from nerves and blood vessels that surround the brain. This mechanism is similar to that which causes migraine headaches.

Symptoms

Tension-type headaches often start in the afternoon or early evening, and their intensity typically comes and goes over time. The main symptom is usually a sense of tightness around the head — the "tight hatband" or "vise" sensation. Neck and shoulder muscles are often tense and sore to the touch. Other symptoms may include trouble concentrating and difficulty sleeping.

It is common for some people to have symptoms of both tension-type and migraine headaches. For example, headaches may be made worse by bright lights or loud noises, which is typical of migraine headaches, but will also have a constant, non-throbbing quality, which is more typical of tension-type headache.

Diagnosis

There is no specific test to confirm the diagnosis of a tension headache. The diagnosis is determined by your symptoms, your medical history and a physical examination by your doctor. In some patients, a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the head may be ordered to investigate headache pain that is associated with unexpected or unusual symptoms.

Expected Duration

An episodic tension-type headache may last only a few hours or it may linger for a day or more. A chronic tension-type headache typically persists for part or all of the day for most days of the week, although the intensity of pain may fluctuate during that time.

Prevention

Relaxation techniques and avoidance of stressful situation may help to prevent tension-type headaches from occurring. In some people, a medication taken daily may help to prevent headaches as well. Typically, one of the tricyclic antidepressants is used. Even for people without depression, this class of drug has been found to offer significant relief from tension headache pain.