Understanding tension headaches

Tension headaches usually develop in the afternoon. The pain is mild or moderate. It may envelop your entire head or be limited to the forehead or to the back or top of your head. Many people describe the sensation as a dull tightness or pressure that occurs in a band-like pattern (see Figure 1). The intensity of the pain may fluctuate, but it won't be severe enough to keep you from sleeping or to awaken you. Unlike migraines, tension headaches are rarely accompanied by other symptoms, such as nausea, vomiting, or blurred vision. In addition, researchers haven't linked them to any foods, genes, or hormonal changes. Tension headaches can occur infrequently, regularly, or daily (see “Understanding daily headaches”). They are common at any age. Women are more susceptible to them than men are (see “Tension headaches by the numbers”).

Figure 1: Tension headache pain

Tension headaches often produce steady pain across the forehead or in the back of the head. Sometimes, the pain is felt throughout the head, and the sensation is often described as a dull tightness.

Tension headaches by the numbers

Source: Journal of the American Medical Association

Triggers and aggravators

Tension headaches are frequently attributed to stress, but they are also likely to be caused by fatigue or anxiety. Experts believe that the pain of a tension headache is caused by tightness in the muscles of the scalp and the back of the neck. While emotional stress or pressure can trigger this muscle tightness, so can a range of strictly physical problems, such as eyestrain, whiplash, or poor posture (see Figure 2).

Figure 2: Better posture for fewer headaches

Subjecting your head and neck muscles to any prolonged strain can cause them to stiffen, leading to a tension headache. Maintaining good posture and avoiding repetitive motions can help avoid such problems. The following suggestions may also reduce muscle tension:

  • Don’t rest your chin on your chest while reading.

  • Avoiding cupping the telephone between your shoulder and ear. If you use the telephone often, you may want to invest in a headset.

  • Keep your computer monitor at eye level.

  • Avoid excessive gum-chewing, which can tighten jaw muscles.

  • Try not to clench your jaw or grind your teeth.

Treating tension headaches

The muscular tightness that characterizes the classic tension headache is difficult to reverse. Some over-the-counter analgesics, agents that relieve pain without causing loss of consciousness, usually prove inadequate by the time most people seek medical help for a tension headache. While prescription pain relievers can suppress the pain, the headache is usually so entrenched that medications rarely eliminate it altogether. Thus, stopping the pain usually means targeting its major cause: muscle contraction. Talk to your doctor about ways to address underlying muscle tightness.

Stress leads the pack

A survey published in the journal Headache reported that stress was the most common factor precipitating a tension headache. Of the 17 people with tension headaches included in the survey, 14 indicated that stress had previously caused such problems. Other frequent triggers included (in order of their prevalence) missing meals, lack of sleep, and fatigue. How these factors cause the muscle tightness that leads to the headache is unknown. Not surprisingly, the researchers found that these factors also aggravated tension headaches already in progress. Overall, the results confirm the advice doctors often give to people with tension headaches:

  • Don't skip meals.

  • Get enough sleep.

  • Pace yourself to avoid excessive stress.