What Is a Tension Headache?

What Is a Tension Headache?

Tension headaches also referred to as tension-type headaches (TTH), are headaches that are mild to moderate in severity. Sufferers describe them as feeling like a band around their heads. 

There are two different types of tension headaches. Episodic ones happen on fewer than 15 days a month; chronic ones happen more than 15 days per month.

Tension Headache Symptoms

The symptoms you experience during a tension headache may not be as severe as in a migraine, but they can still be debilitating:

• A dull pressure in the head
• A feeling of a tight band around the head
• Pain is all over, not localized to any area
• Worse in scalp, temples, back of the neck, and/or shoulders
• Insomnia

What Causes Tension Headaches?

There are two schools of thought about the cause of tension-type headaches. One is that the headaches cause muscle tension. The other posits that muscle tension causes tension headaches. (Either way, muscle tension is present in 70% of those with tension headaches).

A more recent study points to this muscle-contraction theory potentially not holding water. This study looked at patients who received Botox (botulinum toxin) injections to paralyze the temporal muscle (i.e., the temples.) Despite the freezing of the muscles, participants didn’t see any significant decreases in their headaches.

The more recent research points to headaches being caused by trigger points (also known as knots in your muscles) in the myofascial tissue,which is the tissue that encases all of your body's organs, bones, etc.

“We think the myofascial tissues send signals to the brain [that create] increased activity in those pain pathways. They become more sensitized and dysregulated,” says Dr. Jennifer Robblee, Assistant Professor of Neurology at Jan & Tom Lewis Migraine Treatment Program, Barrow Neurological Institute.

Some triggers may include: 

• Stress
• Alcohol use
• Caffeine (either too much or withdrawal symptoms)
• Sinus infections
• Jaw clenching or teeth grinding
• Eye strain
• Smoking
• Fatigue 
  

Tension Headache Diagnosis

Tension headaches are difficult to diagnose because there is an overlap of many symptoms with migraines, but a tension headache is generally diagnosed by the absence of migraine features, such as an aura or nausea.

Two of the following features must be present for a tension headache diagnosis:

• A pressing or tightening of the head
• Presence on both sides of the forehead, temples, or back of the head
• Mild to moderate in severity
• Not worsened by physical activity 

Sometimes photophobia (light sensitivity) or phonophobia (discomfort from sound) may be present, but not both. 

There is a high rate of overlap between people with mood disorders and people who deal with tension headaches. In one study, 84% of the participants with tension headaches also had a psychiatric diagnosis, such as anxiety or depression. There is a theory that some tension headaches may be the physical manifestations of psychological distress.

How Are Tension Headaches Treated?

Tension headaches are treated in two main ways: pharmacologically (through medication) and non-pharmacologically, which may include things from cognitive-behavioral therapy to acupuncture.

Pharmacological Treatment for Tension Headaches

Many tension headaches can be managed with over-the-counter medications, but if the pain begins to become chronic, there are prescription medications you can try.

Over the Counter Medications

Some medications that people typically use are the usual non-steroidal anti-inflammatories (NSAIDs) such as Aleve (naproxen), Advil (ibuprofen) or Tylenol (acetaminophen).

Prescription Medications

• Antidepressants: For chronic tension headaches, Elavil (amitriptyline) or Remeron (mirtazapin), older tricyclic antidepressants are often used, as they have been studied to be effectivein treating pain.
• Migraine medications: Traditional migraine medications like Topamax (topiramate), Imitrex (sumatriptan), or newer ones such as Aimovig (erenumab), Ajovy (fremanezumab), or Emgality (galcanezumab) may be used to treat tension headaches.
• Nerve pain medication: Medications that treat nerve pain, such as Neurontin (gabapentin) may help reduce tension headache pain.
• Muscle relaxers: Muscle relaxants like Tizanidine (Zanaflex) might also be effective in treating tension headache pain.

Non-Pharmacological Treatments

Dr. Robblee notes that behavioral techniques and therapy can be used to treat these kinds of headaches. “They use the body’s innate response to turn down its response to being in pain," says Dr. Robblee.

• Cognitive-behavioral therapy: CBT is used to provide psychoeducation about the relationship between tension headaches and stress as well as help patients replace potential negative cognitions about pain, such as "I'm going to feel like this forever" with more positive or constructive ones, like "this is a signal from my body trying to tell me something, but I am safe." This technique helps people better cope with headaches.
• Biofeedback: This therapeutic method teaches you to associate the levels of tension in your mind with tension in your body to keep your body and muscles relaxed.
• Progressive muscle relaxation: This technique calms the muscles associated with tension headaches. 
• Mindfulness:This may help reduce the intensity of the pain by reducing the amount of anxiety and stress that trigger the pain. It also helps with emotion regulation, which in turn increases self-efficacy—the belief in the ability to accomplish goals. In headache patients, this helps with quality of life.
• Acupuncture: Regular acupuncture may help reduce pain associated with chronic tension headaches by targeting the nerves that lead to a release of endorphins and neurotransmitters to blunt the pain signals to the brain.

Other ways to manage acute tension headaches without medicine that Dr. Robblee frequently recommends to patients are:

• Applying heat or ice to your head
• Neck stretches
• Taking a hot bath
• Using a massage ball
• Aromatherapy
• Deep breathing 

Coping 

Coping with tension headaches may sometimes be harder to deal with than the actual headaches—the pain isn’t severe, but it’s just present enough to cause some level of impairment, whether that be once in a while or chronically.

There’s actually a condition called cephalalgiaphobia, which is the fear of having a headache while in a pain-free state. The irony of this condition is that, given that stress is a headache trigger, this may actually cause more headaches.

She says that she will explain to patients why the symptoms of a headache are leading her to a certain diagnosis, and why she’s not worried. 

“One of the most important things is to alleviate fear and make sure the person is being heard,” says Dr. Robblee. 

A Word From Verywell 

Headaches can be incredibly frustrating, especially when they become chronic or interfere with you doing the things you want to do, but most of the time, they are just a normal reaction within your body to stress or another trigger. Remind yourself that they have passed before and will pass again If you find that your headaches are painful or impacting your quality of life, reach out to your healthcare physician.