What Is a Tension Headache?

Tension headaches are very common and not a sign of serious disease. But a tension headache can be miserable and interfere with your work and quality of life.

Tension-type headaches, usually simply called tension headaches, are the most common types of headache. A majority of people experience them. While they may not occur often for some folks, others experience tension headaches so frequently their head discomfort sometimes interferes with their work and quality of life.

That’s why it’s important to get the facts about what a tension headache is and its symptoms and causes — and when to talk to your doctor about ways to prevent and treat tension-type headaches.

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Tension headache causes

Tension-type headaches are primary headaches, meaning they aren’t caused by some other disease or injury. In previous decades, such headaches were often called psychogenic headaches and chalked up to emotional or mental problems. While it’s true that stress, anxiety, and depression can play a role in triggering tension headaches, there are many reasons you may develop one.

For example, if you are not getting enough quality sleep, working many hours, missing meals, or experiencing stress in your personal life, muscles in your face, scalp, neck, and jaw can contract and trigger pain in your head, the National Institute of Neurological Disorders and Stroke (NINDS) explains. Sleep apnea, a disorder in which breathing repeatedly stops and starts during sleep, may also cause tension-type headaches, especially those you feel first thing in the morning.

If you are worried about a problem or an extra workload you face in your workplace — or if you are anxious about conflicts with spouse or kids at home — you may develop a tension headache in the morning before work or in the evening when you face family tensions.

Other causes of tension-type headaches include poor physical posture, often while working at a computer or spending a lot of time on your phone. Holding your chin down while reading or your phone between your ear and shoulder while talking can strain your neck and head muscles and trigger a tension headache, the NINDS warns.

The pain of degenerative arthritis in your neck can result in tense face and neck muscles, resulting in tension headaches, too. Temporomandibular joint dysfunction, better known as TMJ, affects the joints between the temporal bone, located above the ear, and the lower jawbone (the mandible). TMJ can result in sore facial muscles.

Types of tension headaches and symptoms

Tension headaches typically first occur in the teen years and are most often reported when people are in their 30s. Women are slightly more likely to experience tension headaches than men, but symptoms are usually similar in all adults.

Tension-type headaches may sometimes be confused with migraine headaches because both TTHs and migraines can cause sensitivity to light and sound. The American Migraine Foundation, however, explains tension headaches are not accompanied by pre-headache auras (flashing lights and other visual disturbances) many people who have migraines experience.

Another difference: Migraines usually cause pain, sometimes severe, on one side of the head, while tension headache pain is usually mild to moderate and felt on both sides of the head. In addition, tension headaches don’t exhibit the throbbing or pounding type pain of a migraine.

Instead, tension-type headaches are often described as tightness around the head, a constant pressure-type discomfort felt in the front of your face, head, or neck.

Tension headaches aren’t all the same

There are three types of tension headaches:

• Infrequent episodic type tension-type headaches describe headaches that occur once a month or even less.
• Frequent episodic type tension-type headaches occur between 10 and 15 days a month and can last from half an hour to several days. The pain is not disabling, but it can become more painful if you have frequent tension headaches.
• Chronic tension-type headaches are very frequent headache episodes, 15 or more each month for three months (sometimes more). The pain, usually felt on both sides of the head, can be constant over the course of days or weeks and may be accompanied by mild nausea. Chronic tension headaches are typically more severe and more likely to interfere with work and home life than episodic tension headaches. They can cause your scalp to be so sore even brushing or combing your hair may be painful.

Diagnosing and treating tension headaches

If you have a minor headache associated with missing a good night’s sleep, skipping meals, or other likely causes, once you get some rest or a stressful situation resolves, your tension-type headache will likely resolve. Over-the-counter medications like aspirin or ibuprofen can help, if needed.

Self-help measures for infrequent tension-type headaches include taking a hot shower or applying moist heat to the back of your neck. Other alternative, non-drug approaches for relieving and helping prevent chronic tension-type headaches include cognitive-behavioral therapy, relaxation techniques, yoga, physical therapy, massage, and gentle exercise of the neck, according to NINDS experts.

But if your headaches are new or likely triggered by other health issues — like arthritis of the neck, depression, or TMJ — the first step in finding relief involves a doctor visit to evaluate your head discomfort and treat any likely headache-linked problems. If you have frequent tension headaches and risk factors for sleep apnea (including a history of snoring, obesity, or daytime sleepiness), your doctor will likely order a sleep study to see if sleep apnea is behind your headaches.

Even if you have a history of tension headaches, don’t assume that any new type of headache with different symptoms is related. The NINDS advises calling your doctor or getting urgent medical care if you, or someone you are with, experiences a headache that is severe and different from “regular” headaches. Symptoms could indicate a serious and even life-threatening condition, including a stroke.

Examples of signs indicating immediate medical care is needed include a:

• Sudden severe headache (often described as the “worst ever”)
• Headache associated with confusion, weakness, or loss of consciousness
• Headache that gets worse over days or weeks
• Headache accompanied by weakness in part of the body
• Headache following a head trauma

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