Tension Headache

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    Last Updated: October 13, 2024

    Tension headaches are often described as a dull ache, pressure, or tightness on both sides of the head – starting from the forehead and continuing to the base of the skull. They are very common, and approximately 30-70% of people will experience at least one in their lifetimes.

    Tension Headache falls under the Pain category.

    What are tension headaches?

    Tension headaches or tension-type headaches were formerly called “muscle contraction headaches.” They are often described as dull aches, pressure, or tightness on both sides of the head. They can be further classified into frequent or infrequent episodic or chronic tension type headaches.[1][2]

    How are tension headaches diagnosed?

    Tension headaches typically do not require an official diagnosis if they are not very severe or frequent and do not occur secondary to another health condition. Tension headaches can be differentiated from other types of headaches because they usually respond to over-the-counter treatments such as acetaminophen and ibuprofen.[3][4]

    What are some of the main medical treatments for tension headaches?

    Most often, tension headaches are treated with over-the-counter treatments including non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil), diclofenac (Voltaren), and naproxen (Aleve). Other commonly used medications include acetaminophen (Tylenol) and aspirin. Botulinum toxin (botox) injections have been used with limited success. To avoid the development of chronic headache, it is recommended that these treatments are used no more than two times weekly.[3]

    Have any supplements been studied for tension headaches?

    Whether certain dietary supplements help tension headaches has not been explored at length in clinical research or clinical guidelines. Limited research has been conducted with melatonin, 5-hydroxytryptophan (5-HTP), and riboflavin.[5][6]

    How could diet affect tension headaches?

    The connection between diet and tension headache has not been explored at length in clinical research or clinical guidelines.[5][6]

    Are there any other treatments for tension headaches?

    Certain modalities are beneficial for stress reduction and also seem to help reduce tension headaches. Some examples include acupuncture, chiropractics, trigger point therapy, massage, magnet therapy, and others.[3]

    What causes tension headaches?

    The exact cause of tension headaches is unknown and can differ if the tension headache is infrequent or frequent (chronic). Some research suggests that the pain occurs from muscle tenderness and nerve sensitization on the outside of the head. This can be brought on by stress, poor posture, and possibly weak neck muscles. Increased frequency of tension headache is thought to occur because the nerves around the head become more and more sensitive over time.[3][7] Episodic headaches can be secondary to factors such as poor sleep, muscle tension, eye strain, low blood sugar, and others.[8]

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    Frequently asked questions

    What are tension headaches?

    Tension headaches or tension-type headaches were formerly called “muscle contraction headaches.” They are often described as dull aches, pressure, or tightness on both sides of the head. They can be further classified into frequent or infrequent episodic or chronic tension type headaches.[1][2]

    When do I need to see a doctor for a headache?

    Certain red-flags can differentiate between ordinary tension headaches and more serious conditions:[8]

    • The headache is sudden and severe, and reaches maximal intensity immediately.
    • The headache is the “worst of your life”.
    • The headache occurs upon performing the Valsalva maneuver (bearing down), possibly while lifting a heavy object, straining during a bowel movement, or having sexual intercouse.
    • The headaches only started after 50 years of age or after pregnancy.
    • The headaches worsen or improve when changing positions from sitting up to laying down (or vice-versa).
    • The headaches are worse in the morning, and get better during the day on most days.
    • Other symptoms start along with the headache (fever, muscle pain, weight loss, neurological symptoms)

    Note that the following list is not comprehensive, and when in doubt, always check with a health-care provider.

    How are tension headaches diagnosed?

    Tension headaches typically do not require an official diagnosis if they are not very severe or frequent and do not occur secondary to another health condition. Tension headaches can be differentiated from other types of headaches because they usually respond to over-the-counter treatments such as acetaminophen and ibuprofen.[3][4]

    What are some of the main medical treatments for tension headaches?

    Most often, tension headaches are treated with over-the-counter treatments including non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil), diclofenac (Voltaren), and naproxen (Aleve). Other commonly used medications include acetaminophen (Tylenol) and aspirin. Botulinum toxin (botox) injections have been used with limited success. To avoid the development of chronic headache, it is recommended that these treatments are used no more than two times weekly.[3]

    Have any supplements been studied for tension headaches?

    Whether certain dietary supplements help tension headaches has not been explored at length in clinical research or clinical guidelines. Limited research has been conducted with melatonin, 5-hydroxytryptophan (5-HTP), and riboflavin.[5][6]

    How could diet affect tension headaches?

    The connection between diet and tension headache has not been explored at length in clinical research or clinical guidelines.[5][6]

    Are there any other treatments for tension headaches?

    Certain modalities are beneficial for stress reduction and also seem to help reduce tension headaches. Some examples include acupuncture, chiropractics, trigger point therapy, massage, magnet therapy, and others.[3]

    What lifestyle considerations can help prevent tension headaches?

    Lifestyle factors such as smoking cessation and stress reduction can prevent tension headaches. Below is a non-comprehensive list of factors to consider when trying to determine preventative actions.

    • Water consumption: Based on activities and environment, headaches can be secondary to dehydration. If you think this is the case, drinking a few glasses of water may help.
    • Posture: Sitting hunched over a computer or in a car for a prolonged period of time or waking up in a strange position may cause a tension headache. Doing 10-15 minutes of light stretches or a self-massage may help.
    • Adequate rest: Most adults sleep 6-8 hours to feel refreshed the next day, and insufficient sleep may lead to tension headaches.
    • Eye strain: Prolonged focusing on small text or staring at screens may cause tension headaches. The “20-20-20 rule” suggests that, for every 2o minutes of screen time, one should spend 20 seconds looking at an object at least 20 feet away.
    • Adequate nutrition: Insufficient total energy or micronutrients may contribute to tension headaches.
    What causes tension headaches?

    The exact cause of tension headaches is unknown and can differ if the tension headache is infrequent or frequent (chronic). Some research suggests that the pain occurs from muscle tenderness and nerve sensitization on the outside of the head. This can be brought on by stress, poor posture, and possibly weak neck muscles. Increased frequency of tension headache is thought to occur because the nerves around the head become more and more sensitive over time.[3][7] Episodic headaches can be secondary to factors such as poor sleep, muscle tension, eye strain, low blood sugar, and others.[8]

    References

    1. ^Barry L Hainer, Eric M MathesonApproach to acute headache in adultsAm Fam Physician.(2013 May 15)
    2. ^Tension-Type Headache Awareness Campaign
    3. ^Paul J Millea, Jonathan J BrodieTension-type headacheAm Fam Physician.(2002 Sep 1)
    4. ^Anne WallingFrequent Headaches: Evaluation and ManagementAm Fam Physician.(2020 Apr 1)
    5. ^Paolo Curatolo, Romina MoaveroUse of Nutraceutical Ingredient Combinations in the Management of Tension-Type Headaches with or without Sleep DisordersNutrients.(2021 May 13)
    6. ^Jeremy Y Ng, Christina HannaHeadache and migraine clinical practice guidelines: a systematic review and assessment of complementary and alternative medicine recommendationsBMC Complement Med Ther.(2021 Sep 22)
    7. ^
    8. ^Joseph R Yancey, Richard Sheridan, Kelly G KorenChronic daily headache: diagnosis and managementAm Fam Physician.(2014 Apr 15)

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