Tension Headaches: Triggers and Treatment

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Tension headaches are the most common type of headache disorder. You can experience them once in a while or chronically. With a tension headache, you may have head pain, irritability, or trouble concentrating.

This article will explore what a tension headache is, its symptoms, and its triggers. It will also cover how tension headaches are diagnosed and treated.

Tension Headaches May Resemble a Rubber Band Around Your Head
plherrera / Getty Images

What Are Tension Headaches?

Tension headaches are a primary headache disorder, not a symptom of another medical or neurological problem. Typically, tension headaches are diagnosed based on symptoms, but you may need some diagnostic tests to rule out another cause of your headaches.

Tension headaches are bothersome, but they are not dangerous, and they are usually managed with over-the-counter (OTC) medication and by getting some rest.

Symptoms of Tension Headaches

Tension headaches are common, and most children and adults have experienced them at some point. They can begin at any age, and you can have bouts of frequent tension headaches that recur for weeks or months at a time.

Head pain is the most prominent symptom of a tension headache. These headaches are characterized by a dull tightening or pressure on both sides of the head. They may start at the forehead and radiate to the back of the head. A tension headache can feel like a nagging "rubber band around the head" sensation.

Aside from head pain, a tension headache can cause:

  • Irritability
  • Trouble sleeping
  • Difficulty concentrating
  • Fatigue
  • Shoulder or upper back stiffness

Tension headaches can last anywhere from 30 minutes to 7 days.

You may experience a slight decrease in your appetite when you have a tension headache, but, unlike migraines, tension headaches are not associated with nausea or vomiting.

Complications

If you overuse pain medication for your tension headaches, you can develop rebound headaches, also called medication overuse headaches or medication withdrawal headaches. These headaches occur when your body becomes accustomed to the medication. Recurrent head pain can begin as pain medication wears off—resulting in a cycle that is hard to break.

Talk to your healthcare provider before taking any medication so you can avoid complications like rebound headaches.

Causes of Tension Headaches

There are several triggers that can increase your likelihood of developing a tension headache. While anyone can develop a tension headache, some people are more prone to them.

Common triggers that precipitate tension headaches include:

  • Lack of sleep: When you don't sleep well or if you don't get enough sleep, you can develop a headache. These usually improve after a good restorative sleep.
  • Stress or anxiety: Worrying, overthinking, and conflicts can trigger a tension headache.
  • Hunger or dehydration: When your body lacks nutrients and fluid, it can manifest as a headache.
  • Uncorrected vision defects: Straining your eyes can cause a headache. If you wear corrective lenses, an increase in headaches could signal that you need an updated prescription due to vision changes.
  • Stress release: After a stressful time—such as studying for exams, working hard on a project, or resolving a conflict—you can experience a headache when you relax and release your pent-up tension.
  • Alcohol: Some people develop tension headaches from drinking alcohol. These headaches are less severe than a migraine or a hangover.
  • Dental problems: Teeth clenching, cavities, and dental work can all trigger tension headaches.
  • Climate: You may get tension headaches when you feel too hot or cold. Humidity can also trigger them.

While triggers may precede a tension headache, you can experience these types of headaches even in the absence of any triggers.

Tension headaches are described as primary headaches, which means that they aren't caused by a medical problem. Nevertheless, if you are prone to tension headaches, small events in your life can make you more likely to experience one.

Diagnosing Tension Headaches

Usually, your description of your headaches can help your medical team distinguish between tension headaches, migraines, cluster headaches, and headaches caused by severe neurological issues.

An accurate diagnosis of tension headaches is important because some health problems can cause headaches, such as meningitis (an infection surrounding the brain), brain tumors, brain aneurysms, strokes or transient ischemic attacks (TIAs), and head trauma. These health problems must be detected and treated promptly.

Tension headaches are quite different from other types of headaches, including migraines. Among the biggest differences is that tension headaches affect both sides of the head, whereas most migraines are localized to one side of the head.

You may need to have some diagnostic tests as part of the evaluation for your headaches.

Diagnostic Tests

If there is a concern that you could have a serious disorder, you may have one or more diagnostic tests.

  • Brain imaging: A computerized tomography (CT) or magnetic resonance imaging (MRI) of the brain can detect headache-inducing changes such as tumors, bleeds, or inflammation.
  • Blood tests: Severe medical illnesses, such sepsis (a blood infection) can cause headaches. Blood tests such as a complete blood count (CBC), electrolyte levels, inflammatory markers, or liver function tests can help identify these problems.
  • Lumbar puncture (LP): An LP, often referred to as a spinal tap, is a diagnostic procedure that involves collecting spinal fluid with a needle placed in the lower back. This test is used when there is a chance of an infection or inflammation in or near the brain or to measure spinal fluid pressure to test for idiopathic intracranial hypertension.
  • Sleep study: A sleep study is a non-invasive test that is usually done overnight. It can help in identifying sleep issues that could prevent you from getting enough restorative sleep.

Treatment of Tension Headaches

Tension headaches usually resolve with home remedies or over-the-counter (OTC) medications.

When you have a tension headache, you can try strategies such as:

  • Getting some sleep
  • Taking a break from what you are doing
  • Make your environment more comfortable by adjusting the temperature
  • Moderate intensity exercise
  • Drinking fluids
  • A caffeinated beverage
  • A cold pack on your head or shoulders
  • Doing something enjoyable

You might improve your tension headaches with some of these strategies but not others. It is important to do what works for you when managing your tension headaches.

Examples of medications often used for treating a tension headache include:

  • Tylenol (acetaminophen)
  • Non-steroidal anti-inflammatories (NSAIDs) like Aleve (naproxen sodium), Motrin/Advil (ibuprofen), and Bayer/Bufferin/Ecotrin (aspirin)  
  • Excedrin Tension Headache contains a combination of acetaminophen and caffeine.

​​As always, it's important to talk with your healthcare provider before taking any medication, including OTC therapies, to ensure it's safe for you. Be sure to limit any medication for your tension headache to no more than three times a week to prevent medication overuse headaches or side effects like stomach upset (common with NSAIDs) or kidney or liver problems (which can happen with acetaminophen overuse or from using acetaminophen if you are a heavy alcohol drinker).

Keep in mind that it is beneficial to combine home remedies with OTC medications. But you have to be careful when using a combination of methods to manage your headaches.

For example:

  • Drinking a caffeinated beverage and also using an OTC therapy that contains caffeine can be harmful to your health.
  • Using more than one NSAID can cause side effects, such as bruising.

Preventing Tension Headaches

Prevention is a critical component of managing tension headaches. If you notice that things like sleep deprivation, alcohol, or certain stressful situations trigger your headaches, it can help to avoid these precipitating factors. Maintaining a regular sleep schedule can effectively reduce tension headaches for many people.

While it is impossible to avoid stress completely, it helps to think about ways to manage stressful situations and pre-emptively plan for conflict management techniques when you anticipate a headache-inducing event.

Preventative Medication

Infrequent tension headaches generally do not need to be treated with preventive prescription medication. However, if you have chronic tension headaches, you may benefit from these types of medications to help reduce the frequency and duration of your headaches.

Medications that may be effective in chronic tension headache prevention include Elavil (amitriptyline) and Neurontin (gabapentin). Preventative headache medications are available by prescription, and they are taken on a daily schedule. They do not treat an ongoing headache or reduce the pain of a headache while it's already occuring.

Behavioral Strategies

Behavioral therapies are also sometimes used on their own or in combination with preventative medication to reduce the occurrence of chronic or recurrent tension-type headaches. However, the data on the effectiveness of these therapies is not strong.

Some examples of behavioral therapies that are occasionally used for tension headache prevention include:

  • Acupuncture
  • Biofeedback
  • Cognitive behavioral therapy (CBT)
  • Massage Therapy
  • Physical therapy

Summary

Tension headaches are among the most common headaches most people suffer at some point. Causes might include stress, lack of sleep, dehydration or hunger, and dental problems. It's important to rule out more serious causes of headaches, including meningitis, head trauma, brain bleeds, and tumors. Lifestyle changes and appropriate medication use can treat and prevent tension headaches. If you're concerned about the headaches you are experiencing, speak with a healthcare provider.

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By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.