What Is a Chronic Tension Headache?

Most people have at one time or another experienced a tension-type headache. The pain is typically a dull tightening or pressure on both sides of the head, often described as having a tight rubber band around the head.

Tension headaches are typically caused by stress, anxiety, dehydration, fasting, or lack of sleep and usually resolve with over-the-counter medicine, like Tylenol (acetaminophen).

Some people experience these headaches frequently, a condition known as chronic tension-type headaches. A primary headache disorder that affects approximately 3% of the population, chronic tension headaches can occur daily and negatively impact one's quality of life and daily functioning.

Symptoms

Tension headaches are commonly referred to as "stress headaches" or "muscle contraction headaches." They are typically a dull, aching pain and may include tightness or pressure across the forehead, sides or back of your head. Some people experience tenderness on the scalp, neck, and shoulders as well.

Causes

Tension-type headaches are typically caused by tight muscles in the shoulders, neck, scalp, and jaw. Teeth grinding (bruxism) and clenching the jaw can also be a factor.

Headaches can be due to stress, depression, or anxiety, and are more common in people who work long hours in stressful jobs, do not get enough sleep at night, skip meals, or regularly drink alcoholic beverages.

Diagnosis

If you are experiencing headaches that interfere with your daily life or you need to take medication for your headache more than twice a week, talk to your healthcare provider.

Prior to your appointment, it can be helpful to keep a headache diary noting the days, times, description of the pain, intensity, and other symptoms. Some questions your healthcare provider might ask include:

• Does your pain pulsate, is it sharp or stabbing, or is it constant and dull?
• Are you able to work?
• Do your headaches interfere with your sleeping?
• Where do you feel the pain? Is it all over your head, on only one side of your head, or just on your forehead or behind your eyes?

Your healthcare provider will likely be able to diagnose you based on symptoms alone. However, if your headaches don't fit into a usual pattern, your practitioner may order imaging tests, such as Magnetic resonance imaging (MRI) or Computerized tomography (CT) scans to rule out other diagnoses.

Chronic tension-type headaches can often be confused with other chronic daily headache disorders like chronic migraine, hemicrania continua, temporomandibular joint dysfunction (TMJ), or cluster headaches.

Treatment

Pharmacological therapy for sufferers of chronic tension headaches usually involves a preventive medication.

Amitriptyline (Elavil) is one medication that has been found to be beneficial in chronic tension headache prevention. Amitriptyline – a tricyclic antidepressant – is a sedating medication and is usually taken at bedtime.

Additional preventive medications that your healthcare provider may consider include other antidepressants—like Remeron (mirtazapine), or an anti-seizure medication—like Neurontin (gabapentin) or Topamax (topiramate).

Your healthcare provider may also prescribe medication to treat headache episodes, such as:

• Prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) including acetaminophen, naproxen, indomethacin, ketorolac, or naproxen
• Opiates
• Muscle relaxants
• Benzodiazepines, such as Valium

Non-Drug Treatments

Behavioral therapies are sometimes used alone or in combination with medication to prevent chronic tension headaches. Examples of behavioral therapies include:

Acupuncture: Acupuncture is an alternative therapy that involves using needles to stimulate specific points on the body believed to connect with certain pathways (or "meridians") that carry vital energy (or "chi") throughout the body.

Biofeedback: In Electromyography (EMG) biofeedback, electrodes are placed on the scalp, neck and upper body to detect muscle contraction. The patient is then trained to control that muscle tension in hopes of preventing a headache.

The process, however, is costly and time-consuming, and there is a lack of evidence to support its effectiveness for treating or preventing tension headaches.

Physical therapy: A physical therapist can prescribe exercises that work on tight head and neck muscles.

Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy involves learning how to identify headache triggers and cope with them in a more adaptive, less stressful manner. Many headache specialists will often recommend CBT in addition to medication when devising a treatment plan for their patients.

Treating teeth-grinding and jaw-clenching can help when those are causing the headached. In addition, getting regular exercise as well as practicing good sleep hygiene can be beneficial in preventing tension headaches.

Supplements

Some people with chronic tension headaches find relief using supplements. The American Academy of Neurology and the American Headache Society reports the following supplements are possibly effective:

• Butterbur
• Feverfew
• Magnesium
• Riboflavin 

A Word From Verywell

Chronic tension headache is an uncommon, debilitating form of a tension headache. It can interfere with work, relationships, and daily living. If you are affected by headaches that occur 15 or more days per month on average for more than three months, see your healthcare provider, who can prescribe medication to help treat and prevent chronic tension-type headaches.

If the headaches come on suddenly, wake you up from sleep, or last for days at a time, it's also important to see a healthcare provider to rule out any underlying causes of your headaches.