What is a tension headache?

A tension-type headache (TTH) or tension headache is the most common type of headache. It is often felt behind the eyes, in the temples, forehead, and neck, radiating from the lower back of the head. It is described as a pressure or tightness and causes persistent, mild-to-moderate dull pain.

Are some people more prone to tension headaches?

Tension headaches can occur at any age, but mostly affect adults. Women are more prone to them than men. It Is suspected that genetic factors also play a role.  

How are tension headaches classified?

Tension-type headaches can be classified according to frequency:

• infrequent episodic: a headache occurring occasionally or once a month
• frequent episodic: from one to 15 attacks per month
• chronic: occurring more than 15 times a month

What are the symptoms?

The symptoms of tension-type headaches are persistent, dull headaches on both sides of the head that comes on quite slowly. The pain can be mild to moderate and it usually affects the occipital area. Furthermore, you may also develop sensitivity to light and sound. You may experience a pain that is usually described as if the head were being squeezed in a vice.

What causes tension headaches?

It is not clear yet what causes tension-type headaches; however, it has been hypothesised that they may be caused by a prolonged contraction of the muscles on the lower back of the head, the forehead, temples, neck, and shoulders. Furthermore, tension-type headaches can also be associated with problems of the mandibular joint, hormone imbalance, and misuse of medications.  

What triggers tension headaches?

TTH may be triggered by: 

• stressful events
• anxiety or depression
• dehydration
• skipping meals
• dental problems
• eye strain
• sinus infections
• poor posture
• lack of sleep or fatigue
• bright and noisy environments
• excessive caffeine
• smoking
• alcohol
• overuse of pain relief medication

How do you get rid of tension headaches?

To quickly relief the pain caused by a tension headache:

• take pain relief medicine
• use a hot or cold compress
• massage the head, neck, and shoulder area
• drink water
• rest in a dark place

Can tension headaches be prevented?

The best way to prevent tension headaches is to avoid or change habits that trigger them. If caused by the cold, try to stay warm. Change pillows or sleeping positions, practice good posture, and exercise the neck and shoulder frequently. Relaxation and stretching exercises are also beneficial.

How long do tension headaches last?

The duration and frequency of TTH attacks or episodes depend on your individual case: when it is sporadic, an attack usually lasts 30 minutes to several hours but can last several days. Chronic TTH can involve long-lasting and/or recurrent headaches that occur frequently over a period of weeks, months, or even years.

When should I be worried about a headache?

Most headaches are not serious. There is usually no need to see a doctor if you only suffer headaches occasionally; however, tension headaches don’t usually cause other symptoms so if you experience the following as well, you should see your GP:

• sudden or severe headache
• loss of consciousness
• head injury
• difficulties seeing, walking, or speaking
• numbness in limbs
• nausea or vomiting
• fever
• light-sensitivity
• rash

What is the difference between a migraine and a tension headache?

If the pain caused by a tension headache is severe, you may think that it is a migraine. A tension headache, however, does not cause all of the symptoms of migraines, like vomiting.

How is a tension headache diagnosed?

There are no specific tests that diagnose TTH. Typically, it can be diagnosed by simply describing the symptoms you are suffering from and taking a detailed medical history into account. The doctor might suspect a more serious condition is behind your headaches, like a brain tumour, stroke, or aneurism. They may send you for tests, such as blood tests, sinus x-rays, CT scans, or MRI scans.

How are tension headaches treated?

Chronic TTH tends to be treatment-resistant, but frequent and infrequent tension-type headaches can be treated with medication, biofeedback therapy, and massage therapy. Other treatments, such as cognitive-behavioural therapy, acupuncture, and stress management techniques, may be beneficial as well.

What is the best medicine for a tension headache?

Over-the-counter medications, such as ibuprofen and aspirin are good for short-term pain relief.

You may be prescribed stronger pain killers or:

• antidepressants
• beta-blockers
• muscle relaxants

Overuse of medication can have negative effects, such as your body building up a tolerance and becoming dependent on them. They can also cause rebound headaches, similar to withdrawal. Also, read the instructions carefully and ask your pharmacist for advice.

Which doctor should I see?

If you are suffering from repeated or chronic tension-type headaches, you should see your GP. Depending on the nature of the headaches, you may be referred to a specialised neurologist, psychologist or dental practitioner.