About 90% of headaches are caused by one of three conditions: migraines, cluster headaches and tension headaches. Today we’ll cover the last one.

Danger level: Low

What is it?

Tension headaches (or tension-type headaches) are the most common cause of headaches.

Who gets it?

Tension headaches can happen at any age, but it happens mostly in young adults.

About 30-80% of the adult US population suffers from tension headaches from time to time. It happens twice as much in women.

What causes it?

The exact cause isn’t known. One of the theories behind tension headaches is that the pain is the result of muscle tension in the face, neck and scalp. Yet this hasn’t been proven. Other evidence shows that there is a change in chemicals in our brain which causes this type of headache.

Whatever the cause may be, there are certain triggers, or things which are believed to bring about the headache:

1. Stress – Such as problems at home or with family, around exam time, deadlines at work, etc.
2. Depression and anxiety
3. Not enough rest
4. Poor posture
5. Working in awkward positions or holding one position for a long time
6. Jaw clenching

Stress. It can bring about tension headaches. Photo by vidrio.

How does it feel?

The pain in tension headache is usually mild to moderate. It feels like pressure or tightness around both sides of the head or neck (people will say it feels like a vice). The muscles in the head, neck or shoulders may feel tender.

The pain is usually steady, and activity doesn’t make it worse. It lasts for anything from 30 minutes to several days. It typically starts several hours after waking and worsens as the day progresses.

Unlike migraine headaches, tension headaches usually don’t involve nausea or vomiting, sensitivity to light and sounds or auras (you can read our article about migraine headaches to see what aura means).

Tension headaches can be divided into three categories, according to how often they occur:

1. Infrequent episodic – When it happens less than once per month
2. Frequent episodic – When it occurs 1-14 times per month
3. Chronic – When it happens 15 days or more in a month

Usually people can go on with their daily routine in spite of the headache.

How is it discovered?

The story and physical check are usually enough to diagnose tension headaches, and no special tests are needed.

If the doctor suspects another cause, they may order other tests (such as a CT scan) to rule out other problems.

How is it treated?

A lot of people will just take over-the-counter painkillers for their tension headaches. This can be a problem, since taking too much of those can cause headaches by itself. (these headaches are then called “medication-overuse headaches”).

There are a couple of drugs which can be used against tension headaches:

1. Anti inflammatory drugs – These drugs can both take down inflammation and relieve pain. They are the first drugs used for tension headaches. Examples of such drugs include aspirin, ibuprofen, naproxen, indomethacin, and ketorlac. Acetaminophen may also help. Most of these drugs are over-the-counter drugs (OTC. meaning you don’t need a prescription for them). If OTC drugs don’t work, your doctor may write a prescription for something stronger.
2. Behavioral and psychological interventions – Sometimes relaxation and stress management can help, especially when combined with drugs.

What happens after treatment?

Usually treatment provides relief from the headaches. As long as not too much of the medications is taken (which may cause headaches by itself) they can be controlled.

If you tend to get tension headaches, there are medications which can be taken to prevent these headaches from occurring. These include drugs like antidepressants (those usually used to treat depression), blood pressure medications, and anti-seizure medications. You should consult your doctor about these drugs.

Another option is to deal with the stressors in your life that may bring about these headaches in the first place.

This video sums it up:

What next?

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