Types of Tension Headaches

Tension type headaches can be a chronic problem that occurs regularly on an everyday basis for some people while others will experience irregular tension headache activity.

• Episodic tension headaches occur less than 15 days in a month
• Chronic tension headaches occur more than 15 days in a month

Depending on the type of headache, a headache can last from less than an hour to several days. Episodic tension headaches are normal and start with a mild pain that usually starts in the middle of the day and can be treated easily by hydrating and taking some over the counter medications. Chronic tension headaches last for a much longer time and while the pain levels may fluctuate, the aching remains persistent.

Where Do Tension Headaches Hurt?

Tension type headache pain generally starts at the back of your skull and then expands forward. The sensation of tightness around your head expands to encompass your forehead which causes the sensation of a tight band wrapped around your head. When fully expanded, a tension headache will cause discomfort on both sides of the head as well as potentially causing muscles tightness in your neck, shoulders, and jaw.

What Are Some Tension Headache Causes?

The exact cause for tension headaches is still up for debate because there are several factors that may impact the likelihood that an individual will suffer from these types of headaches. There can be factors that are genetic that can be difficult to control and other factors that are environmental or due to lifestyle choices. The mechanism that has been determined to be a big contributing factor of tension headaches is generally muscle tightness or contractions around the head and neck. This puts unnecessary pressure on different muscles in the structures that make up your skull which results in tension pain. This muscle tension can also be exacerbated by stress which can increase pressure as some individuals tend to clench their jaws or grind their teeth when stressed out. Beyond that, there are several known headache triggers that can cause the onset of a tension headache:

• Not getting enough sleep or rest
• Incorrect posture
• Emotional stress or depression
• Drugs / alcohol / cigarettes
• Anxiety
• Hunger / dehydration
• Macro / micronutrient deficiency
• Being over caffeinated
• Dental problems
• TMJ disorders
• Being sick or fighting an infection
• Over medication

What are Tension Headache Symptoms?

The most common physical symptoms of tension headaches include:

• Pain that starts at the base of the skull and then expands to encompass the entire head
• Mild to moderate pain levels
• Slow but steady increase in pain
• Typically starts mid-day
• Consistent dull aching
• Pain that is felt on both sides of the head
• Sensation of tightness across the forehead, temples, and back of the head
• Tender muscles around neck, shoulder, and scalp

Due to aggravated pain caused by tension headaches, some mental symptoms also include irritability, difficulty focusing, and trouble sleeping. Symptoms can also vary depending on the type of tension headache. Episodic tension type headaches typically last as short as 30 minutes but can also persist up to a week. If episodic tension headaches happen frequently, they can become chronic. To become chronic tension headaches, the headaches must persist for over 15 days a month for 3 months or more. 

Can Tension Headaches Be Prevented?

Tension headaches can’t always be prevented but avoiding known triggers can definitely help mitigate the onset of tension headaches. By maintaining a healthy lifestyle with regular rest, nutrition, and exercise, most individuals can ensure that tension headache occurrences are not frequent. Ensuring that mental health is prioritized will also help reduce other factors like stress, depression, and anxiety that may prompt a tension headache. There are some additional therapies that can help reduce stress and improve relaxation:

• Biofeedback training: Using biofeedback, an individual can learn to regulate their heartrate and control their breathing which can help reduce muscle tension caused by stress.
• Cognitive behavioral therapy: This type of talk therapy helps manage stress which can reduce the number and strength of tension headaches.
• Relaxation therapy: These therapies include anything that an individual does to reduce stress including yoga, meditation, and deep breathing.

In addition to therapy and positive lifestyle choices, there are some preventative medications that can be used to help minimize the occurrences of tension headaches. These are often recommended for individuals that suffer from chronic tension headaches.

• Antidepressants: Drugs like amitriptyline, protriptyline, venlafaxine, and mirtazapine are all effective antidepressants that will prevent tension type headaches.
• Anticonvulsants / muscle relaxers: Gabapentin and topiramate may also help reduce muscle tension which is often the culprit behind tension headaches.

Tension Headache Treatments

In addition to prevention strategies, there are several medications that can be used to treat tension headaches.

• Pain relievers: These over-the-counter drugs typically contain aspirin, ibuprofen (Motrin & Advil), acetaminophen (Tylenol), and naproxen sodium (Aleve).
• Triptans / narcotics: For more severe instances of tension headaches, stronger medications may be recommended by a doctor. These can include opioids and triptans which are designed to treat more severe headaches like migraines. These types of medications are often used as a last resort due to the increased likelihood of dependency.

Other ways to provide tension headache relief include remedying the problem that may have caused its onset. This could be as simple as drinking water and eating a meal to increase hydration and nutrition or taking a nap to get some additional rest that your body needs.

How are Tension Headaches Diagnosed?

Tension headaches will be diagnosed with a neurological exam with a physician that asks questions about the symptoms that an individual is experiencing. Common questions include:

• When do the headaches happen?
• Where are the headaches occurring?
• How strong is the pain?
• What kind of pain is felt?
• How long do headaches last?
• Have there been any noticeable changes in behavior?
• Are there any potential triggers that have been causing the headaches?
• How much stress are you experiencing?
• Has there been recent trauma to the head or neck?

The responses will determine if further tests are needed. If there is the possibility that the tension headaches are the result of something more serious, then blood tests, x-rays, CT scans, and MRIs may be needed to determine the best treatment option.

When Should I Call a Doctor About Tension Headaches?

Dealing with headaches is often something that can be taken care of at home with OTC medications. That being said, there are several signs that indicate when professional help should be sought out immediately.

• Severe headache with immediate onset
• Headache accompanied by fever, confusion, dizziness, seizures, muscle weakness, stiff neck, numbness, tingling, or trouble communicating
• Headache that occurs after head trauma
• Headache that worsens beyond mild to moderate pain level

Contact an Experienced Headache Doctor if You Have Been Experiencing Tension Headaches

In the event that you have been dealing with episodic or chronic tension type headaches, it may be time to seek professional help from an experienced headache doctor. Dr Kathy Omrani has years of experience successfully treating different headache types that are caused by serious underlying problems. Call today to speak with a representative to schedule an appointment to be seen and treated so you can go about your life without dealing with on-going tension type headaches.