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Tension Headache

Learn if your headaches are tension headaches and how to better treat them.
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Medically reviewed by
2019 - 2020 - MS and Clinical Neuroimmunology Fellow, Columbia University Irving Medical Center
Last updated January 4, 2021

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What is a tension headache?

A tension headache feels like pressure pain around your head as opposed to headache pain in one spot. It can seem like a tight band is squeezing your head. You may also notice pain and tightness in the back of your neck.

Typically the pain is bearable and goes away on its own in a few hours or you can use over-the-counter (OTC) pain relievers.

Most common symptoms

Pro Tip

If you are suffering from multiple headaches, start keeping a journal to track frequency, severity, response to medication, wellness habits (for example, exercise and sleep quantity), and potential triggers (for example, workload, interpersonal conflict, or major life event. —Dr. Kathryn Fong

By far the most common symptom of a tension headache is mild pain that comes on slowly, and gradually gets worse. It feels like a tight band wrapped around your head. Pain and tightness may also spread to the back of your neck.

  • All-over dull pain on both sides of your head.
  • Pain feels like a band wrapping around your head.
  • Pain comes on slowly, not suddenly.
  • Pain is mild, not severe.
  • Pain may spread to your neck.

Severe head pain, pain on one side of the head only, nausea, vomiting, or pain that gets worse with physical activity or because of bright light or noise are not signs of tension headache. It may be a migraine or be caused by other issues. You should talk to your doctor.

Tension headache causes

Scientists have an idea of what may set off a tension headache, but the specific causes remain unclear. Genetics are not thought to be a factor. They can be triggered by:

  • Stress
  • Lack of sleep
  • Anxiety
  • Depression
  • Repressed resentment, anger, and hostility.

Examples of tension headache triggers include the death of a loved one, coping with chronic illness (yours or someone close to you), losing a job, problems at home, financial difficulties, divorce, moving, and preparing for big events such as tests, vacations, and even weddings.

How do you get rid of tension headaches?

Dr. Rx

Scalp massage, acupuncture, or aromatherapy as relaxation strategies may be helpful for treating headaches. —Dr. Fong

Most of the time, tension headaches get better on their own and usually don’t require a doctor visit. Some treatment approaches are:

  • Stress-reduction, take a break to relax and see if it goes away on its own within a few hours.
  • For faster relief, take OTC pain relievers like ibuprofen (Advil or Motrin), acetaminophen (Tylenol), or naproxen (Aleve). For some people, a drugstore combination pill that contains aspirin, acetaminophen, and caffeine (Excedrin) works best.
  • If you get tension headaches regularly and OTC pain relievers don’t help, talk to your doctor. They may suggest taking a preventive medication on a daily basis, such as the tricyclic antidepressant called amitriptyline.
  • Talk therapy, such as cognitive behavioral therapy, can help if issues like anxiety or depression may be contributing to the headaches. A therapist can help you recognize and better understand the specific stressors in your life and develop coping skills.

Are tension headaches serious?

While a tension headache isn’t usually serious, a change in symptoms could be a sign of something else. Talk to your doctor if headaches increase in frequency (weekly or daily) or feel different (different kind of pain or different pain location). And if you have new symptoms such as: fever, weight loss, double vision, hearing change, numbness/tingling, or reduced arm or leg strength/coordination.

Call 911 or seek urgent medical care if the following red-flag symptoms occur:

  • Sudden onset of severe headache pain, or the “worst headache of my life.”
  • Headache with sudden onset disability like difficulty speaking, vision loss, numbness, arm or leg paralysis, difficulty walking, or generalized convulsive seizure.
  • Severe headache pain with fever, nausea, vomiting, and/or loss of consciousness.
  • Let a family member or friend know if you have a severe headache with the above red-flag symptoms so that someone can help get you to medical care.

Tension headache vs. migraine

Pro Tip

If headache frequency is at the point where you can remember your last 3 headache episodes, get checked by a doctor to confirm whether you have tension vs migraine type headaches—and to come up with a plan to break the headache cycle. —Dr. Fong

Typically, tension headaches are milder than migraine headaches. Tension headache pain does not stop you from doing your daily activities and generally goes away sooner than a migraine, which could last for hours to days. Whereas most people work through a tension headache, people with migraine seek dark, quiet places to rest and recover from the headache episode.

Unlike migraine, tension headaches aren't affected by light, sound, or smell, and don’t come with vision changes, known as an “aura,” or nausea or vomiting. These all can occur with a migraine.

Preventative tips

Lifestyle changes can go a long way to preventing headaches. In addition to doing your best to address sources of stress in your daily life, aim to:

  • Eat an overall healthy, balanced diet. An example of a healthy eating plan is the Mediterranean diet. In general, try to avoid processed foods with excess sugar and salt.
  • Drink more water. Aim for 8 glasses of water each day plus more water if drinking caffeinated beverages, such as coffee, or alcohol.
  • Get enough sleep. A good night’s rest gives the brain time to recover from the day and get ready for the next. Lack of sleep can contribute to tension headaches.
  • Decrease stress. Reducing stress is much easier said than done, but taking up calming activities such as yoga or meditation can help you deal with typical everyday stressors before a headache starts.
Share your story

Dr. Dasani is a resident physician at Penn and Brigham and Women's Hospitals. She graduated from Columbia University in 2013 with a BA in Neuroscience and Behavior. Upon graduation, she served as a Fulbright scholar on the island, Bangka, Indonesia. After her Fulbright, she pursued a MD/MBA at Penn during which she worked on various health care consulting projects solving problems across multiple sectors of the health care system. She is currently a medicine resident physician at Penn and is planning to continue her anesthesia training at Harvard starting in July 2020. She is primarily interested in increasing the efficiency of health systems delivery with attention to patient safety, specifically within the perioperative realm.

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