There are two major types of tension headaches.
Episodic tension headaches follow a stressful event. Chronic tension headaches are associated with contraction of the muscles that stretch from the back of the neck over the top of the head.
Symptoms of tension headaches include tight, squeezing, gripping pain. The pain may be felt in the following areas: across the foreheadbehind the eyesover the top of the head
The pain often settles in the back of the neck, and is worse when the person moves. The person may have insomnia, or be sensitive to sounds and light.
Tension headaches are associated with muscle contractions, but there is no proof that the contractions cause the headache. The following are believed to contribute to tension headaches: anxietydepressionpoor posturepsychological disorderssocial concernsstress
Stress management may prevent some cases of tension headache, as can relaxation routines, biofeedback and meditation.
Medications used to prevent chronic tension headaches include: amitriptyline (i.e., Elavil)desipramine (i.e., Norpramin)imipramine (i.e., Tofranil)nortriptyline (i.e., Pamelor)beta blockers such as propranolol (i.e., Inderal), nadolol (i.e., Corgard) or atenolol (i.e., Tenormin)isometheptene-dichloralphenazone-acetaminophen (i.e., Midrin)
Diagnosis of a tension headache begins with a history and physical exam. The healthcare provider may order tests to rule out other causes of the headache. These may include a cranial CT scan or cranial MRI.
While some tension headaches may improve with resolution of stressors or triggers, some tension headaches may become relentless and daily. On rare occasion the treatment may require hospitalization.
Tension headaches are not contagious, and pose no risk to others.
Medications used to treat tension headaches include the following: aspirinbarbiturates, such as butalbital in combination with various pain medicinesopioids, such as codeine with acetaminophennonsteroidal anti-inflammatory drugs, NSAIDs, including ibuprofen (i.e., Advil, Motrin, ketoprofen (i.e., Orudis), ketorolac (i.e., Toradol), fenoprofen, and naproxen (i.e., Aleve, Naprosyn)sedatives, such as prochlorperazine or promethazine
However, the same medicines can cause or at least trigger tension headaches if they are taken too frequently. As such, opioids should usually be avoided, but can be useful for occasional severe headaches. Physical therapy, including ice packs and massage, can help relieve pain.
Medications used to treat tension headaches may cause stomach upset, drowsiness, rash, or allergic reactions. Individuals who are given long-term treatment with opioids may develop dependence.
A person with tension headaches may benefit from stress management techniques. Biofeedback and relaxation therapy can teach the individual to control the responses that lead to the headache. Counseling or cognitive-behavioral therapy can be helpful for some individuals.
Any new or worsening symptoms should be reported to the healthcare provider.