Tension Headaches: Symptoms, Causes, Complications, Diagnosis, Treatment, Prevention and Outlook

A man whos holding his head because he has a tension headache


Pain is an unpleasant feeling and it can occur anywhere in the body. One of the most common causes of pain is a headache. Tension headaches, particularly, may bring discomfort to the people experiencing them. Also dubbed as a stress headache, this is common among adults because of having a long and stressful day at work. In some cases, people who work long hours in front of a computer may experience these type of headaches more frequently.

A tension headache happens when the muscles of the head and neck tighten up and squeeze all the structures beneath. It is described as a mild to moderate chronic tightness in the head. It’s as if a band is placed over the head and gradually tighten up, making the structures to produce pain and discomfort. The pressure of a headache tightens the skull and all the structures like the nerves and blood vessels, causing pain.

The pressure is mostly felt at the forehead, back of the head and the neck.
The condition, however, is called benign because it does not indicate a serious underlying cause or illness. However, it can cause alterations in the daily lives of those who have it because they are extremely painful and could last for several days.

About 80 percent of adults in the United States get tension headaches from time to time. About 3 percent have chronic daily tension headaches. Between men and women, the latter suffer from the condition more than men.

Most people who experience tension headaches may have them no more than once or about twice a month. In some people, however, it can happen more often.


The common signs and symptoms of tension headaches include:

  • Mild to moderate pain or pressure on the head, particularly around the front, tip or sides of the head
  • Dull and aching pain
  • Pressure around the forehead
  • Sensation of tightness or pressure across the forehead or the sides of the head
  • Tenderness on the scalp, shoulder muscles and neck
  • Trouble sleeping
  • Irritability
  • Feeling very tired
  • Trouble concentrating or focusing
  • Muscle aches
  • Mild sensitivity to noise or light

Differentiating tension headaches and migraine headache

Tension headaches can be hard to distinguish from migraines. Unlike some forms of migraines, tension headaches are not linked with nausea and vomiting and visual disturbances. Moreover, in tension headaches, you will not have muscle weakness or blurred vision.
Also, they do not cause stomach ache and sensitivity to light.

Episodic tension headaches can last between 30 minutes and a week. However, episodic tension headaches happen about less than 15 days a month for at least three months.

When to seek medical help

If you experience any of these symptoms, seek emergency care immediately:

  • A headache with stiff neck, fever, seizures, mental confusion, double vision, numbness, speaking problems and weakness
  • An abrupt or a severe headache
  • A headache after a trauma or head injury


There is no single cause for tension headaches. Often, these headaches are triggered by stress from work, school, family or experiences. Sometimes, people are not aware that they are feeling tired or stressed, but even simple tasks may produce tension in the neck, head, and shoulders.

Headaches can be triggered by a variety of causes:

  • Stress from various reasons like physical or psychological stresses at work, school or life events.
  • Not getting enough rest or sleep
  • Bad posture due to the use of computers, reading a lot, using a computer for a long time and due to driving.
  • Injury and trauma to the head and neck
  • Emotional or mental stress like depression or anxiety
  • Hunger
  • Fatigue
  • Low iron levels


Tension headaches are very common that they can affect the people in terms of their work and school performance. Moreover, the overall quality of life is not affected that much. However, frequent pains and chronic tension headaches may affect one’s daily activities and in some cases, people with headaches may not be able to attend activities, events, work or school.


To diagnose tension headaches, the doctor will take the complete medical history and conduct a thorough physical examination. Neurological examinations may also be recommended. The doctor will assess for:

Pain intensity – Pain intensity can show the severity of a headache. Also, it can show how severe the effects are in daily activities. Some people may not be able to work or function effectively if they are having tension headaches.

Pain characteristics – The doctor will palpate the head to see if there are pulsations on the area where the pain is felt. Does the pain pulsate, is it dull or constant or is it stabbing or sharp?

Pain location – The doctor will also determine the location of the pain, whether it is located on the side of the head, the back or the forehead. In some cases, the pain may be felt behind the eyes.

In some cases, imaging tests are recommended:

Computerized tomography (CT scan) – A CT scan is a test that can produce 3D cross-sectional images to determine the structures of the head and to potentially detect the cause of a headache.

Magnetic resonance imaging (MRI) – An MRI scan will produce clear images of the structures in the head, the skull, and the brain.


There is no single cure or treatment for tension headaches. Some treatment therapies may work on a person but not on another. It is important to determine what works for you.



Often, patients can take over-the-counter (OTC) painkillers like ibuprofen to reduce tension headaches. Prescription medications may also be taken like ketorolac, indomethacin, and naproxen. However, this medicine should prescribe by a doctor because certain medicines may induce allergic reactions or adverse side effects if taken more frequently.

Triptans and narcotics – In some people who experience tension headaches and migraines, a triptan drug may help provide pain relief of both headaches. Narcotics are rarely prescribed because of the tendencies of addiction and overdose.

Combination medicines – In some people whose headaches are not relieved by the mentioned drugs, combination medicines are recommended. These drugs include those with combinations of aspirin, acetaminophen, and caffeine.

If painkillers do not work, the doctor may prescribe a muscle relaxant, which will help relax the tension in the head and neck. Also, some doctors may prescribe selective serotonin reuptake inhibitor (SSRI). These drugs can stabilize the levels of serotonin in the brain, which will help the patient cope with stress.

Preventive medications

These drugs are prescribed to decrease the frequency of attacks, especially in people with chronic tension headaches that are not managed or relieved by medicines and other methods of treatment.

Anticonvulsants and muscle relaxants – Anticonvulsants and muscle relaxants may prevent tension headaches. These drugs include topiramate (Topamax), which are anticonvulsants.

Tricyclic antidepressants – These antidepressants, including protriptyline and amitriptyline, are prescribed to prevent tension headaches. The common side effects include drowsiness, dry mouth, and constipation.

Other antidepressants – Other antidepressants can help reduce the tendencies of having tension headache attacks. These drugs include mirtazapine (Remeron) and venlafaxine (Effexor XR).

These preventive drugs may require many weeks to work or build up in the system.

Alternative Treatment and Medicine

There are alternative treatments that can be done to provide pain relief for tension headaches including:

Massage – Massage can help provide stress relief. It can also provide pain relief because it promotes circulation. It’s effective for relieving tender and tight muscles in the back of the head, shoulders, and neck.

Acupuncture – Acupuncture may provide temporary pain relief. This is recommended for those who have a chronic headache.

Deep breathing, behavior therapies, and biofeedback – These are relaxation techniques that may relieve pain, and relax tight muscles.


There are many methods you can do at home to relieve pain and tension brought about by headaches.

  • Rest when you’re stressed and feeling a headache
  • Use ice packs or a long and hot shower whichever is needed to relieve pain
  • Manage the stress levels. Make sure you plan the day ahead to prevent stressful situations.
  • Apply heat or cold packs, depending on which is most effective.
  • Correct bad posture. Good posture can help the muscles from being tense.
    Buy ergonomic furniture to help you manage muscle pain and prevent strain.


Aside from using preventive medicines, you can change lifestyle habits to prevent the occurrence of tension headaches. Living a healthy lifestyle may help prevent headaches including:

  • Get enough sleep and rest, especially after a long day’s work
  • Avoid smoking or using tobacco products
  • Exercise regularly
  • Eat well-balanced diets
  • Avoid alcohol intake
  • Avoid caffeine and too much sugar
  • Drink plenty of water
  • Avoid slouching when watching TV or using a computer
  • Do not sleep with too many pillows
  • Maintain a regular time for sleeping
  • Avoid working on the computer when you’re about to sleep
  • Reduce exposure to blue light at night from gadgets and computers
  • Try to have the same amount of sleep each day


Tension headaches are benign or not potentially-fatal. Underlying diseases do not cause them. However, some forms of a headache may signal serious diseases such as stroke and hypertension. It is important to seek medical help if the pain can’t be relieved by any of the measures mentioned above.