Chapter 2, Episode 1: What is Tension Headache?


This content has been medically reviewed by Dr. Larry Charleston.

Tension headaches are the most common type of headache. 

Although the cause of tension headache is unknown, it is most likely multi-factorial. Theories include increased sensitivity to pain and muscle tension. 

Most people with tension headache experience a tight or pressing pain on both sides of the head. Tension headaches may last from a few hours to days. Pain is often mild to moderate and headaches are not aggravated by physical activity. Diagnostic criteria for tension headache includes no more than one associated symptom such as photophobia, phonophobia or mild nausea. Moderate to severe nausea or vomiting does not occur with tension headache. 

Migraine differs from tension headache in many ways. First, migraine typically causes moderate to severe head pain that is often unilateral and may be pulsating or throbbing. Second, typical migraine attacks last 4-72 hours and are aggravated by exercise for most people with the disease. Migraine must have at least 2 of the following associated symptoms: photophobia, phonophobia, nausea and vomiting. 

Like migraine, more women are affected by tension headache than men. Triggers for tension headache are the same as migraine and may include stress, lack of sleep, alcohol, menstruation and skipping meals. 

Tension headache is diagnosed by a clinician using the International Classification of Headache Disorders criteria as well as neurological and physical examinations. During the physical examination, a clinician may identify trigger points or tenderness in the pericranial muscles around the skull. Trigger points are sensitive areas of tight muscle fibers that can cause pain. Other conditions, including migraine without aura, should be ruled out prior to diagnosis of tension headache.

Tension headache may be classified as episodic or chronic. Episodic tension headache occurs less than 15 days per month. It may or may not be associated with pericranial muscle tenderness. Chronic tension headache occurs more than 15 days per month for three months or greater. Medication overuse headache may present similarly to tension headache and should be ruled out prior to chronic tension headache diagnosis. 

Using a diary to track symptoms and headache characteristics may be helpful in leading to an accurate diagnosis. Tension headache is often self diagnosed and self treated. 

Abortive medications include NSAIDS such as ibuprofen or naproxen sodium. Antidepressants such as amitriptyline, nortriptyline and mirtazapine are commonly used as preventive medications. Muscle relaxers should be avoided as they have low efficacy for tension headache. Opioids should also be avoided.

Non-pharmacological modalities include psychological therapies such as relaxation therapy, cognitive behavioral therapy and biofeedback. Massage and acupuncture are also common therapies. Physical therapy is one of the most commonly used non-pharmacological treatments for tension headache. 

If you have headaches that are severe, occur frequently or last more than a day, consult with a doctor. 

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This video is sponsored in part by Amgen and Biohaven.

*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.