Pain or discomfort in the head, scalp, or neck, usually associated with muscle tightness in these areas.

Alternative Names

Muscle contraction headache; Benign headache; Headache - tension

Causes, incidence, and risk factors

A tension headache is one of the most common forms of headache . It can occur at any age, but is most common in adults and adolescents. If headache occurs two or more times weekly for several months or longer, the condition is considered chronic . Tension headache is a result of contraction of the neck and scalp muscles. One cause of this muscle contraction is a response to stress , depression or anxiety . Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or use of computers, fine work with the hands and use of a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position can also trigger this type of headache. Other causes include eye strain, fatigue , alcohol use , excessive smoking , excessive caffeine use, sinus infection , nasal congestion , overexertion, colds and influenza . Tension headaches are not associated with structural lesions in the brain.

Signs and tests

A headache that is mild to moderate, not accompanied by other symptoms and that responds to home treatment within a few hours may not need further examination or testing. If a neurologic examination is performed, tension headache causes no abnormal findings but musculoskeletal tenderness is often present.

The health care provider should be consulted (to rule out other disorders that can cause head pain ) if a headache is severe, persistent or if other symptoms accompany the headache. Headaches that disturb sleep, occur whenever the person is active, or that are recurrent or chronic may also require examination and treatment by a health care provider.

Treatment

Treatment is aimed at relieving symptoms and preventing recurrence of the headache. Prevention is the best treatment. If possible, remove or control precipitating factors. Learn and practice stress management strategies. Relaxation through meditation, relaxation exercises or other means can be helpful for some people. Biofeedback (a means of providing information about certain body functions) may aid in performance of relaxation exercises and may be helpful for chronic tension headache. Other preventive measures may include keeping warm if the headache is associated with cold, using a different pillow or sleeping position or similar changes. Use good posture when reading, working or doing other activities that may cause headache. Exercise the neck and shoulders frequently when typing, working on computers, doing close work, etc. Adequate sleep and rest or massage of sore muscles can help reduce the chance that a headache will occur. Hot or cold showers or baths may relieve a headache for some people. Over-the-counter analgesics such as aspirin, ibruprofen or acetominophen may relieve pain if the above measures are ineffective. An antidepressant or other medications may be advised for chronic headache. The use of a nonsedating muscle relaxant like Skelaxin has also been of some benefit to patients. A headache diary may be used to try to identify the source of chronic headaches. When a headache occurs, write down the date and time the headache began. Note what was eaten for the preceding 24 hours, sleep pattern and amount of sleep, what was being experienced immediately before the headache, unusual stress or other circumstances, how long the headache lasted and what made it stop. Lifestyle changes may be required for chronic tension headaches. This may include adequate rest and exercise, change in job or recreational habits or other changes.

Expectations (prognosis)

Tension headaches usually respond well to treatment without residual effects. They are annoying, but not dangerous.

Complications

The headache may not be a tension headache, but it may be a symptom of another more serious disorder. Rebound headaches may occur from overuse of analgesic medications.

Calling your health care provider

See your health care provider if headaches occur and are severe, persistent, recurrent or accompanied by other symptoms (such as drowsiness , vision changes, changes in movement or sensation, seizures , changes in alertness, nausea/vomiting or other symptoms). Also call if headaches disturb sleep, occur whenever the person is active, are recurrent or chronic or if a headache does not respond to treatment.

Prevention

Avoid situations that may cause tension headache. This can include keeping warm if the headache is associated with cold, using a different pillow or sleeping position or similar changes. Use good posture when reading, working or involved in activities that may cause headache . Exercise the neck and shoulders frequently.