A Headache is pain or discomfort in the head, scalp, or neck, usually associated with muscle tightness in these areas.

Causes, incidence, and risk factors

Tension headaches are one of the most common forms of headaches. They may occur at any age, but are most common in adults and adolescents.

If a headache occurs two or more times a week for several months or longer, the condition is considered chronic. Chronic daily headaches can result from the under- or over-treatment of a primary headache. For example, patients who take pain medication more than 3 days a week on a regular basis can develop rebound headaches.

Tension headaches can occur when the patient also has a migraine.

Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, a head injury, 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 other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.

Other triggers of tension headaches include:

  • Alcohol Use
  • Caffeine (too much or withdrawal)
  • Colds and the flu
  • Dental problems such as jaw clenching or teeth grinding
  • Eye strain
  • Excessive smoking
  • Fatigue
  • Nasal Congestion
  • Overexertion
  • Sinus Infection

Tension headaches are not associated with structural changes in the brain.

Signs and tests

A headache that is mild to moderate, not accompanied by other symptoms, and responds to home treatment within a few hours may not need further examination or testing, especially if it has occurred in the past. A tension headache reveals no abnormal findings on a neurological exam. However, tender points (trigger points) in the muscles are often seen in the neck and shoulder areas.

The health care provider should be consulted — to rule out other disorders that can cause headache — if the headache is severe, persistent (does not go away), or if other symptoms are present with the headache.

Headaches that disturb sleep, occur whenever you are active, or that are recurrent or chronic may require examination and treatment by a health care provider.


  • Rebound headaches — headaches that keep coming back — may occur from overuse of painkillers.It’s important to see a doctor if you have chronic headaches. In some cases, the headache may be a symptom of a more serious disorder.


 The headache pain may be described as:

  • Dull, pressure-like (not throbbing)
  • A tight band or vise on the head
  • All over (not just in one point or one side)
  • Worse in the scalp, temples, or back of the neck, and possibly in the shoulders

The pain may occur as an isolated event, constantly, or daily. Pain may last for 30 minutes to 7 days. It may be triggered by  or get worse with stress, fatigue, noise, or glare.

There may be difficulty sleeping.Tension headaches usually do not cause nausea or vomiting.

People with tension headaches tend to try to relieve pain by massaging their scalp, temples, or the bottom of the  neck


Understanding your headache triggers  can help you avoid situations that cause  your headaches. A headache diary can  help you identify your headache  triggers. When you get a headache,  write down the day and time the pain  began. The diary should include notes  about what you ate and drank in the last  24 hours, how much you slept and  when, and what was going on in your  life immediately before the pain started.  For example, were you under any  unusual stress? Also include  information about how long the  headache lasted, and what made it stop.

Hot or cold showers or baths may  relieve a headache for some people. You  may need to make lifestyle changes if  you have chronic tension headaches.  This may include changing your sleep  habits (usually to get more sleep),  increasing exercise, and stretching the  neck and back muscles. In some  situations, you may need to change your  job or recreational habits.

Over-the-counter painkillers such as  aspirin, ibuprofen, or acetaminophen  may relieve pain if relaxation techniques  do not work. If you are planning to take  part in an activity that you know will  trigger a headache, taking one of these  painkillers beforehand may be helpful.

Narcotic pain relievers are sometimes prescribed. Remember that pain  medications only relieve headache  symptoms for a short period of time.  After a while, they do not work as well  or the help they provide does not last as  long. Regular, overuse of pain  medications can lead to rebound  headaches.

Other prescription treatments may  include:

  • Muscle relaxants such as tizanidine
  • Selective serotonin-reuptake inhibitors (SSRIs) such as paroxetine (Paxil) or citalopram (Celexa) taken daily to help prevent or decrease the number of headaches
  • Tricyclic antidepressants such as amitriptyline, nortriptyline, or doxepin taken daily to help prevent or decrease the number of headaches

Combining drug treatment with  relaxation or stress-management training, biofeedback, cognitive behavioral therapy, or acupuncture  may  provide better relief for chronic  headaches.

Botox (botulinum toxin) is becoming popular as a treatment for chronic  daily  headaches, including tension  headaches.  However, it is currently not  approved  for such use.

 Calling your health  care provider

  • You are experiencing “the worst headache of your life”
  • You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before
  • Your headaches are more severe when lying down
  • The headache starts very suddenly

Also, call your doctor if:

  • Your headache patterns or pain change
  • Treatments that once worked are no longer helpful
  • You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
  • You are pregnant or could become pregnant — some medications should not be taken when pregnant