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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Headache, Tension

What is it?

Tension headaches, or stress headaches, are the most common type of headache in adults. They were so named because it was once theorized that tensing and stretching of the scalp and neck muscles caused the pain. However, it is now known that muscle tension itself does not cause such headaches (although it may exacerbate them). Such headaches are presumed to be the body's response to stress in a person's life, although the stress cannot always be identified. Tension headache symptoms may overlap with migraine, and in fact, people may suffer simultaneously from both tension headaches and migraines because both are so common (see Headache, Migraine, for more information). Pain and pressure from tension headaches may occur intermittently and last for hours at a time. Tension headaches most commonly affect people of middle age and older. Treatment is aimed at relieving symptoms.

What Causes It?

  • The cause of tension headaches is unknown. However, certain conditions seem to be associated with the onset or worsening of a tension headache, including stress and fatigue; depression or anxiety; too little or too much sleep; a noisy environment; physically exhausting work; and eyestrain.
  • Contrary to popular belief , mental concentration does not cause headaches; eyestrain and poor posture while sitting are more likely culprits in such cases.
  • Whether depression and anxiety are the cause or the result of chronic, unremitting tension headaches is controversial.
  • Overuse of medication or caffeine withdrawal can cause tension headaches.

Prevention

  • Get plenty of rest.
  • Reduce stress; allow time in your schedule for regular exercise and relaxation.

Diagnosis

  • Patient history and the presence of symptoms suggest positive diagnosis.
  • In severe or persistent cases, a doctor may perform vision tests or sinus x-ray. MRI or CT scan is not necessary unless a neurological exam is abnormal. Although brain tumor is often feared by patients, the chance that tension headache alone would be caused by a tumor is less than one in 10,000.

How to Treat It

  • Over-the-counter pain relievers (such as aspirin, ibuprofen, naproxen, or acetaminophen) may be taken as needed. Daily use of these medications for more than one week, however, should be avoided.
  • Massaging the muscles of the scalp and neck may help reduce pain.
  • A hot bath may help relax muscles and ease the headache.
  • A brief nap or even a rest in a dark, quiet room may be helpful.
  • Relaxation training may be advised.
  • Biofeedback—a technique in which the patient learns voluntary control over certain of the body's activities—may be used to treat tension headaches.
  • Patients with daily headaches over months or years usually have depression or anxiety. Antidepressant medications or tranquilizers may be prescribed.

When to Call a Doctor

  • Call a doctor if headache is severe, persists more than 24 hours, or is accompanied by other symptoms, such as fever, drowsiness, nausea and vomiting, blurred or double vision, or weakness.