A tension headache is a condition involving pain or discomfort in the head, scalp, or neck, usually associated with muscle tightness in these areas.

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.

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 causes of tension headaches include:

• Alcohol use
• Caffeine (too much or withdrawal)
• Colds and the flu
• Eye strain
• Excessive smoking
• Fatigue
• Nasal congestion
• Overexertion
• Sinus infection

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

The headache pain may be described as:

• Dull, pressure-like
• 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

The pain may occur as an insolated 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.

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. If a neurologic (nervous system) examination is performed, a tension headache causes no abnormal findings. However, tenderness in the muscles near the skull is often present.

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 happen with 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.

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 getting plenty of sleep and exercise, stretching the neck and back muscles frequently, and possibly changing 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.

An antidepressant or other medication may be advised for chronic tension headache. A nonsedating muscle relaxant like metaxalone (Skelaxin) helps some patients. In severe cases, the combination of butalbital and acetaminophen (Fioricet) or butalbital and aspirin (Fiorinal) may be helpful.

Tricyclic antidepressants such as amitriptyline, nortriptyline, doxepin taken every day may help decrease the number or prevent the headaches.

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

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.

See your health care provider if headaches are severe, persistent, recurrent, or are accompanied by other symptoms (drowsiness, vision changes, changes in movement or sensation, seizures, changes in alertness, nausea and vomiting).

Also call if headaches disturb sleep, occur whenever you are active, are recurrent or chronic, or if a headache does not respond to treatment.

Learn and practice stress management. Some people find relaxation exercises or meditation helpful. Biofeedback may improve relaxation exercises and may be helpful for chronic tension headache.

Tips to prevent tension headaches:

• Keep warm if the headache is associated with cold.
• Use a different pillow or change sleeping positions.
• Practice good posture when reading, working, or doing other activities.
• Exercise the neck and shoulders frequently when typing, working on computers, or doing other close work.
• Get plenty of sleep and rest.

Massaging sore muscles may also help.

Silver N. Headache (chronic tension-type). Am Fam Physician. 2007:76(1):114-116.

Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008:7(1):70-83.