Tension-type headaches (TTHs) are the most common type of primary headache. Researchers estimate that over 70% of people have episodic TTHs. They generally affect women and people assigned female at birth more than men and people assigned male at birth.
The most common description of how the headache feels is like a tight band or vise wrapped around the head that exerts pressure on the forehead and temples.
Many factors can trigger a TTH, and you may be unable to avoid all of them. Fortunately, however, you can do a number of things to prevent TTHs from occurring, and if home-based treatments don’t work, healthcare providers have medications and other therapies to ease the pressure and pain.
Types of tension headaches
Doctors classify TTHs based on how often they occur. They include:
- Infrequent episodic: occur one day a month or less frequently
Frequent episodic: one to 14 headaches every month for at least three months
Chronic: more than 15 headaches every month for at least three months
As we’ve mentioned, episodic headaches are the more common form.
Symptoms of tension headaches
Symptoms vary from person to person, but most describe a TTH attack as including:
- Constant mild-to-moderate pressure and pain
Feeling like a vise is squeezing both sides of the head
Aching or tight neck and shoulder muscles
Sensitivity to light and sound
These symptoms tend to emerge slowly, and they can last anywhere from 30 minutes to as long as a week. Some people with chronic TTHs feel like they’re always struggling with headache pain and pressure.
What causes a TTH?
Researchers are still trying to pin down a single cause for tension headaches. Some believe they start when the muscles between your head and neck knot up, sending the pain up into the head, and eventually tightening your scalp muscles. This muscular ripple effect often occurs when you’re stressed or dealing with emotional conflict. Other causes may include:
- Neck strain from looking down to read, look at your phone, or work on a tablet (colloquially called tech neck)
- Eye strain from staring at a screen or documents for a long time without taking breaks
Temporomandibular jaw disorder (TMJ): damaged or misaligned muscles lead to pain and stiffness
Degenerative arthritis in your neck
Sleep disorders: e.g., sleep apnea and insomnia
Anxiety
Depression
Complications of TTHs
Chronic tension headaches that don’t let up for weeks and months can easily affect your quality of life, making it hard to focus on your work or family responsibilities because you’re always in pain.
Treating TTHs
Treatments vary depending on what type of tension headache you have. For example, for episodic headaches, the doctor may recommend you start with over-the-counter pain relievers like:
- Acetaminophen (Tylenol®)
Aspirin
Ibuprofen (Advil®, Motrin®)
Naproxen sodium (Aleve®)
If you have chronic tension headaches, your provider may prescribe:
Antiseizure medications like gabapentin (Neurontin®) or topiramate (Topamax®, Topiragen ®)
Antidepressants like amitriptyline that also relieve pain
Alternative therapies like biofeedback, meditation, or cognitive-behavioral therapy to help manage stress
Physical therapy for sleep apnea or TMJ problems
Treatment side effects or complications
Side effects or any complications you might develop vary depending on the specific treatment, but one of the most common potential side effects are what used to be called rebound headaches and are now called medication overuse headaches. This can happen no matter if the medication is over-the-counter or a prescription pain reliever.
These headaches happen if you use the medication too often. Most doctors recommend limiting your dose 10 days in any given month.
Preventing a TTH
Managing your stress level may be the most effective way to prevent a TTH from forming. The most effective stress management tools fit into your daily routine and make you feel good, like massage therapy, regular exercise (150 minutes a week), and getting enough good-quality sleep (7-9 hours a night).
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