Tension headache, by far the most common type of headache in adults and teens, is the dull, aching, pressure headache which often develops after a stressful day at work or school or during times of emotional upheaval – particularly when you are overtired, rushed and anxious.

These headaches can also stem from eyestrain or sitting for prolonged periods in one position such as at your computer or behind a steering wheel. Typically, the headache worsens towards the end of the day.

Tension-type headaches are sometimes associated with tension or spasm in muscles of the head, neck, face or jaw. This may be accompanied by other symptoms of tension such as palpitations, sweating and depression.

Unlike migraine headaches, nervous system symptoms (such as distorted vision, tingling or numbness in the face or hands) are not typical with tension headaches.

Many people have occasional or episodic tension-type headaches (fewer than 15 per month). If you have 15 or more headaches per month for at least 6 months, you may have a chronic tension-type headache. We recommend you see a doctor if the headaches have been recurring for 6 months.

What causes tension headaches?

Physical or emotional stress may trigger tension headaches.

Stress may be as a result of:

    • Anxiety or depression

    • Problems with family, work, school or other stress-provoking situations

    • Lack of sleep or relaxation

    • Excessive glare

    • Neck strain from poor posture, work environment or injury.

    • Strain in the chewing muscles of the jaw from grinding or clenching the teeth.

Symptoms of tension headaches

A typical tension-type headache has the following features:

    • Steady, dull headache that slowly worsens. It is usually associated with a feeling of fullness, tightness or pressure. Some people say it feels as if the head is being squeezed in a vice or has a tight band around it.

    • The pain usually occurs on both sides of the head, including the neck and temple. Occasionally, it may be on one side or in one small, well-defined area.

    • The headache may last from an hour to several days. It may start soon after you get up in the morning, although seldom wakes you or disturbs sleep. Headaches which disturb sleep may be related to anxiety or depression.

Other symptoms that may occur with tension headaches include:

    • Tenderness of the scalp

    • Pain, stiffness or tightness in the neck, upper back or shoulders

    • Fatigue, tiredness, dizziness

    • Sensitivity to light or sound. (This is more typical of migraine and is usually milder with tension headaches.)

    • Nausea or loss of appetite. (Vomiting may be more likely with a mixed tension and migraine headache.)

    • Depression is common in chronic tension-type headaches. Some doctors think depression may be the result of chronic headache pain rather its cause. Anxiety is common in people who have recently started experiencing tension headaches.

Managing tension headaches

Occasional mild or moderate tension headaches should respond to home treatment. Over-the-counter painkillers such as aspirin, paracetamol or ibuprofen are usually adequate. Natural remedies may also be effective to help address the cause of the headache if a nutritional deficiency is present. In times of great stress, your body's vitamin and mineral requirements are greater, so taking a supplement designed to support the nervous system may be of help. Look for a supplement with B-group vitamins and vitamin C - both are in higher demand during times of stress. Also try for a supplement containing magnesium and CoQ10. Both of these nutrients are critical for maintaining muscle and nerve function, and deficiency in either of these has been linked to headache.

Although muscle relaxants may be helpful, they are not generally satisfactory for long-term use.

If headaches occur more than twice a week or persist longer than two days, ask your doctor whether medication to prevent them should be considered. Certain antidepressants can be helpful for preventing tension headaches in some people; therapy to learn methods for managing stress and anxiety may also be worth considering.

If a drug or drug combination doesn't work or has too many side effects, another will be tried until you and your doctor establish one that works for you.

Don’t only rely on medication or supplements alone to manage headaches. These measures will help relieve pain and prevent headaches from getting worse:

    • At the first sign of headache, if possible find a quiet, dark place to lie down and relax.

    • Have someone gently massage your neck and shoulder muscles, or give yourself a massage.

    • Take a break from work or whatever seems to be triggering the headache. Go for a five-minute walk or do some stretches. Take some deep, calming breaths.  Aim in future to pre-empt stress by organising your time better and building in regular periods to rest and relax.

    • Heat or cold application may provide some relief. Try applying heat (a warmed towel or heating pad) or cold (a wrapped ice pack) to sore tense muscles. A hot or cool shower/bath may also be soothing.

    • Practise good posture. This helps prevent your muscles from tensing in an attempt to compensate and align your body correctly when your posture is poor. Avoid hunching your shoulders and tensing your neck when stressed. Keep your shoulders back, hold your head up and get into the habit of pulling in your stomach when standing. Use a seat with good lower back support, and keep knees and hips level and feet on the floor. Take breaks every 30 minutes.

    • Plan a regular exercise regime. Exercise triggers release of hormones that help alleviate stress.

Many tension headache sufferers turn to physical therapies, the most popular being chiropractic, acupuncture and various forms of massage. Although there is debate in medical circles as to whether these therapies are truly effective in treating headaches, many people say they have experienced pain relief through using them.

Meditation, properly practised, has been shown to help ease several kinds chronic pain, including headaches. It is also very effective in reducing stress levels, which in turn help reduce the incidence of tension headaches.

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