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Tension headaches, or stress headaches, are the most common type of primary headache. A primary headache is a headache that does not stem from another condition.
In 2011, the World Health Organization (WHO) estimated that approximately 50–75 percent of people in the world experience episodic tension-type headaches, and 1–3 percent have chronic tension headaches. Episodic tension headaches are more common in women than in men.
The International Headache Society (IHS) puts the figure for tension headaches between 30 and 78 percent.
Tension headaches can happen at any age, but they often begin during adolescence and peak when a person is in their 30s, according to the WHO.
People often describe tension headaches as a pressing or tightening pain of mild to moderate intensity that affects both sides of the head. They often come with a stiff and aching neck and shoulder muscles.
They tend to develop slowly and increase in intensity. Sometimes a person will have a sensitivity to light or sound. People do not usually have nausea with a tension headache.
The pain from tension headaches causes discomfort, but it is not usually severely disabling, as migraine headaches can be.
The pain does not worsen with physical activity, such as walking or climbing stairs, but physical or mental stress can make it more severe.
To help doctors diagnose tension headaches, the IHS classify them as either episodic (occasional) or chronic (persistent or constantly recurring). There are also subcategories.
Episodic tension headaches
These can be infrequent or frequent.
Infrequent episodic tension-type headache: A person will have at least 10 episodes per year, occurring on less than 1 day per month on average, and without nausea. Headaches may last from 30 minutes to 7 days. There may also be sensitivity to light or sound but no nausea or vomiting.
Frequent episodic tension-type headache: The individual will experience 10 or more episodes, occurring on between 1 and 14 days each month on average for between 12 and 180 days per year, without nausea. Headaches may last from 30 minutes to 7 days, and there may be sensitivity to light or sound but not nausea or vomiting.
Chronic tension headaches: Headaches occur on at least 15 days each month on average, and for more than 3 months. The person may have mild nausea, sensitivity to light or sound, or all of these. Headaches may last for hours, or they may be ongoing.
A person who experiences episodic tension headaches may develop chronic tension headaches over time.
People do not know exactly what causes tension-type headaches, but factors that trigger them may include:
- physical or emotional stress
- lack of sleep
- lack of exercise
- eye strain
- regular exposure to loud noise
- poor posture
- jaw clenching
- alcohol use
The triggers can differ between individuals.
Keeping a headache diary can help people to identify and avoid headache triggers and patterns.
Information can include:
- when a headache started
- any food and drink consumed over the past 24 hours
- what the person was doing before the pain started
- the amount of sleep the person had the previous night
Certain lifestyle changes may help prevent tension headaches.
- getting enough sleep
- practicing good posture when sitting, standing, and doing other daily activities
- taking regular breaks when working at a desk
- stretching regularly and exercising neck and shoulder muscles during office work
- engaging in exercise, which may also help with sleep patterns
- having regular eye checks and using the correct glasses
- managing stress
- avoiding alcohol
- monitoring for side effects of any medications
- drinking enough fluids, and especially water
- wearing sunglasses on bright days
- eating regular meals
People can usually relieve the pain of a tension headache with over-the-counter medications, such as aspirin, ibuprofen, or acetaminophen.
However, the overuse of such pain medications can increase the risk of episodic tension headaches developing into chronic tension headaches. This can happen because rebound headaches may occur after each medication dose wears off.
Headaches can be common during pregnancy. It is important to check with a doctor before using any medication at this time.
A variety of pain relief medications, specially shaped ice packs, and other headache relief tools are available for purchase online.
Home and alternative remedies
Some people find that home remedies may be enough to relieve their headaches.
- taking a hot bath
- placing an ice pack on the head
- relaxation techniques
Aromatherapy involves the application of essential oils. In 2016, the authors of a meta-analysis concluded that aromatherapy, in general, may be useful for treating pain.
In 2012, researchers found that inhaling lavender oil helped to reduce the severity of symptoms in 92 cases out of 129 cases of migraine headaches.
Find out more here about how essential oils might help to relieve a headache.
Biofeedback may help to treat headaches and also muscle tension, anxiety, and other factors that relate to them, according to findings of a 2008 meta-analysis.
Counseling for stress
Counseling, including cognitive behavioral therapy (CBT), may help people who have chronic tension headaches due to stress.
Learning new ways to cope with stress and anxiety may lead to a reduction in headaches.
Sometimes a headache can have a serious underlying cause that needs medical treatment.
A person should see a doctor about their headaches if:
- the headache becomes so severe it affects everyday activities
- a change occurs in the severity and frequency of tension headaches
- they are over 50 years of age and have no previous history of headaches
- speech difficulty, vision loss, and movement problems accompany headaches
- a headache develops suddenly and feels like the worst headache they have ever had
- they have a new type of headache and a history of cancer
- they become pregnant, as some medications may not be safe to use during pregnancy
- medication may be causing side effects
- they need medication to relieve pain more than three times a week
- previously effective medication no longer works
- changes in level of consciousness, personality, thinking, or behavior
- they have slurred speech
- there is a fever or rash
- they have visual disturbances
- they have had a recent head trauma, specifically within the last 3 months
Apart from tension, there are many other possible causes of headaches.
- a tumor
- an infection or abscess
- a stroke
- internal bleeding
- blood clots
- problems with the back or neck
- using incorrect eyeglasses
- mood disorders
All of these need medical or other attention.
A doctor can often diagnose tension headaches by asking questions about the frequency and intensity of headaches, as well as about health and lifestyle factors.
They may also want to ensure that a person is not experiencing other types of headache, such as:
Migraine headaches: This is a debilitating headache disorder in which throbbing pain usually affects one side of the head. Nausea, disturbed vision, sensitivity to light, and other symptoms often occur alongside it. It can seriously disrupt a person’s daily life.
Cluster headaches: These are recurring headaches that suddenly occur in groups, resulting in severe pain on one side of the head. Other symptoms may include restlessness, red or watery eyes, pain that is worst behind the eye, and a runny nose. Find out more about this type of headache.
Rebound headaches: A person who uses pain relief medication regularly may experience headaches when they do not take the medication.
At times of tension, I can get a severe headache, which I thought was a migraine.
It includes nausea and vomiting—which can be severe—and sensitivity to light. Sometimes I need 1–2 days in bed to recover. However if I take over-the-counter migraine tablets at the first sign, it stays away. It happens about twice a year.
Is this a tension headache or a migraine?
This is a migraine headache. Both tension type headaches and migraine headaches can occur during times of emotional or physical stress. Migraine headaches are usually more severe than tension headaches.
Migraine headaches are also usually accompained by nausea, vomiting, or both, which tension type headaches are not.Nancy Hammond, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.