Tension Headaches: Symptoms, Causes & Treatments
|Neck Related Headaches
|Mild to Moderate
|Mild to Severe
|Mild to Moderate – Sometimes Severe
|Usually Both Sides
|Usually One Side
|Usually One Side
About Tension Headaches
Just about everyone has experienced a headache and many of us accept headaches as an unavoidable part of our lives. The most common type are called tension type headaches, which affect one in three people and account for 90% of all headaches diagnosed by healthcare professionals. When headaches occur at the end of a busy workday, they may be attributed to stress, anxiety, and muscle tension, especially associated with poor posture.
The pain is mostly mild or moderate, and usually located on both sides of the head. People with tension type headaches usually describe feeling pressure or a tight sensation and sometimes can be throbbing, like a migraine. Nausea can occur with a severe tension headache, but auras or other migraine symptoms are not experienced.
Tension headaches that are mild and infrequent do not usually pose a significant problem, but if the pain is severe or frequent, and interferes with the daily activities, then more intense treatment may be needed.
For some time it had been presumed tension type headaches were being caused by tense neck muscles as well as the muscles at the base of the head, and tension ended up being triggered through emotional stress. We currently understand the reasons are usually more complex than simply basic muscular tension and stress. There are usually biochemical alterations in the brain comparable to those observed in migraine headaches, plus research indicates the pain may well originate in the brain, while muscle pain is actually a secondary effect. It’s very feasible that they might actually be considered a type of migraine. Individuals having all three forms of headaches frequently have tight as well as painful muscles that contribute to pain which comes from much deeper areas like the brain or even spinal components.
- A 2020 study in the Clinical Journal of Pain found that higher frequency and intensity of pain along with occasional migraines are predictors of future disability over a 3-month period.
Treatment For Tension Headaches
The fist step in the treatment of tension type headaches is to eliminate or reduce some contributing factors, triggers, or aggravating factors. Some of these potential factors are faulty posture that contributes to poor movement patterns or neck muscle weakness. These demand attention to bad habits that have developed over time and you will need the right information.
A good place to start is with methods similar to managing neck pain. Short term methods like ice, moist heat therapy or over the counter NSAIDs like Aspirin or Ibuprofen should be able to alleviate the pain.
- A 2015 review in the European Journal of Pain noted the significant factor the muscles play, not only in developing tension type headaches, but in their being related to progression into a chronic or a long term issue. The authors recommend 1000 mg of aspirin or 400 mg of ibuprofen based on cost, safety profile, and treatment effect. They also recommend therapy focused on muscles.
- A 2018 study in the journal Cephalalgia found that the number of neuromuscular trigger points in head and neck and shoulder muscles was associated with widespread pressure hypersensitivity in tension headaches.
- A 2019 study in the journal Pain Medicine found widespread pressure pain hypersensitivity over nerve and muscular structures in women with frequent episodic tension type headaches, suggesting an altered pain processing from central sensitization.
If reasonable attempts at basic methods fail to produce results, greater efforts will be needed in areas like exercises to strengthen neck muscles or exercises for neck and shoulder muscles, posture training exercises and medications prescribed by your doctor. Medications used are many of the same used for prevention of migraine headaches including antidepressants (notriptyline, amitryptiline) as well as beta blockers.
- A 2020 study in the Nigerian Postgraduate Medical Journal found that of those with tension type headaches, about 70% has generalized anxiety disorder and about 54% had a depressive disorder. They ranged in severity, however, it shows a high prevalence of a co-morbid or coexisting condition. That does not mean it is causative, although it should be addressed as a factor that can help alleviate symptoms.
Although psychological stress is not the cause of tension type headaches, it can make pain worse, therefore, stress reduction techniques and psychotherapy can be helpful. Chiropractic care and massage can also help, especially for periodic flare-ups of head pain.
- A 2020 study in Pain & Therapy Journal found in patients with chronic tension type headaches who took 3 mg of melatonin at bedtime for 60 days noted significant improvement in pain, anxiety, depression and sleep quality. The authors indicated it is a safe and effective alternative treatment.
- A 2021 study in the Journal of Back & Musculoskeletal Rehabilitation found that suboccipital muscle inhibition and forward head posture correction exercises caused a significant improvement in patients with chronic tension-type headaches. Improvements were noted in pressure pain threshold of the headache areas and the type and number of myofascial trigger points.
- A 2021 study in International Journal of Environmental Research and Public Health found the severity of headache is reduced by decreasing hamstring tension in patients with tension headache.
- In an article published in the 2013 Journal of Orthopedic Sports Physical Therapy, it was indicated that individuals suffering from chronic tension headaches will benefit from an isometric neck flexor exercise as a means to reduce headache frequency. The neck flexor muscles have also been shown to have poor endurance for those suffering from neck pain. So, this exercise will benefit those with neck pain generally, and those with chronic tension type headaches specifically.
- In the 2015 Pain Physician journal indicated that increased isometric strength of the neck flexor muscles was significantly related to decreased pressure pain in a study of 145 subjects suffering from chronic tension headaches.
To perform this exercise, lay on your back on a comfortable, firm surface (carpeted floor or floor with exercise mat). Relax and breathe normally – don’t strain!
1) Perform a slight motion of tucking the chin in and allowing the back of the head to stretch slightly up (red arrows), but maintain contact with the floor. This motion is slight and prevents the chin from sticking outward, which will defeat the purpose of the exercise.
2) Lift the head approximately 1 inch off the surface and hold. Initially, try for 5 seconds, breathing normally – do not hold your breath. Slowly lower your head to the floor and relax. Repeat by first doing the retraction or chin tuck in #1, then raising the head and holding. Do what you can, try to do 10 repetitions. This should only take a couple minutes.
If you can, do this as frequently as possible or is reasonable throughout the day. Try to take a break and do the tension headache exercise every hour or two. When you are comfortable, hold each one for 10 seconds and progress at 5 second intervals. The goal would be to perform the exercise by holding the position longer, even if you have to reduce the number of repetitions. If the neck flexor muscles are particularly weak, you may start shaking a bit. Stop at this point and try to progress over time and the shaking will stop.
If you experience any sharp pain or increase in pain, stop the tension headache exercise and consult your doctor or therapist.
- A 2018 study in the journal Cephalalgia notes that neck pain is a common feature of tension-type headache. The study compared strength training of the shoulder muscles with posture and ergonomic correction. The results indicated strength training reduced the duration (10%) and frequency (11%), while the ergonomic/posture correction reduced the duration (27%) and frequency (24%). The authors suggest combining the two interventions in a future study.
- A 2018 study in the Journal of Pain Research found similar and long term benefits with strength training and ergonomic/posture correction. In this study, the strength training focused on the neck extensors, however, there is a trend toward ergonomic interventions along with exercise to reduce pain and suffering.