First Time User? Sign Up Now
First Time User? Enroll now.
Home > Health Library > Tension Headaches
This topic is about tension headaches in adults. If you are looking for information about migraine headaches, see Migraine Headaches.
If you are looking for information about tension headaches in children, see Headaches in Children.
Most headaches are tension headaches. These headaches tend to happen again and again, especially if you are under stress. They are not usually a sign of something serious. But they can be very painful and hard to live with.
Tension headaches can last from 30 minutes to 7 days.
If you have a headache on 15 or more days each month over a 3-month period, you may have chronic tension headaches. This type of headache can lead to stress and depression, which in turn can lead to more headaches.
Tension headaches are very common. Symptoms can start in childhood, but they are more likely to occur during middle age.
Some people have both tension headaches and migraine headaches.
Doctors don't know for sure what causes tension headaches. Experts once thought that tension or spasms in the muscles of the neck, face, and head played a role. Now they think that a change in brain chemicals also may be a cause.
Tension headaches are one of the most common types of headaches. They can be brought on—or triggered—by things such as stress, depression, hunger, and muscle strain. Tension headaches may come on suddenly or slowly.
Symptoms of tension headaches include:
This is different than migraine headaches, which usually cause throbbing pain and start on one side of your head.
Tension headaches tend to come back, especially when you are under stress.
Pain from a tension headache is usually not severe and does not get in the way of your work or social life. But for some people, the pain is very bad or lasts a long time.
A doctor can usually diagnose tension headaches by asking you questions about your health and lifestyle and by examining you.
Most people can treat their tension headaches with over-the-counter pain relievers like acetaminophen (such as Tylenol) or aspirin (such as Bayer).
But if you take these pain relievers more than 3 times a week, you may get rebound headaches. These are different from tension headaches. Rebound headaches usually start after pain medicine has worn off, which leads you to take another dose. After a while, you get a headache whenever you stop taking the medicine.
Your doctor may prescribe medicine if you get chronic tension headaches.
Even with treatment, most people still have some headaches. But with treatment, you will probably have them less often. And when you do get them, they probably won't be as bad.
Home treatment may help you avoid headaches. You can:
Health Tools help you make wise health decisions or take action to improve your health.
The cause of tension headaches is not clear. In the past, doctors believed that tension or spasms of the muscles of the neck, face, jaw, head, or scalp played a role in causing these headaches. Now they think a change in brain chemistry may also help cause a tension headache.
Tension headaches are the most common type of headache. They can be brought on—or triggered—by things such as stress, depression, hunger, and muscle strain. Tension headaches may come on suddenly or slowly.
Chronic tension headaches often occur along with other health problems such as anxiety or depression.
Unlike migraines, tension headaches usually don't occur with nausea, vomiting, or feeling sensitive to both light and noise. But light or noise could make your headache worse. Tension headaches usually aren't bad enough to keep you from doing your daily activities.
If you have a headache on 15 or more days each month over a 3-month period, you may have chronic tension headaches.
Call 911 or other emergency services if:
Call your doctor now or go to the emergency room if:
Watch closely for changes in your health, and be sure to contact your doctor if:
Watchful waiting is a wait-and-see approach. If your headache gets better on its own, you won't need treatment. If it gets worse or you get headaches often, you and your doctor will decide what to do next.
Watchful waiting and using over-the-counter pain medicines work well if your tension headaches don't keep you from doing the things you want to do. But if your headaches are disrupting your life, talk to your doctor about other treatments that you could try.
Most health professionals can recognize and treat tension headaches. You may seek treatment from any of the following:
If you think that your headaches are caused by depression or anxiety, talk to your doctor. Treating these problems may help reduce how bad your headaches are and how often you get them.
It can be hard to know which type of headache you have, because different types can have the same symptoms. But the treatments may be different, so it's important to find out which type you have.
In very rare cases, headaches can be caused by more serious health problems (such as brain tumors or aneurysms). But most headaches aren't caused by anything serious, so you probably won't need to have tests.
You can treat most tension headaches with:
Medicines can help you feel better. But they can also be dangerous, especially if you don't take them the right way. Be safe with medicines. Read and follow all instructions on the label.
Your doctor may recommend that you take a prescription medicine every day to prevent headaches. You may want to try a prescription medicine to prevent a headache if:
Your doctor may have you try one or more medicines, such as an antidepressant or a medicine that prevents seizures. These medicines can help prevent headaches even if you don't have depression or seizures.
You may be able to prevent or reduce tension headaches by learning what causes your headaches and trying to avoid those triggers. For more information, see Living With Tension Headaches.
How you think can affect how you feel. So finding ways to relax and stop negative thoughts may help prevent headaches.
You may want to try:
For more information, see Living With Tension Headaches.
If you continue to have tension headaches while you are getting treatment, you and your doctor may want to try another treatment.
You may have to try different drugs or doses. If you have already tried several medicines, your doctor may order tests (such as an MRI or CT scan) to find out if a health problem is causing your headaches.
Finding and avoiding the things—or triggers—that lead to tension headaches can reduce how often you get headaches and how bad they are when you do get them.
Headache triggers can include:
Using a headache diary( What is a PDF document? ) can help you find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you were doing before the headache started. This information can help you avoid things that bring on your headaches. And the diary also can help your doctor plan your treatment.
If you have headaches caused by muscle tension in your neck, shoulders, and upper back, pay attention to your posture during your daily activities. You also can try muscle relaxation and other ways to reduce muscle tension.
Your doctor also may prescribe medicine to help prevent tension headaches.
You may have fewer headaches—and less pain when you do get them—if you:
You can reduce how many headaches you have by finding out what triggers them and avoiding those things. Triggers may include stress, hunger, and lack of sleep.
Use a headache diary( What is a PDF document? ) to find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you were doing when the headache started. This information can help you avoid things that bring on your headaches. A diary also may help your doctor plan your treatment.
If you have mild to moderate headaches, your doctor probably will want you to take over-the-counter medicines to stop your headaches. These include medicines like acetaminophen (such as Tylenol) and ibuprofen (such as Advil). Be safe with medicines. Read and follow all instructions on the label.
If over-the-counter medicines don't stop your headaches well enough—or you get a lot of headaches—your doctor may prescribe medicine to prevent headaches.
Don't take medicine too often. Talk to your doctor if you're taking medicine more than 3 days a week to stop a headache, or if you have a headache on more than 15 days a month. Taking too much over-the-counter pain medicine can lead to more headaches. These are called rebound headaches.
One Man's Story:
"I hold my stress in my shoulders and neck. My shoulders are always up around my ears. A lot of times, I leave at the end of the day with a big headache."—Jerry
Read more about how Jerry reduced his stress.
Stress can cause tension headaches.
You can lower your stress with positive thinking and relaxation methods. Research shows that you can change how you think. And how you think affects how you feel. Try these techniques on your own or with help from a therapist or counselor trained in muscle relaxation, meditation, biofeedback, or cognitive-behavioral therapy.
Learn how to lower your stress with these topics:
You also can learn to stop thinking all the time about things that bother you.
Seek help if you think that your tension headaches may be linked to depression or anxiety. Treating these health problems can reduce how often you get headaches.
Your doctor may recommend medicine to treat or prevent tension headaches.
You might only need to take an over-the-counter medicine for pain. These medicines usually have fewer side effects than prescription drugs. Always be safe with medicines. Read and follow all instructions on the label.
Over-the-counter medicines that you can use to stop a headache include:
Try to avoid taking over-the-counter drugs more than 3 times a week, because you may get rebound headaches. These are different from tension headaches. They usually occur after headache medicine has worn off. This leads you to take another dose. After a while, you get a headache whenever you stop taking the medicine.
Your doctor may recommend that you take a prescription medicine every day to prevent headaches. You may want to take this medicine if:
Medicines used to prevent tension headaches include:
Botulinum toxin type A (BTX-A) is sometimes injected into the muscles in the face and head to treat headaches. In the past, doctors thought that spasms caused tension headaches. But BTX-A injections do not seem to help with symptoms of tension headaches.footnote 1 And BTX-A may cause weakness of the facial muscles and may make it hard for you to swallow.
Using other treatments along with medicines may help you stop a tension headache or prevent one.
If you decide to try one or more of these treatments, make sure your doctor knows. He or she may have advice on how to use other treatments safely. Other treatments for headaches include:
Jackson JL, et al. (2012). Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: A meta-analysis. JAMA, 307(6): 1736–1745. DOI: 10.1001/jama.2012.505. Accessed February 1, 2016.
Other Works Consulted
Digre KB (2016). Headaches and other head pain. In L Goldman, A Shafer, eds., Goldman-Cecil Medicine, 24th ed., vol. 2, pp. 2356–2364. Philadelphia: Saunders.
Haghighi AB, et al. (2010). Cutaneous application of menthol 10% solution as an abortive treatment of migraine without aura: A randomised, double-blind, placebo-controlled, crossed-over study. International Journal of Clinical Practice, 64(4): 451–456.
Headache Classification Committee of the International Headache Society (2013). The international classification of headache disorders, 3rd ed. (beta version). Cephalalgia, 33(9): 629–808. DOI: 10.1177/0333102413485658. Accessed February 1, 2016.
Holland S, et al. (2012). Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology, 78(17): 1346–1353.
Kedia S, et al. (2014). Neurologic and muscular disorders. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 776–861. New York: McGraw-Hill.
Ropper AH, et al. (2014). Headache and other craniofacial pains. In Adams and Victor's Principles of Neurology, 10th ed., pp. 1310–1390. York: McGraw-Hill Education.
Current as ofJune 3, 2018
Author: Healthwise StaffMedical Review: Kathleen Romito MD - Family MedicineE. Gregory Thompson MD - Internal MedicineMartin J. Gabica MD - Family Medicine
Current as of:
June 3, 2018
Medical Review:Kathleen Romito MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Martin J. Gabica MD - Family Medicine
To learn more about Healthwise, visit Healthwise.org.
© 1995-2018 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
UNC Medical Center
101 Manning Drive
Chapel Hill, NC 27514
UNC Health Care Citrix
UNC Medical Center Intranet
Copyright 2019 UNC Health Care. All rights reserved.