Tension Headache Definition and Symptoms

Tension headache art

Artist: Richard MacCormack, “Silent Scream”

Tension headaches cause one to feel like their head is “in a vice” or like wearing a “really tight headband.”  Tension headache may also be referred to as tension-type headache (preferred), muscle contraction headache, psychogenic headache, stress headache, idiopathic headache, and “normal” headache.

Tension Headache Symptoms

You may be suffering from tension headache if you have even, band-like pain surrounding your head plus at least two of the following:

  • pain of a pressing/tightening quality
  • pain that is not pulsating or throbbing
  • pain not aggravated by physical activity

Additionally, if the pain is associated with nausea or vomiting, it is unlikely that you have a tension headache alone.  Tension headaches are more common in young adults, and these headaches rarely start in patients over 50 years old.

Between 30% and 70% of people will have tension headache at some point in their life.  For such a common problem which can be disabling for some, it is surprising that tension headache is not better described in the medical literature.

There is a wide variation in headache timing for those with tension headaches. Those with episodic tension headache have pain less than 15 days per month. The headache is classified as chronic tension headache when there is a headache for >15 days per month over a six-month period.  A single tension headache can last from 30 minutes to seven days.

One of the difficulties with headache diagnosis is that individuals with complicated headache problems may have multiple types of headaches.  It is not uncommon for me to assess someone in the office with migraine, tension-type headache, cervicogenic headache, and medication overuse headache.  In fact, those with migraine are more prone to having tension headaches, and vice versa.

Scientists do not understand the exact mechanism of tension headache, yet it seems that there may be several factors that contribute to the pain. A lack of sleep, emotional stress, and tender muscles cross neck, face, and head are likely causes.  Since any one headache type can have multiple causes, and any one headache sufferer can have multiple types of headaches, successful headache management should involve a comprehensive evaluation and multimodal treatment.

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