Tension Type Headache
A tension type headache is very different from a migraine. Here are a few facts about tension type headache.
What does a tension type headache feel like?
- The pain is mild to moderate, not severe, which does not prevent you from functioning
- Pain on both sides of the head, similar to a headband, with pressure on the top of your head, in your neck or behind your eyes. Some people will feel tension in the neck or in the jaw
- You are NOT nauseous
- Light and sounds do not bother you
- Pain is not pulsating like a heartbeat
- Pain does not increase if you are physically active, like going up steps or using physical force; physical activity can actually alleviate the headache
- Pain lasts for a few hours, goes away completely and easily with over-the-counter medicines
If you have answered yes to these questions, you probably have tension headaches.
Is it possible to have tension type headache very often or even every day?
It should be noted that if people have tension-type headache on 15 days a month or more, then they are classified as suffering from chronic tension type headache. This is a very rare condition. Headache experts report that they see it rarely, compared to chronic migraine that is very frequent.
It’s important to recognize migraine, as treatments are different
If you have attacks which prevent you from functioning, with nausea and sensitivity to sounds and light, you probably have migraines. If you live with chronic migraine, you may have a mix of headaches of different severities. Some may even look like tension type headache, but quite often the migraine symptoms (light and sound sensitivity for example) are still present.
What is the cause of tension type headache (TTH)?
This headache is still misunderstood. We now know more about migraine than TTH. (See this post)
Tension headache is a primary headache, i.e. it is caused by an activation of brain areas that process pain signals, WITHOUT illnesses or lesions in the brain, sinuses, teeth, etc. It is thought that the pain comes from an interplay between psychological tension and muscle tension. In stressful situations, pain can become more frequent.
How common is tension type headache?
Tension type headache is the most common headache of all. Up to 80% of people will get this type of headache during their life. Over a year, 25% of people will have it. Because it is less severe and disabling than migraine, few people consult for TTH. If a person goes during a difficult phase where the headache becomes more frequent, a doctor may be consulted.
What are the treatments for tension type headaches?
Many people with tension headache do not need treatment, especially if the frequency is not to high. Analgesics and anti-inflammatories can be used as needed but be careful not to fall into overuse (See this post). With some reassurance during a bad phase, the situation can calm down. If the headaches are frequent and disabling, preventive treatment can be tried.
- Exercise and anxiety management
- Massage therapy
- Tricyclic antidepressants (amitriptyline/Elavil)
- Other antidepressants
- Muscle relaxants
- Trigger point injections, acupuncture, dry needling
The research on TTH is quite limited. Some physicians will recommend migraine preventives assuming that any chronic and disabling headache must be somehow in the migraine family and involve the same networks. This is a controversy that will be solved with research.
Burch R. Migraine and Tension-Type Headache: Diagnosis and Treatment. The Medical clinics of North America. 2019;103(2):215-33.
Kahriman A, Zhu S. Migraine and Tension-Type Headache. Semin Neurol. 2018;38(6):608-18.