young woman holding her head in painAccounting for about 50% of headaches, tension-type headaches are the most common type. You will sometimes hear these referred to as “muscle contraction headaches”. Although women are more likely than men to get these, pretty much everyone will have at least one tension headache at some point in their life.
The pain reported is usually mild-to-moderate in intensity, with a continual pressing/tightening feeling. Some people state that it feels like their head is being squeezed. Head tension is typically not accompanied by nausea and/or vomiting.

Four types of tension headaches:

  • Frequent episodic tension-type headache – occurs at least once/month, but not more than 15 days per month, for at least 3 months. These last anywhere from 30 minutes up to 7 days.
  • Infrequent episodic tension-type headache – at least 10 headaches that occur less than 1 day per month. Quality of life typically is not affected by these headaches.
  • Chronic tension type headache – occurs at least 15 days per month for a minimum of 3 months. These persist for hours and can be continuous.
  • Probable tension type headache – these headaches may be classified as probable frequent episodic, probable infrequent episodic, or probable chronic. They have basically the same symptoms of tension-type. (Probable chronic tension-type headaches can be related to medication overuse).

Symptoms of tension-type headaches include a tight feeling around the head, shoulder pain, neck pain, and sometimes even light or noise sensitivity.  The pain is typically steady, not throbbing or pulsing.
Tension-type headaches and migraines have some similar characteristics, so people tend to think they have migraines when they actually don’t. Some key differences are:

  • Migraine pain involves a pulsating, throbbing pain
  • Migraine pain often affects only one side of the head (tension-type typically affects both sides of the head)
  • Migraine headaches are often accompanied by nausea/vomiting & sensitivity to light/sound

Head tension episodes are rarely disabling and do not usually require emergency treatment. Chronic headaches, however, can have a negative impact on your quality of life.  For many suffering from chronic tension-type headaches, depression and anxiety also come into play.  Stress can trigger or aggravate these headaches as well.
Common triggers for head tension include:

  • Physical activity or Over activity – athletics or other intense physical exertion (even sexual activity) can be a trigger. Alternatively, lack of activity can also be a cause.
  • Foods and Beverages – rapidly consuming very cold foods/beverages can also be a trigger. Keep in mind that “brain freezes” brought on by ice cream are NOT tension headaches. Skipping meals can also be a source of these as well.
  • Fatigue – lack of sleep is a headache trigger.
  • Medications – many persistent headaches are the result of medication overuse. On the other hand, withdrawal from caffeine, nicotine or alcohol can also trigger headaches.
  • Poor posture – sleeping in an uncomfortable position or working at a computer all day hunched over, straining your eyes is another common trigger.
  • TMJ Dysfunction (TMD) – jaw clenching or grinding (during the day or overnight) triggers headaches. Splint therapy to address the underlying TMJ disorder addresses the chronic headache issue.

Tension-type headaches can usually be treated and prevented.  It is more likely that patients who experience head tension ONLY will not have them for more than 1-2 years.  Patients who experience migraines in addition to tension-headaches are up against much greater challenges.  Over-the-counter pain relievers like Advil or Ibuprofen are the most popular choices (NSAIDs), followed by Aleve (naproxen).  Many patients also report that caffeine helps as well as massage therapy.  More aggressive treatments include things like stress management therapy, drug treatment with antidepressants, and relaxation training.
For more information on tension-type headaches, or if you are currently suffering from head tension, please contact our office at (586) 573-0438.
Medical News Today. (16 May 2006). Study suggests tension-type headaches may actually be TMJD.
Temporal change in headache and its contribution to the risk of developing first-onset temporomandibular disorder in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study
Pain:  January 2017 – Volume 158 – Issue 1 – p 120–129
Sanders AE, Ohrbach R. General health status and incidence of first-onset temporomandibular disorder: OPPERA prospective cohort study. J Pain.
Macfarlane TV, Glenny AM, Worthington HV. Systematic Review of Population-based Epidemiological Studies of Orofacial Pain. J Dent. 2001; 29:451–46.