What Are Tension Headaches?

If you suffer from headaches after a long stress-filled day, you may be suffering from tension headaches. Here’s what you should know about what these are and how to treat them.

Tension headaches are a type of headache that is relatively common in the general population. Typically, tension headaches are located:

  • Over or behind the eyes
  • At the base of the skull
  • In the cervical spine
  • In the facial muscles

Often patients suffering from tension headaches will describe their pain as intense pressure around the head or forehead that is sometimes associated with stabbing, throbbing, or grinding of the muscles of the face. This type of headache is often associated with:

  • Irritability
  • A decreased ability to concentrate
  • An increased sensitivity to sound and light

The majority of tension headache patients experience symptoms on both sides of the head.

Tension headaches are either episodic or chronic in nature, depending on their duration. Episodic tension headaches usually last from 30 minutes to several days and typically occur on less than 15 days per month. Tension headaches that are experienced more frequently are classified as chronic tension headaches. Chronic tension headaches may be a persistent source of head pain. While the pain of tension headaches may be less severe than other types of headaches, such as migraines, they can be disruptive to normal activities of daily living and can be incredibly frustrating.

Tension Headaches Causes

A variety of individual risk factors may accompany these types of headaches including:

  • Stress
  • Eyestrain
  • Dehydration
  • Hunger
  • Sleep deprivation
  • Jaw clenching or grinding

Tension headaches are not strongly associated with one specific major nerve group, as is usually seen with migraines. They are more strongly associated with muscle strain in the temples or jaw, which is transmitted to the brain by various nerves. These may include the occipital nerve, sphenopalatine ganglion, and the trigeminal nerve.

Tension Headache Treatments

If you’re suffering from tension headaches, there are treatments that can help. Always start with the least interventional form of therapy as you can. For many patients, this will include:

  • Practicing simple stress reduction techniques, such as deep breathing, yoga, or meditation
  • Ensuring that they drink enough water
  • Working to release tension in the jaw and neck
  • Getting episodic breaks from their computer screens

If your tension headaches don’t respond to these simple techniques, you can try other therapies to find relief.


Two non-pharmacological options are acupuncture and biofeedback training. These have shown to be effective for treating tension headaches.

Acupuncture involves inserting small needles into specific acupuncture points within the body. A technician inserts needles at the site of pain as well as at distant sites, which may be contributing to a patient’s pain. The side effects associated with acupuncture are usually limited to minor bleeding and bruising at the needle insertion site.


Biofeedback training involves teaching the patient to modify their body’s physiologic response by utilizing visual feedback. Patients are shown various physiologic responses on a computer screen that records their headache episode. These physiologic tests may include:

  • An electromyogram that measures muscle tension
  • An electroencephalogram that measures brain wave activity
  • A galvanic skin response that measures sweat production

These physiologic responses can be negatively impacted by stress and tension. By visualizing their responses on a screen, patients can gain a better understanding of their body’s reaction to their headaches. They can also learn how to control their responses through relaxation.

In the initial phases of biofeedback training, patients practice in a health care facility with a biofeedback professional. Over time patients will be able to implement changes on their own. Additionally, biofeedback training may help patients identify headache triggers, which will allow them to either avoid them, or apply relaxation techniques when they feel them oocur. Biofeedback training allows patients to have more control over their tension headache symptoms.

Manual therapies

Manual therapy techniques, including massage therapy, physical therapy, or chiropractic care, may also be beneficial for patients suffering with tension headaches. These therapies can help ease muscular strain that often leads to these types of headaches.

Physical therapists can use a variety of modalities including ice, heat, ultrasound, and electric currents, in addition to manual therapy, to help reduce muscular strain and stress that may be contributing to a patient’s tension headaches. Additionally, they can develop an exercise program that will help to strengthen the affected muscle groups, in turn, helping to reduce tension headache symptoms.

Chiropractic manipulation of the affected area may help to reduce muscle tension, thereby reducing headache pain.

Massage therapy helps to remove muscle tension and may help to alleviate stress, in turn resulting in reduced headache pain.

Tension headaches medications

A common type of pharmacological treatment for tension headaches is oral analgesics (pain medications), such as non-steroidal anti-inflammatory drugs (NSAIDs). However, if a patient takes NSAIDs frequently, there is a risk of organ failure. Similarly, if they take too much acetaminophen, liver failure may occur.

Additional pharmacologic treatments that may be used in patients who suffer from tension headaches include carbamazepine, which is an anti-convulsant, and venlafaxine, which is an antidepressant. However, side effects of carbamazepine include allergic reactions and skin irritation.

Patients with tension headaches that are being managed with pharmacological therapy should always work closely with their doctor to avoid adverse reactions. They should also be incorporating other therapies into their treatment, to lessen their use of medications.


Stress, sleep deprivation, and hunger can all lead to tension headaches. In addition, muscle strain in the neck or face may result in tension headaches. Tension headaches can be either episodic or chronic in nature. While the pain is not usually as severe as migraine pain, it can be disruptive to daily living and can have a detrimental impact on an individual’s life.

Once the cause of a patient’s tension headaches is identified, treatment can be targeted to help alleviate their pain. Options include:

  • Lifestyle changes to reduce stress
  • Complementary manual therapies, such as physical therapy and massage
  • Pain medications, anti-inflammatory drugs, as well as anti-convulsant and antidepressant medications

Patients receiving pharmacologic treatment should be monitored for side effects as many of the drugs used for the trea