Tension Headaches

//Tension Headaches
Tension Headaches 2016-11-17T10:02:56+00:00

What Are Tension Headaches?

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, and 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, and an increased sensitivity to sound and light. The majority of tension headache symptoms are experienced on both sides of the head.

Tension headaches are classified as 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 associated with 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.

Causes Of Tension Headaches

headachesTension headaches are associated with a variety of individual factors including stress, eyestrain, dehydration, and hunger. They can also occur in patients who are sleep deprived. Patients who grind or clench their jaw are also more susceptible to tension headaches. 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, including the occipital nerve, sphenopalatine ganglion, and the trigeminal nerve.

Treatments For Tension Headaches

A common type of pharmacological treatment for tension headaches is oral analgesics (pain medications), which may include non-steroidal anti-inflammatory drugs (NSAIDs). However, if NSAIDs are taken frequently, there is a risk of organ failure. Similarly, if acetaminophen is abused, 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 be closely monitored for adverse reactions.

Acupuncture and biofeedback training are two options that are non-pharmacological, which have shown to be effective for treating tension headaches. Acupuncture involves inserting small needles into specific acupuncture points within the body. These needles may be inserted 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 are recorded during a headache episode. These physiologic responses may include muscle tension that is measured by an electromyogram, brain wave activity which is measured by an electroencephalogram, and sweat production which is measured by galvanic skin response. 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, and learn how to control their responses through relaxation. In the initial phases of biofeedback training, sessions may need to be practiced in a health care facility with a biofeedback professional; however, 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 in response to being exposed to them. Biofeedback training allows patients to have more control over their tension headache symptoms.

Manual therapy techniques, including massage therapy, physical therapy, or chiropractic care, may also be beneficial for patients suffering with tension headaches, as these types of headaches are often caused by muscular strain. 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. Additionally, massage therapy helps to remove muscle tension and may help to alleviate stress, in turn resulting in reduced headache pain.


Various factors are associated with tension headaches, including stress, sleep deprivation, and hunger. In addition, muscle strain in the neck or face may result in tension headaches. Tension headaches can be either episodic or chronic in nature, and 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. Oftentimes, pharmacological therapy is vital for tension headache relief. Pharmacologic options include 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 treatment of tension headaches carry a risk of serious side effects.

Acupuncture and biofeedback training have also been shown to provide effective pain relief for patients suffering from tension headaches. For patients that are suffering from these types of headache due to muscle strain or stress, manual therapies including physical therapy, chiropractic care, and massage therapy may provide pain relief. Patients are encouraged to speak to their medical practitioner to determine the most effective treatment plan for their case.


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