Tension headache is the most common type of headache caused by severe muscle contractions triggered by stress or exertion. Tension headaches usually occur in the front of the head, although they may also appear at the top or the back of the skull, as shown in the illustration above. (Illustration by Electronic Illustrators Group.)

  Definition

This most common type of headache is caused by severe muscle contractions triggered by stress or exertion. It affects as many as 90% of adult Americans.

  Description

While most American adults get a tension headache from time to time, women and people with more education are slightly more likely to suffer with them. People who are so anxious that they grind their teeth or hunch their shoulders may find that the physical strain in their body can be experienced as pain and tension in the muscles of the neck and scalp, producing almost constant pain.

  Causes and symptoms

Tension headaches are caused by tightening in the muscles of the face, neck and scalp because of stress or poor posture. They can last for days or weeks and can cause pain of varying intensity. The tightening muscles cause more expansion and constriction of blood vessels, which can make head pain worse. Eyestrain caused by dealing with a large amount of paperwork or reading can cause a tension headache as well.

Many people report tension headache pain as a kind of steady ache (as opposed to a throb) that forms a tight band around the forehead, affecting both sides of the head. Tension headaches usually occur in the front of the head, although they also may appear at the top or the back of the skull.

Tension headaches often begin in late afternoon and can last for several hours; they can occur every day and last throughout most of the day. When this happens, the headache is called a chronic tension headache. Unlike migraines, tension headaches don't cause nausea and vomiting, sensitivity to light, or any kind of aura before the headache begins.

  Diagnosis

Diagnosis of tension headaches is made from a medical history, discussion of symptoms, and elimination of other types of headaches or underlying disorders.

Very few headaches are the sign of a serious underlying medical problem. However, sufferers should call a physician at once if they:

• have more than three headaches a week
• take painkillers almost every day
• need more than the recommended dose of painkiller
• have a stiff neck and/or fever in addition to headache
• are dizzy, unsteady, or have slurred speech, weakness, or numbness
• have confusion or drowsiness with the headache
• have headaches that began with a head injury
• have headaches triggered by bending, coughing or exertion
• have headaches that keep getting worse
• have severe vomiting with the headache
• have the first headache after age 50
• awaken with headache that gets better as the day goes on

  Treatment

There are many different treatments for tension headaches, which respond well to both medication and massage. If these headaches become chronic, however, they are best treated by identifying the source of tension and stress and reducing or eliminating it.

Medication

Tension headaches usually respond very well to such over-the-counter medicines as aspirin, ibuprofen, or acetaminophen. However, some of these drugs (especially those that contain caffeine) may trigger rebound headaches if discontinued after they are taken for more than a few days.

More severe tension headaches may require combination medications, including a mild sedative such as butalbital; these should be used sparingly, though. Chronic tension headaches may respond to low-dose amitriptyline taken at night.

Massage

Massaging the tense muscle groups may help ease pain. Instead of directly massaging the temple, patients will get more relief from rubbing the neck and shoulders, because tension headaches can arise from tension in this area. In fact, relaxing the muscles of the neck can cut the intensity and duration of tension headaches at least in half.

To relax these muscles, the neck should be rotated from side to side as the shoulders shrug. Some people find that imagining a sense of warmth or heaviness in the neck muscles can help. Taking three very deep breaths at the first hint of tension can help prevent a headache.

Other therapy

If tension headaches are a symptom of either depression or anxiety, the underlying problem should be treated with counseling, medication, or a combination of both.

  Alternative treatment

Eliminating the source of the tension as much as possible will help prevent tension headaches. Acupuncture may be helpful in treating some chronic tension headaches. Homeopathic remedies and botanical medicine can also help relieve tension headaches. Valerian (Valeriana officinalis), skullcap (Scutellaria lateriflora), and passionflower (Passiflora incarnata) are three herbal remedies that may be helpful. A tension headache can also be relieved by soaking the feet in hot water while an ice cold towel is wrapped around the neck.

  Prognosis

Cutting down on stress and relying less on caffeine-containing medications can reduce the number of tension headaches for most people.

  Prevention

Tension headaches can often be prevented by managing everyday stress and making some important lifestyle changes. Those who are prone to tension headaches should:

• take frequent "stress breaks"
• get regular exercise--even a brisk 15-minute walk can help prevent tension headaches
• get enough sleep
• release angry feelings

   Resources:

Books

• Rapoport, Alan M., and Fred Sheftell. Headache Relief for Women. Boston: Little, Brown and Co.,1996.
• Robbins, Lawrence, and Susan S. Lang. Headache Help. New York: Houghton Mifflin, 1995.
• Solomon, Seymour, and Steven Fraccaro. The Headache Book. New York: Consumer Reports Books, 1991.

Periodicals

• Byfield, Ted. "Sock It to Headache Pain." Body Bulletin (1 Feb. 1996): 3.
• Kleiman, Carol. "For Women, Success at Work Can Be a Tension Headache." St. Louis Post-Dispatch, 2 Apr. 1998, C8.
• Munson, Marty, Therese Walsh, and Yun Lee. "On the Mark: Aim Low to Relieve Tension Headache." Prevention Magazine, 1 Jan. 1996, 24-25.
• Rogers, June. "Your Aching Head." Chatelaine 69 (1 Aug. 1996): 47-50.

Organizations

• American Council for Headache Education (ACHE). 19 Mantua Road, Mt. Royal, NJ 08061. (800) 255-2243. http://www.achenet.org
• National Headache Foundation. 428 W. St. James Place, Chicago, IL 60614. (800) 843-2256. http://www.headaches.org