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Tension Headaches: Symptoms, causes, Diagnosis, treatment & More


What is a tension headache?

A tension-type headache (TTH) is generally considered to be a type of primary headache without other apparent physical causes.

Tension Headaches
 A tension headache is usually caused by an increase in one or more types of neck and/or head tension, such as strain, tightness, cramping or stiffness. The pain may radiate around the head and extend down the neck or limit to one area. Tension headaches are also associated with excessively tense facial muscles that pull on the nerve roots in the back of your eyes (the ophthalmic nerve). This can cause reduced function in your eyesight so it is important to see an eye specialist if you experience any vision symptoms with a TTH.



1.The precise symptoms of tension-type headaches can vary from person to person, but generally people with TTH will experience a constant headache without any specific cause (ex. excessive alcohol use, head injury, etc.). TTH is not a disease, but more of a symptom of an underlying problem.

2.Unlike migraine headaches which usually get worse over time, the pain of TTH usually gets better or disappears when you change position. TTH is also unlikely to affect other parts of your body with pain such as the shoulders and arms and isn't accompanied by nausea or sensitivity to light and sound as tension-type headaches are.

3.The exact symptoms of a TTH will vary from patient to patient, depending on which muscle areas are affected in their head and neck area, along with which nerves are being compressed or irritated from the muscles in their head and neck moving around too much.

4.A tension-type headache usually begins anywhere from one to three hours after some kind of physical activity or after sitting for a long period of time, such as when studying or working at a computer for many hours.

5.Tension headaches are not usually caused by any specific physical injury or trauma to your head and neck like whiplash from an auto accident, although in some cases the trauma can cause compression in the muscles which can lead to TTH.

6.The pain from TTH is usually a dull ache, tightness or pressure in the back of the head or neck, shoulders or eyes. The symptoms can vary from person to person, but one of the most common symptoms is a feeling of having a tight band around your head. Sometimes people with TTH also experience mild nausea and/or sensitivity to bright light.

7.People with TTH may think that they have developed a migraine headache because their headaches come on rapidly and are severe at first, but unlike migraine headaches they typically do not get worse over time and most importantly tension-type headaches are not usually accompanied by any other symptoms like nausea and sensitivity to light and sound which are very common with migraine headaches.

8.Tension headaches are not caused by a specific physical injury or trauma to the head and neck, like whiplash from an auto accident.

9.Most people with TTH have no other physical condition that can cause their headaches such as thyroid disease, sinusitis, arthritis and/or rheumatism. In very rare cases, some people may experience symptoms of another type of headache if they have another underlying physical condition in which the head and neck muscles are being overused or strained by muscles, such as allergies.


When to see a doctor?

If you experience symptoms of a tension-type headache in which your head and neck muscles are overly tense or strained and causing compression to the nerves, ligaments and tendons causing pain then it is important to see a doctor as soon as possible. You may have TTH if your headaches get worse after continuous physical activity such as sitting at a computer for many hours or any other physical activity that tends to make your head and neck muscles tense. You may also suspect you have TTH if over time your headaches are becoming more frequent or severe.



Overuse of any muscle group in the head, neck or shoulders can lead to symptoms of TTH. This includes the muscles in your upper and lower body as well as the muscles around your eyes (oculomotor nerve). People with TTH may feel that their headaches are caused by some sort of physical trauma, but this is often not the case. People with TTH may also have an overactive thyroid gland that can cause the facial muscles to become overly tense and overuse them. Some people may also feel that they get TTH from holding a stress position such as in their work place for a long time. When sitting for long periods of time, muscles in your head and neck tend to become overly tense causing compression on nerves and ligaments which in turn cause pain.



While TTH is not a disease, it is important that if you experience symptoms of tension-type headaches you are evaluated by a doctor to make sure that other serious problems aren't causing your headaches. A doctor may suspect TTH if your headache pain gets better when you change positions and doesn't get worse over time. 

This can help them rule out other causes of headaches such as:

1. Over active thyroid gland. Both hyper and hypothyroidism can cause TTH symptoms because the thyroid is involved with the movement of muscles in the head and neck.

2. Sinusitis and upper respiratory infections. These can cause facial muscle tension which can lead to TTH symptoms over time.

3. Arthritis and/or rheumatism. These conditions are very common in the general population and can cause TTH because they cause the muscles in your head, shoulders, arms and upper trunk to become tense so that compression will occur on nerves and tendons leading to pain in these areas.

3. Migraine Headaches – Some people with TTH may also have a migraine headache which is caused by abnormal electrical activity in the nerves of the brain that control vision, pain, smell, sound and other bodily functions (the trigeminal nerve). The pain is most often felt in the head or face because of abnormal electrical impulses from the brain and/or from other nerves involved in these systems. These impulses can also travel to the muscles around the eyes, ears, nose and mouth causing pain and sometimes nausea and sensitivity to light, sound and taste. The pain from a migraine headache is usually a throbbing, sharp type of pain that can last anywhere from 4-72 hours after which one headache can occur within 24 hours or less. Migraine headaches may be accompanied by sensitivity to light and sound.

4. Cervical spondylosis - This is a term that describes degenerative changes in the cervical spine (neck) due to wear on the discs and bones of the spine from age.

5. Trauma to head or neck – Some people with TTH may have had a whiplash injury in an automobile accident that occurred many years ago, but typically this is not the case.

6. Temporomandibular Joint Syndrome – The temporomandibular joint (TMJ) is where your lower jaw meets your skull right behind your ears. Pain on one side of the jaw and/or neck can be an indication of TMJ.

7. Headaches resulting from a brain tumor – These types of headaches are rare in younger people, but can occur at any age.

8. Shingles – This is a skin rash caused by a virus and is usually associated with pain in one or both arms or legs, especially the face and head. This can also occur in people who have had chickenpox as an infant, although this rash is very different than shingles. Shingles causes skin blisters to form on one side of the body and these blisters turn into a scaly crust that may ooze fluids when the blisters break open. The blisters usually appear in a bandlike pattern on an area of skin. The pain from shingles may worsen with touch and be accompanied by fever, headaches and fatigue. Shingles is often treated with antiviral drugs and/or over the counter medications such as acetaminophen, ibuprofen or aspirin to decrease pain and inflammation. There is also a vaccine that can prevent shingles known as Zostavax.

9. A brain hemorrhage – This type of headache is rare in younger people and can occur with other symptoms such as vomiting, blurry vision, weakness or confusion.

10. Intracranial Infection – This type of headache is caused by an infection in the brain, usually caused by a virus or bacteria and can cause a fever, vomiting and stiff neck.

11. A brain tumor – This type of headache is also very rare in younger people, but can occur at any age.

12. Headaches from substance abuse – Alcoholism and its related substances can cause headaches because they change your body chemistry in many different ways that include increased heart rate, constriction of blood vessels and muscle tension.

13. Migraines in Men – Some men may experience migraine headaches when taking certain types of medicines.

14. Menopause – Changes in hormone levels cause some women to experience migraines that are caused by increased water retention, fluid pooling in the head and neck, fatigue and general weakness.

15. Pre-menstrual syndrome – This is a term used to describe a variety of headaches and related symptoms that are usually experienced by women in the days before their period starts.

16. Headaches caused by sinusitis – This type of headache can be associated with sinusitis, a disease that inflames the tissues in the nose and sinuses and can cause mild to severe pain, itchy eyes, nose or throat, runny nose and congestion.

17. Painful period headaches – These headaches are relieved by using hormonal birth control pills or estrogen therapy during your cycle.

18. Migraine Associated Vertigo (MAV) – This is a type of migraine that is accompanied by vertigo, the sense that you or your environment is spinning or moving.

19. Spinal misalignment – This type of pain is often associated with muscle spasms in the neck, shoulders and upper back.

20 . Non-Structural Causes – These are many other causes for headaches that do not include structural problems in the head or neck, including: tension, stress, depression and anxiety which can cause muscle tension in the head and neck. Medications such as non-steroidal anti-inflammatory drugs (NSAIDS), diuretics and steroids may cause headaches when taken for any length of time. Medications known as ergotamines, often used to treat migraine headaches, may cause other symptoms such as burning or tingling sensations in the fingers and toes. Pain from diabetes that is poorly controlled may also cause headaches. The birth control pill and other hormones used for contraception can cause pain in some women. The side effects of some medications for high blood pressure, depression and thyroid disorders can include headaches. It can also be caused by the withdrawal of caffeine, chocolate or phenylephrine which are substances found in many over the counter headache medications such as Anacin, Excedrin and Midrin (no longer available). Heavy intake of salt (sodium) can increase water retention causing a headache.

Hormones, hormones and more hormone triggers.

Some women with TTH think that hormonal triggers are a factor in their headaches. As noted above, headaches can result from the use of birth control pills and estrogen therapy can help some women deal with their menstrual cycles and associated headaches. Women who have migraines will tell you that they are worse when they are menstruating and that the hormones trigger their migraines. Many women believe that a drop in estrogen levels is one of the causes for their premenstrual syndrome (PMS) as well as other hormone changes throughout their menstrual cycle. Hormones are powerful triggers for headaches, but in many cases there is no clear-cut dose-response relationship between hormone levels and headache triggers. Making any changes to the medications that are being taken to control headaches will be done with the help of a doctor.



Preventive measures used to prevent headaches include:

▪ Maintaining a healthy diet.

▪ Getting regular exercise.

▪ Getting enough sleep.

▪ Avoiding excess stress and avoiding stressful situations when possible.

▪ Avoiding triggers such as caffeine, chocolate or high levels of salt in the diet or in medications.

▪ Keeping a food diary to identify foods that may trigger headaches.

▪ Taking your medications for headaches on schedule and as prescribed with any side effects reported to your doctor immediately if they get worse or more frequent over time.



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