Doctor's Notes on Tension Headache
Tension headache is the most common type of headache. A majority of people will develop a tension headache sometime during their lives. Tension headache can occur at any age but most commonly begins during adolescence or young adulthood, with the highest frequency among those aged 20-50 years. Tension headaches are different from migraine or cluster headaches.
Symptoms of tension headache include diffuse pressure or tightness and sometimes, tenderness of the muscles surrounding the head. The pain may be on both sides of the head, or it may cause an aching or squeezing sensation located in the forehead, temples, or back of the head that radiates to the neck and shoulders. Pain is usually moderate, not severely disabling, and not associated with the typical symptoms of migraine, such as nausea, vomiting, or sensitivity to sound or light. The onset of pain is usually gradual and not associated with a period in which a person can feel a headache coming on. The onset of a tension-type headache often occurs in periods during or after stress and usually toward the latter part of the day.
Tension Headache Symptoms
In general, a tension-type headache may cause diffuse (spread out, not in one place) pressure or tightness. Sometimes, muscles surrounding the head are tender.
- The pain may be on both sides of the head, or it may cause an aching or squeezing sensation located in the forehead, temples, or back of the head with radiation to the neck and shoulders. Pain is usually moderate in intensity, not severely disabling, and not associated with the typical symptoms of migraine, such as nausea, vomiting, or sensitivity to sound or light.
- The onset of pain is usually gradual and not associated with any prodrome or period in which a person can feel a headache coming on.
- People may associate the onset of a tension-type headache to periods during or after stress and usually toward the latter part of the day.
- If the tension-type headache is present for more than 15 days a month or longer than 6 months, it is considered chronic rather than episodic.
Tension Headache Causes
- Many people associate the onset of tension-type headache with stress or upsetting emotional situations. However, these factors have not been shown to lead to muscle contraction or reduced blood flow. Although people may have tenderness of the muscles surrounding the head, tension-type headache is not the result of sustained muscle contraction.
- The most compelling and current evidence points to a central nervous system dysfunction as the underlying cause of tension-type headaches. Thus, the muscle ache of tension-type headache is thought to be a result of increased sensitivity of the nervous system and pain from occasional or long-term imbalances in brain chemicals known as neurotransmitters (serotonin, dopamine, norepinephrine, enkephalins).
- Studies show that some people with primary headache disorders respond to medications that specifically target and influence serotonin. These are mostly people who have migraine or cluster headaches. Most of those who do not have migraine or cluster headaches do not respond to serotonin-targeted drugs.
- People with chronic tension-type headache may also have imbalances in neurochemicals. In fact, depression may be an underlying cause in some people with chronic tension headaches. Depression and some sleep disorders are linked to serotonin.
Anything (or anyone) that boosts your stress level can make you more vulnerable to tension headaches or migraines. Doctors don’t know exactly how it happens. Many things may be involved, including certain nerves in the brain that relay pain messages and may be extra sensitive. Changes within the brain itself may also be involved in migraine headaches.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.