Tension-Type Headaches

A tension-type headache is usually mild to moderate, band-like pain that affects the whole head.

The cause of tension-type headaches is not well understood but may be related to a lower-than-normal threshold for pain. Stress may be involved. However, its role is not clearly understood, and it is not the only explanation for the symptoms.

Symptoms and Diagnosis

The pain is usually mild to moderate, although it may be severe. It feels like tightening of a band around the head, making the whole head ache. The pain may last 30 minutes to 1 week. Unlike a migraine headache, a tension-type headache is not associated with nausea and vomiting and is not made worse by physical activity, light, sounds, or smells. Tension-type headaches typically start several hours after waking and rarely awaken a person from sleep.

The diagnosis is based on the person's description of the headache and the results of a physical examination. No specific procedures can confirm the diagnosis. Rarely, computed tomography (CT) or magnetic resonance imaging (MRI) of the head is performed to rule out other disorders that may be causing the headache, particularly if headaches have developed recently.

Treatment

For most mild to moderate tension-type headaches, almost any over-the-counter analgesic, such as aspirin, acetaminophen, or ibuprofen (see Section 2, Chapter 18 and Section 6, Chapter 78), can provide fast, temporary relief. Massaging the affected area may help relieve the pain. Severe headaches may require stronger, prescription analgesics, some of which contain opioids (narcotics), such as codeine or oxycodone (see Section 6, Chapter 78). For some people, caffeine, an ingredient of some headache preparations, enhances the effect of analgesics. However, overuse of analgesics or caffeine can lead to chronic daily headaches. Such headaches, called rebound headaches, occur when a dose of an analgesic is missed or late or when caffeine intake is reduced or stopped.