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Tension headaches
Medically reviewed article

What is a tension headache?

Tension headaches most often occur across the head and feel like pressure or a tight band around the head. The headache can be triggered by tension in the muscles of the neck, shoulders, and outside the skull (the bone structure that makes up the skeleton of the head).

By
Hemi Health
Hemi Health

Some people may be more prone to developing tension headaches due to genetic factors or lifestyle conditions. It is a type of headache that often develops as a result of stress, poor posture, awkward working positions, or other causes of muscle tension. Tension headaches are the most common form of headache. Three out of four Danes have experienced tension headaches during their lifetime1.

What characterizes tension headaches?

Tension headaches are characterized by a constant, pressing pain that can feel like wearing a helmet that is too small or having a tight band around the head that tightens throughout the day2. The pain is typically mild to moderate and most often occurs on both sides of the head (unlike migraines, which are usually unilateral), and it can last anywhere from half an hour to several days. Symptoms can vary from person to person, but common to most is a feeling of tightness or pressure across the forehead and/or in the temples.

Symptoms of tension headaches:

  • Mild to moderate in intensity, but can become intense in some cases.
  • Occurs on both sides of the head (bilateral), especially in the forehead, temple, or neck area.
  • A persistent, non-pulsating pain that can last for several hours or even days.
  • Does not worsen with routine physical activities.

Tension headaches often occur when muscle tension in the shoulders, neck, or jaw escalates.

Episodic or chronic tension headaches?

A distinction is made between episodic and chronic tension headaches. Episodic tension headaches occur occasionally and are often related to periods of high stress, increased muscle tension, poor sleep, awkward working positions, and more. Chronic headaches are persistent and may require a more comprehensive treatment strategy.

It is important to note that episodic tension headaches can develop into a chronic form if left untreated. If the headache becomes a regular part of your life and you experience headaches more than 15 days a month, it may indicate a transition to chronic tension headaches.

Some people with chronic tension headaches experience a feeling of tenderness in the scalp, neck, and shoulders, as well as general muscle tension. In addition, some people with chronic tension headaches also experience sporadic tenderness when touching the hair roots or applying light pressure to the head.

Triggering factors

Tension headaches can be triggered by various factors that vary from person to person. Here is an overview of some of the most common triggers:

  • Muscle tension: Especially around the neck and shoulder muscles, often caused by prolonged poor posture, such as sitting at a desk.
  • Stress and anxiety: Physical and psychological stress can lead to muscle tension in the head and neck area.
  • Lack of sleep: Lack of sleep or disrupted sleep patterns can increase the risk of headaches.
  • Incorrect prescription glasses: Can contribute to tension headaches in some people due to strain on the eye muscles.
  • Improper bite function or teeth grinding: Can cause jaw tension, which in some can lead to tension headaches.

Understanding these triggers is an important part of managing and preventing tension headaches, which can help reduce both the frequency and intensity of attacks. In chronic tension headaches, it has been shown that there has been a change in the way the nervous system perceives pain2.

Who experiences tension headaches?

Headache attacks of this type affect men and women almost equally frequently, while more than twice as many women as men experience the chronic form - i.e., tension headaches at least 15 days a month over a period of three months. In addition, genetics play a significant role. There is a three times higher risk of developing the chronic variant of tension headaches if close family members also suffer from the same form3.

Tension headaches often begin in your 20s. After the age of 40, there is a slight downward trend. Tension headaches usually occur in episodes, and about 75% of the population experiences this type of headache3.

Read Sebastian's story about tension headaches here.

Treatment of tension headaches

When experiencing persistent or recurring headaches, it is important to seek professional guidance for a correct diagnosis. A doctor will typically start with a thorough review of your medical history to provide the right medical treatment. Read more about how to prepare for your doctor's appointment here. Your description of the headache, its duration, intensity, and location is crucial for distinguishing tension headaches from other types of headaches, such as migraines. Often, there is no need for advanced tests, such as blood tests or brain scans, to diagnose tension headaches unless the doctor wishes to rule out other medical conditions.

For episodic tension headaches, common over-the-counter painkillers like ibuprofen or paracetamol may be sufficient medical treatment to relieve the pain. If, however, the frequency of the headaches increases, the doctor may recommend measures such as prescription medication, physical therapy, or other forms of treatment. There is no evidence that massage has a relieving effect on tension headaches. Some patients may benefit from increased physical activity and exercise, as well as neck and shoulder exercises, while others need rest and relaxation4.

Many also find relief through lifestyle changes. Regular physical activity, relaxation exercises, and stress management techniques can have a positive effect on both the frequency and intensity of the episodes5.

Get the right help

By identifying triggers and exploring treatment strategies that suit your specific needs, you can succeed in reducing your headaches. If your tension headaches are taking up too much space in your life, we recommend that you talk to a doctor and explore your options for relief.

A headache diary can be a useful tool for spotting patterns in episodes and the effectiveness of treatment strategies. With detailed records of the headache's duration, severity, and possible triggers, you can better adapt your treatment methods and find the most effective path to relief.

Sources

  1. Danish Health Authority, The Health of the Danes (2021), https://www.sst.dk/-/media/Udgivelser/2022/Sundhedsprofil/Sundhedsprofilen.ashx National Treatment Guidelines, Tension Headache (28.10.2020), https://nnbv.dk/spaendingshovedpine/ Medicin.dk, Tension Headache (18.09.2023), https://min.medicin.dk/sygdomme/sygdom/167 Videnskab DK, Why do we get headaches? (2017) https://videnskab.dk/krop-sundhed/hvorfor-faar-man-hovedpine/ Aarhus University Hospital - For patients and relatives, Mindfulness exercises - Pain and headaches, https://www.auh.dk/afdelinger/neurologi/neurologisk-klinik/sygdomme-og-behandling/smerter-hovedpine/mindfulness-ovelser/
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