Tension Headache

Tension headaches are very common, affecting as many as 40% of teenagers and adults. They tend to start at the back of your head and move forward, involving your neck, scalp, and head (for example, the temporal regions on either side of your forehead and the occiput, which is at the base of your head just above the neck). The pain, which is due to contraction (tightness) of the neck and scalp muscles, can ultimately cover your entire head. Such muscle contraction is commonly caused by stress – thus, the name "tension." Headaches originating from tightness in the neck muscles are often called cervicogenic headaches.

Signs and Symptoms


When you feel tense, the muscles in your shoulders, neck, scalp, and jaw tighten up, creating pain. Causes include the following:

Risk Factors


When you see your health care provider, he or she will take a detailed history in order to distinguish tension headaches from headaches of other causes, such as migraines. Your health care provider will ask questions about when your headaches occur, how long they last, how frequently they come on, the location of the pain, and any symptoms that accompany the headaches. Sometimes it helps to keep a diary about your headaches prior to seeing the doctor; this way, you'll have an accurate recording of how often they happen and you won't forget the details related to your headaches.

When you do see your physician, the physical exam will include assessing your head, neck, eyes, and sinuses as well as performance of a neurologic examination. Don't be surprised if the doctor asks you some questions to test your short term memory. On exam, the physician is likely to find musculoskeletal tenderness around your neck and scalp.

Tests that your doctor may order, depending on your symptoms and exam, include:

Treatment Approach

Unfortunately, as many as 60% of people with tension headaches do not seek the advice of their physician and simply resort to taking over the counter medications for the pain. This is too bad because a comprehensive treatment plan including relaxation (see Mind/Body Medicine), exercise and other lifestyle changes, and occasional medication can be very effective in significantly reducing the frequency and intensity of tension headaches.

Many of the medications used to prevent or treat tension headaches, however, have risks and side effects. Therefore, using methods that do not include medications are preferred if you are able to achieve successful pain control and reduce the frequency of your headaches. Biofeedback, yoga, and relaxation techniques, for example, can be quite effective for both acute relief and decreased headache frequency. Regular exercise can also reduce how often you get a tension headache.


Keeping a headache diary, particularly when you first begin to experience headaches, can help identify the source of your tension headaches and how to modify your environment and habits to avoid headaches. When a headache occurs, write down the date and time the headache began. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were experiencing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.

Good health habits, as listed below, are important for helping to lessen stress and tension headaches:


Medications are used both to treat the pain from a headache at the time that you have it (acute therapy) and to prevent the headaches from coming if you are a person who gets them frequently (chronic therapy).

Acute pain control:

Over-the-counter (OTC) pain relievers are usually effective temporary remedies. Talk to your doctor about which of these is best for you. If over the counter medications are not adequate for pain control, a physician may prescribe a more potent version of non-steroidal anti-inflammatory drug (NSAID) such as naproxen, ibuprofen, diclofenac, tolmetin, or ketoprofen. Another medication that your doctor might consider is called isometheptene. Rarely, if your headaches are very severe and nothing else relieves the pain, your physician may consider prescribing opiods like codeine or hydrocodone.

Prevention of chronic, recurrent tension headaches:

Surgery and Other Procedures

If an injury or problem in the cervical spine is contributing to tension headaches, a nerve block, using a steroid to reduce inflammation and muscle contraction, may be considered to lessen the head pain.

Nutrition and Dietary Supplements

Certain foods can trigger tension headaches; these include: On the other hand, following a diet that is rich in fruits and vegetables, whole grains, and uses fish and soy for protein instead of red meat may help lessen the frequency and intensity of your headaches.

Magnesium levels tend to be lower in those with headaches, both migraines and tension types. In the case of tension headaches, this may be due to the fact that low levels of magnesium may trigger muscle tightness and pain. Therefore, if you suffer from frequent tension headaches, consider, together with your physician, taking magnesium supplements and carefully keeping track of whether your headaches happen less often or are less severe.

Vitamin B Complex
Vitamin B complex is considered to be an anti-stress agent and, therefore, potentially helpful to take if you experience tension headaches.

5-hydroxytryptophan (5-HTP)
5-hydroxytryptophan (5-HTP) is an amino acid. The body makes 5-HTP from tryptophan (another amino acid that is obtained from the diet) and converts it to an important brain chemical known as serotonin. 5-HTP dietary supplements help raise serotonin levels in the brain, which may have a positive effect on sleep, mood, anxiety, aggression, appetite, temperature, sexual behavior, and pain sensation. Some studies suggest that 5-HTP supplements may be effective in children and adults with various types of headaches including tension, but more research is needed before knowing its safety and effectiveness.


The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine.

Cayenne (Capsicum frutescens/Capsicum spp.)
Capsaicin, a substance found in cayenne pepper, has powerful pain-relieving properties when applied topically. To relieve chronic, recurrent headaches, including tension and cluster headaches (a severe one-sided headache that tends to occur in clusters, happening repeatedly every day at the same time for possibly several weeks), capsaicin is placed inside the nose.

Peppermint (Mentha x piperita)
When applied topically to the forehead and temples, peppermint has the ability to relieve tension headaches and may be comparable to acetaminophen (a commonly used over the counter medication).

Although studies are lacking, the following herbs have been used clinically by herbal specialist to treat different types of headaches, including tension:


An acupuncturist diagnoses headaches not as migraine, tension, or sinus, but rather as conditions deriving from "energetic" imbalances. Headaches are commonly seen and often successfully treated by acupuncturists.

The National Institutes of Health recommends acupuncture as a treatment for headache. Acupuncturists diagnose tension headaches by paying careful attention to the kidney and its associated meridians (energy pathways in the body), as well as liver and gallbladder meridians. The physical location of the headache also helps the acupuncturist to determine an appropriate treatment plan, which (in addition to placing needles in acupuncture points) may include lifestyle/dietary changes or herbal remedies. While results from studies have been mixed, most researchers agree that acupuncture is safe and that headache patients who wish to try this therapy should not be discouraged from doing so.


Spinal manipulation is commonly used to treat tension headaches, especially tension headaches that originate from the neck. Evidence supporting the use of tension headaches that originate in the neck is quite clear; however, studies examining the effectiveness of spinal manipulation for other types of tension headaches have been less conclusive.

In one very important study, individuals with tension headaches were randomly assigned to receive either spinal manipulation or an antidepressant medication. Both groups experienced significant improvement while they were being treated. When treatment was stopped, however, the beneficial effects of spinal manipulation lasted longer than did the effects of the antidepressant medication.

In addition, a review article evaluating nine studies that tested spinal manipulative therapy for tension or migraine headaches concluded that this chiropractic technique is comparable to medications used to try to prevent either of these two types of headaches.

Massage and Physical Therapy

Stretching exercises for the head and neck, taught by a physical therapist, and receiving massages regularly can help reduce the frequency and duration of tension headaches. Stretching frequently is particularly important if your work involves typing or using a computer. Learning proper posture is another important factor in reducing your number of headaches; a physical therapist can teach you.

Reflexology (a type of massage in which specialized thumb and finger techniques are applied to the hands and/or feet at points that correspond to specific organs and structures throughout the body) may be an especially valuable technique for treating and preventing headaches.

Other techniques that some clinicians recommend include aromatherapy (the use of essential oils from plants, often together with massage, for healing purposes) and Reiki (an energy balancing technique) treatments.


Studies indicate that homeopathy may be no more effective than placebo in relieving tension headaches. Interestingly, however, one of the most common reasons people seek homeopathic care is to relieve the pain associated with chronic headaches. Many homeopaths report that homeopathy helps treat and prevent recurrent tension headaches. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following remedies are commonly prescribed for tension headaches:

Mind/Body Medicine

You can do many things to avoid tension headaches or relieve the pain: Other relaxation techniques that may be helpful include:

Other Considerations


Some women who are prone to headaches will get them more often when they are pregnant. Other women, however, experience fewer headaches during pregnancy, especially during the second trimester.

Warnings and Precautions

It is important to use medications only as directed. Rebound headaches may occur from overuse of medications and complications may occur from side effects of medications.

Call your health care provider if you experience a new headache, a change in quality of a previous headache or previous headache pattern, or if you are unable to manage your symptoms in the usual way (for example, a medication that usually takes away the pain no longer works).

Prognosis and Complications

Serious underlying conditions due to headaches, like a tumor or a stroke, are extremely uncommon, despite the fact that many worry about these possibilities. Situations that may indicate a serious problem include the following: The good news is that over 90% of people with tension headaches can get significant relief from a combination of lifestyle change, relaxation, and medication.


Altura BM, Altura BT. Tension headaches and muscle tension: is there a role for magnesium? Med Hypotheses. 2001;57(6):705-713.

Antidepressants NMIHI. Accessed at http://drugs.nmihi.com/antidepressants.htm on May 28, 2018.

Annequin D, Tourniaire B, Massiou H. Migraine and headache in childhood and adolescence. Pediatr Clin North Am. 2000;47(3):617-631.

Astin JA., Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalagia. 2002;22(8):617-623

Baclofen. NMIHI. Accessed at http://www.nmihi.com/b/baclofen.html on May 28, 2018.

Baghdikian B, Lanhers M, Fleurentin J, et al. An analytical study, anti-inflammatory and analgesic effects of Harpagophytum procumbens and Harpagophytum zeyheri. Planta Med. 1997;63:171–176.

Barrows KA, Jacobs BP. Mind-body medicine: an introduction and review of the literature. Med Clin North Am. 2002;86(1):11-31.

Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Alt Med Review. 1998;3(4):271-280.

Blumenthal M. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council. Boston: Integrative Medicine Communications; 1998.

Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995;18(3):148-154.

Bove G, Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. JAMA. 1998;280(18): 1576-1579.

Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001;24(7):457-466.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 217-220.

Dagenais S. Haldeman S. Chiropractic. Prim Care. 2002;29(2):419-437.

Fusco BM, Giacovazzo M. Peppers and pain. The promise of capsaicin. Drugs. 1997;53(6):909-914.

Fusco BM, Marabini S, Maggi CA, Fiore G, Geppetti P. Preventative effect of repeated nasal applications of capsaicin in cluster headache. Pain. 1994;59(3):321-325.

Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. 1994;14(3):228-234.

Hammill JM, Cook TM, Rosecrance JC. Effectiveness of a physical therapy regimen in the treatment of tension-type headache. Headache. 1996;36(3):149-153.

Headache medications NMIHI. Accessed at http://drugs.nmihi.com/headache.htm on May 28, 2018.

Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001;285(17):2208-2215.

Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine. 1996;21(15):1746-1759.

Ibuprofen. NMIHI. Accessed at http://www.nmihi.com/i/ibuprofen.html on May 28, 2018.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 238-239.

Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 27(17):1835-1843; discussion 1843.

Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med. 2002;136(5):374-383.

Karst M, Reinhard M, Thum P, Wiese B, Rollnik J, Fink M. Needle acupuncture in tension-type headache: a randomized, placebo-controlled study. Cephalagia. 2001;21(6):637-642.

Launso L, Brendstrup E, Arnberg S. An exploratory study of reflexological treatment for headache. Altern Ther Health Med. 1999;5(3):57-65.

Linde K, Melchart D, Fisher P et al. Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane Library, Issue 3, 2001. Oxford: Update Software.

Lipchik GL, Nash JM. Cognitive-behavioral issues in the treatment and management of chronic daily headache. Curr Pain Headache Rep. 2002;6(6):473-479.

Long L, Huntley A, Ernst E. Which complementary and alternative therapies benefit which conditions? A survey of the opinions of 223 professional organizations. Complement Ther Med. 2001;9(3):178-185.

Lundeberg T. Acupuncture in headache. Cephalagia. 1999;19 Suppl 25:65-68.

Manias P, Tagaris G, Karageorgiou K. Acupuncture in headache: a critical review. Clin J Pain. 2000;16(4):334-339.

Marcus DA. Estrogen and tension-type headache. Curr Pain Headache Rep. 2001;5(5):449-453.

Mauskop A. Alternative therapies in headache. Is there a role? [Review] Med Clin North Am. 2001;85(4):1077-1084.

McCrory DC, Penzien DB, Hasselblad V, Gray RN. Evidence report: behavioral and physical treatments for tension-type and cervicogenic headache. Des Moines (IA): Foundation for Chiropractic Education and Research; 2001. Product No. 2085.

McGrady AV, Bush EG, Grubbs BP. Outcome of biofeedback-assisted relaxation for neurocardiogenic syncope and headache: a clinical replication series. Appl Psychophysiol Biofeedback. 1997;22(1):63-72.

Melchart D, Linde K, Fischer P, et al. Acupuncture for idiopathic headache. Cochrane Database Syst Rev. 2001;(1):CD001218.

Melchart D, Linde K, Fischer P, et al. Acupuncture for recurrent headaches: a systematic review of randomized controlled trials. Cephalalgia. 1999;19(9):779-786;discussion 765.

Mueller L. Tension-type, the forgotten headache. How to recognize this common but undertreated condition. Postgrad Med. 2002;111(4):25-26, 31-32, 37-38.

Naproxen. NMIHI. Accessed at http://www.nmihi.com/n/naproxen.html on May 28, 2018.

Newall C, Anderson L, Phillipson J. Herbal Medicines: A Guide for Health-care Professionals. London, England: Pharmaceutical Press; 1996: 174-175, 278-280.

Nilsson N, Christensen HW, Harvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther.1997;20(5):326-330.

NSAIDs NMIHI. Accessed at http://drugs.nmihi.com/nsaids.htm on May 28, 2018.

Penzien DB, Rains JC, Andrasik F. Behavioral management of recurrent headache: three decades of experience and empiricism. Appl Psychophysiol Biofeedback. 2002;27(20:163-181.

Powers SW, Mitchell MJ, Byars KC, Bentti AL, LeCates SL, Hershey AD. A pilot study of one-session biofeedback training in pediatric headache. Neurology. 2001;56(1):133.

Quinn C, Chandler C, Moraska A. massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002;92(10):1657-1661.

Savi L, Rainero I, Valfre W, Gentile S, Lo Giudice R, Pinessi L. A comparison of patients with migraine and tension-type headache. Panminerva Med. 2002;44(1):27-31.

Tension-Type Headaches. Cleveland Clinic. Accessed at https://my.clevelandclinic.org/ on September 12, 2018.

Silberstein SD, Rosenberg J. Multispecialty consensus on diagnosis and treatment of headache. Neurology. 2000;54(8):1553.

Solomon GD. Chronic tension-type headache: advice for the viselike-headache patient. Cleve Clin J Med. 2002;69(2):167-172.

Solomon S. Posttraumatic headache. Med Clin North Am. 2001;85(4):987-996.

Tavola T, Gala C, Conte G, Invernizzi G. Traditional Chinese acupuncture in tension-type headache: a controlled study. Pain. 1992;48:325-329.

Tension Headaches. NMIHI. Accessed at http://www.nmihi.com/h/tension-headache.htm on May 28, 2018.

Tension Headaches. WebMD. Accessed at https://www.webmd.com/ on May 28, 2018.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 89-94.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 236-239.

Vernon H, McDermaid CS, Hagino C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. Complement Ther Med. 1999;7:142-155.

Vithoulkas G. Homeopathic treatment of chronic headache: a critique. Homeopathy. 2002;91(1):32-34.

Venlafaxine. NMIHI. Accessed at http://www.nmihi.com/u/venlafaxine.html on May 28, 2018.

Walach H, Haeusler W, Lowes T et al. Classical homeopathic treatment of chronic headaches. Cephalalgia. 1997;17:119-126.

Walach H, Lowes T, Mussbach D et al. The long-term effects of homeopathic treatment of chronic headaches: 1 year follow up. Cephalalgia. 2000;20:835-837.

Walach H, Lowes T, Mussbach D et al. The long-term effects of homeopathic treatment of chronic headaches: one year follow-up and single case time series analysis. Br Homeopath J. 2001;90(2):63-72.

White AR, Resch K-L, Chan JCK et al. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia. 2000;20:632-637.

Yucal B, Kora K, Ozyalcin S, Alcalar N, Ozdemir O, Yucel A. Depression, automatic thoughts, alexithymia, and assertiveness in patients with tension-type headache. Headache. 2002;69(2):167-172.

What can I do about tension headaches? MedicalNews. Accessed at https://www.medicalnewstoday.com/.