Tension-type Headache

Tension-type headache is also known as “muscle contraction” headache, or simply, tension headache. Other names include “psychogenic” headache and “stress” headache. The current name evolved from new theories about the causes of tension-type headaches. As the name implies, tension-type headaches were originally thought to be brought on by emotional tension. But recent studies have indicated that abnormalities of the brain’s biochemistry might also play a role, as they do with migraine.

Also, the symptoms of tension-type headache and those of migraine often overlap. These two factors lead experts to believe that tension-type headache might not be due to muscle tension alone. We’ll examine these factors in more detail in the sections below.

There are two types of tension-type headache: chronic (also called chronic daily headaches) and episodic (also called acute and occasional). Chronic headache symptoms are very severe and occur with great regularity, every day for weeks or years. Episodic headaches are often triggered by stress, and the symptoms are not as severe as they are in chronic headache.

Who gets tension-type headaches?

Tension-type headache is the most common of headache varieties; about 100 million Americans suffer from these headaches in any particular year. A substantial number of people with migraine have symptoms that, over time, become tension-type headache. Some people have intermittent bouts of both.

Individuals who take pain relieving drugs are prone to a “rebound” effect – a syndrome whereby the pain becomes greater when the painkillers wear off. The rebound effect is implicated strongly as the cause of some chronic migraines as well.

Symptoms of tension-type headache

Location of pain

• Both sides of the head at once
• Band of pain around forehead, scalp, back of head or neck
• Pain, knotting and/or stiffness in neck, shoulders and/or upper back

Quality of pain

• Tightness or intense “vise-like” pressure
• Steady dull, ache (versus throbbing or stabbing)

Other characteristics

• Headache may begin as tension-type and turn into a migraine
• Many patients also suffer from depression
• Not aggravated by physical activity, light or sound
• Not often accompanied by nausea or vomiting
• Not preceded by aura

Pattern of pain

• Chronic: lasts several hours to several days, or even weeks, with frequency
• Episodic: lasts a few hours or a day

Causes of tension-type headache

The cause of tension-type headaches is under debate among Western medical doctors. Some argue that tension-type headache reflects biochemical changes in the brain that are caused by, or result in, muscle tension — and the same mechanisms that cause by migraine also cause tension-type headaches.

In short, they believe that migraine and tension-type headache is two ends of a continuum of symptoms that emerge from the same underlying cause.

Other experts maintain that tension-type headache is a distinctly unique disorder. Based on the name, conventional wisdom would have it that tension-type headache is caused by tension around the head and neck, and that it’s a common result of emotional tension. There appears to be some truth to this intuitive thought.

People who have stressful jobs, who are under emotional pressure or have anxious dispositions, seem to be more prone to tension-type headaches. Though these descriptions seem to imply that there is a tension headache personality, this is not true; these same conditions are a part of daily life, and tension-type headaches afflict every type of person.

The muscle tension could also be posture-related, or associated with underlying structural problems such as arthritis or spine injury. There is much evidence to support this concept. Indeed, in studies of people with tension-type headache, muscular tension is often present but, confoundedly, not always at the time of the headache itself, suggesting that muscular tension sets of reactions that cause headache symptoms after the muscles relax.

Common triggers of tension-type headache appear to be related to those of migraine.

» See other headache causes.

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