(Also Called ‘Stress Headaches’)

What are “tension-type” headaches?

“Tension-type” headaches are the most common type of headaches among adults. They used to be commonly referred to as muscle contraction headaches or stress headaches, but these old terms have been abandoned.

A tension-type headache may appear periodically (episodic, less than 15 days per month) or chronically (more than 15 days per month). An episodic tension headache may be described as a mild-to-moderate, constant band-like pain or pressure. These headaches may last from 30 minutes to several days. Episodic tension headaches usually begin gradually, and often occur in the middle of the day.

Tension-type headaches are non-specific headaches, clinically defined by the characteristics of migraine headaches they lack. Unlike migraines they are not throbbing but band-like and aching. They tend to be mild to moderate and are rarely severe, like migraines. In contrast to migraines, tension-type headaches are bilateral and not one sided; they are not aggravated by routine physical activity; they are not associated with light and sound sensitivity; and tension-type headaches are not associate with nausea or vomiting (though there can be anorexia).

Who is affected by tension headaches?

About 30% to 80% percent of the adult U.S. population suffers from occasional tension headaches. Chronic daily tension headaches affect approximately 3% of the population. Women are twice as likely to suffer from tension-type headaches as men.

Most people with episodic tension headaches have them no more than once or twice a month, but the headaches can occur more frequently.

Chronic tension headaches tend to be more common in females. Many patients with chronic tension headaches have usually had the headaches for more than 60 to 90 days. For many headache sufferers, these headaches impair their daily activities.

Chronic tension headaches may co-exist in adults who already have a medical history of migraines.

What causes tension-type headaches?

There is no single cause for tension-type headaches. This type of headache syndrome is not a trait that runs in families. In some people, tension-type headaches are associated with tightened muscles in the back of the neck and scalp. This muscle tension may be exacerbated by:

  • Inadequate rest
  • Poor posture
  • Emotional or mental stress, including depression

Tension-type headaches can be triggered by some type of environmental or internal stress. This stress may be known (overt) or unknown (covert) to the patient and their family. The most common sources of stress include family, social relationships, friends, work, and school. Examples of stressors include:

  • Having problems at home
  • Having a new child
  • Having no close friends
  • Returning to school or training; preparing for tests or exams
  • Going on a vacation
  • Starting a new job
  • Losing a job
  • Being overweight
  • Deadlines at work
  • Competing in sports or other activities
  • Being a perfectionist
  • Not getting enough sleep
  • Being over-extended; involved in too many activities/organizations

How are tension-type headaches treated?

Tension-type headaches are treated with several different strategies, including: stress management/relaxation training, counseling, biofeedback, medications and self-care treatments. Treatment for chronic tension headaches usually involves stress management, counseling, biofeedback, and possibly the use of antidepressant or anxiety-reducing medications.

Regardless of the treatment, tension-type headaches are best treated when the symptoms first appear and are mild, before they become more frequent and painful.

Stress management/relaxation training

Both episodic and chronic tension headaches can be improved by managing stress and practicing relaxation training.

Relaxation techniques include deep breathing exercises, progressive muscle relaxation, mental imagery relaxation or relaxation to music. Ask your health care provider for more information about these techniques.


It is helpful to recognize and treat the underlying stress and tension that are causing the headaches. Often, many people have long forgotten what stressful events initiated their headaches. Counseling can help the person identify his or her headache triggers and learn useful coping methods.


Biofeedback is another method of learning how to manage stress. During biofeedback, a series of sensors are connected to your body. The sensors detect changes in physical functions, such as muscle tension, blood pressure, heart rate or skin temperature, and provide immediate feedback through a tone or display on a computer screen. Biofeedback helps you recognize that your body is tense, identify what you are doing to make it tense, learn how to reduce the tension, and practice releasing the tension through effective physical skills. Biofeedback usually requires several sessions with a skilled biofeedback therapist.


For symptomatic relief of episodic or chronic tension headaches, over-the-counter (OTC) medications are recommended. Ask your doctor or pharmacist about using acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), aspirin, or naproxen sodium (Aleve®) to relieve your headaches.

Take these medications only when necessary. If you do take them, use the smallest dose needed to relieve your pain. Overusing pain medications can actually cause rebound headaches. In addition, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can have serious side effects, including stomach or intestinal pain or bleeding and ulcers.

If OTC pain relievers don’t help, your doctor may prescribe a prescription medication to reduce the severity and frequency of your headaches. The most effective drug for treating tension-type headaches is often the antidepressant amitriptyline (Elavil®), which provides some relief for about 65% of people.

For relief of chronic tension headaches, preventive medications may be prescribed, which are aimed at reducing both the frequency and severity of the headaches. These medications may include antidepressants with a sedating effect, such as Elavil; and NSAIDs, such as Aleve. These medications are not habit-forming.

Benzodiazepines, butalbital combinations, and narcotics (such as codeine and oxycodone) should be avoided because these medications could become habit-forming or addictive. Overuse of these medications or the daily use of OTC pain-relieving medications can cause analgesic rebound headaches.

Keep in mind that medications do not cure headaches and that over time, painkillers and other medications may lose their effectiveness. In addition, all medications have side effects. If you take medication regularly, including products you buy over the counter, discuss the risks and benefits with your doctor. Also, remember that pain medications are not a substitute for recognizing and dealing with the stressors that may be causing your headaches.

This is especially important to prevent rebound or medication overuse headaches.

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