Tension headaches

What are tension headaches?
Also known as muscle contraction or chronic daily headache, this is the most common variety of headache. Most people will have suffered from tension headaches at some point in their lives and never seek medical assistance but for a small minority of patients the condition is severe, long-standing and may be difficult to treat.


What causes tension headaches and who is at risk?
It was long believed that tension headaches were due to overcontraction of the muscles covering the scalp and back of the neck. However, all types of chronic (prolonged) headache may give rise to increased muscle tension and individuals with tension headaches often describe the continuous squeezing discomfort even when completely relaxed.
Despite this condition being one of the most common to affect humans, surprisingly little is understood of the exact mechanisms giving rise to the symptoms.
It is not uncommon for tension headaches and migraine (another type of headache described in a separate factsheet) to occur in the same individual, often with the migraine attack subsiding and evolving into a tension headache.
Tension headaches are undoubtedly more common in people suffering from anxiety and depression and effective treatment of these conditions may result in improvement of the headache. As tension headaches can last for a long time, this often arouses the suspicion in the sufferer and his or her doctor that a brain tumour could be the cause of symptoms.


What are the common symptoms and complications of tension headaches?
This headache usually affects both sides of the head, often involving the back of the head and neck but also frequently the sides and front of the head. Commonly, the entire head is affected in a diffuse manner. The pain is described as a dull, aching or squeezing but others often describe sensations such as fullness, tightness or pressure. Sometimes there may be the sensation that the head is surrounded by a band or being compressed in a vice. The onset of the attack is usually more gradual than in migraine and the duration of the attack may range from hours to years. Frequently the sufferer will claim the pain is present every day without a break, although the intensity may vary considerably during this time. Sleep is not usually affected, although the headache is often present on waking or soon after.
Tension headaches rarely begin during childhood or adolescence but more commonly during middle age. They are more common in women than men.


What is the treatment for tension headaches?
One particularly useful drug for treating tension headache is amitriptyline; this is taken at night before going to bed. Treatment is commenced at a low dose and gradually built up over a period of weeks to minimise problematic side effects which may include morning drowsiness. However, this side effect usually improves within a few days to weeks when the headaches should be improving. Amitriptyline is also an effective antidepressant and may helpfully improve the anxiety commonly associated with tension headaches.


Complementary therapy
Acupuncture, the Alexander technique, reflexology and relaxation exercises linked to visualisation with feedback may all be helpful at reducing stress and the chronic anxiety often associated with tension headache.
Identifying particular causes of stress and making appropriate changes in lifestyle (eg taking up regular exercise) may also prove effective.