Tension Headaches: Key Q&A

Reviewed By:
Vikas Garg, M.D., MSA

What's the difference between a migraine and a tension headache?

A migraine is a severe, throbbing headache that is often accompanied by other symptoms, such as nausea, sensitivity to light or sound, dizziness or chills. The pain is usually located at the side of the forehead. A tension headache is a dull, pressurelike headache over the head, neck and scalp. It is usually not as severe as a migraine. Other symptoms rarely accompany a tension headache.

Are there any other kinds of headaches?

Yes. The International Headache Society has composed a comprehensive list of more than 150 types of headache. However, tension headaches and migraines are by far the most common. Following migraines and tension headaches, the most common type of headache is a cluster headache. A cluster headache is a very severe, chronic headache characterized by sharp, penetrating or burning pain on the side of the head. Unlike tension headaches and migraines, cluster headaches affect men more often than women.

What is the difference between chronic and episodic tension headaches?

When a tension headache occurs on more than 15 days a month for at least six months, it may be described as chronic. The pain may be daily or continuous. Chronic headaches may persist for many years. Episodic tension headaches occur on fewer than 15 days a month. They usually last anywhere from 30 minutes up to a week. They cause tightness and pain around both sides of the head. This pain and tightness does not get worse with physical activity and is not associated with nausea or vomiting.

Are tension headaches caused by muscle tension?

They do not appear to be. For many years, though, researchers believed that tension headaches were caused by the contraction of neck and scalp muscles. Recent research has cast doubt on this theory. Electromyogram studies have not been unable to identify increased muscle tension in people diagnosed with tension headache. An electromyogram is a test used to record electrical currents produced by muscle activity. This shows that muscle tension may not be the main cause of tension headaches. Because of these findings, the International Headache Society has begun to refer to tension headaches as tension-type headaches.

If tension doesn't cause tension headaches, what does?

A new theory suggests that tension headaches are the result of changes in brain chemicals responsible for communication between nerves. These chemicals include serotonin and endorphins. Although scientists do not understand why these chemical changes take place, they believe the process stimulates pain pathways to the brain and hinders the brain's ability to suppress pain.

Nitric oxide is another chemical linked to tension headaches. It is a substance involved in the transmission of nerve impulses. Researchers believe overproduction of nitric oxide is related to chronic tension headaches. In addition, substances that prevent the production of nitric oxide have been linked to a reduction in the muscle tightness associated with tension headache.

When should I see my doctor about my tension headaches?

If your tension headache is not accompanied by other symptoms, and the pain is mild or moderate and responsive to treatment within a few hours, you probably do not require medical attention. But if your headache is severe, recurrent or chronic, you should see your doctor. If other symptoms, such as problems sleeping or thinking clearly, occur with your headache, there may be something more serious present. You should also seek medical attention is your headache suddenly becomes more severe, more frequent, or the type of pain you feel suddenly changes.

Can medications cure my tension headaches?

No. Even after a headache is treated, another is likely to occur eventually. Medications and changes in lifestyle can, however, reduce the frequency and severity of future tension headaches. They can also stop the pain of a current headache.

Are all pain medications equally safe and effective?

No. The two most commonly used classes of pain medication for tension-headache relief are analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs). Analgesics are medications that block pain, such as acetaminophen. NSAIDs, such as aspirin, are popular pain medications that also reduce inflammation. For some women, analgesics work better than NSAIDs. For others, NSAIDs provide superior relief. However, NSAIDs may be associated with numerous side effects, including indigestion and stomach ulcers.

Can I take anything to prevent tension headaches?

Yes. There are a number of medications available that may reduce the frequency of tension headaches. These include antidepressants, NSAIDs, anticonvulsants and muscle relaxants. However, the preventive qualities of these medications take time to work. You may not notice a difference for several months.

Are preventive medications right for everyone?

No. In order for the medications to be effective, you need to take them frequently and at regular intervals. Because of the possibilities of side effects and interactions with other medications, the risks of preventive medications must be weighed against their benefits. Preventive therapy may be right for you if you have very frequent, long-lasting or severe headaches, or if medications for the pain of current headaches do not work.