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Tension Headache

Tension headaches, now referred to as tension-type headaches are the most common types of primary headaches. Individuals who experience this headache get pain radiating from the neck, eyes, and the lower back of the head among other groups of muscles in the body. About 90% of all headaches are tension-type headaches. About 1.4 billion people in the word, which accounts for 20.8% of the population, are affected by tension headaches. This type of headache is more common in women than in men.

Signs and Symptoms of Tension headaches

Tension-type headache is often described as being a constant pressure resembling a feeling of the head being squeezed using a vise. The individual experiences pain on both sides of the head and this can be moderate and in some cases, severe.

Duration and Frequency

Tension-type headaches can either be episodic or chronic. Episodic tension headaches are those that will occur fewer than 15 days in a month while chronic occur more than 15 days in a month for a period not less than 6 months.  A tension-type headache can last for a few minutes, a day, a month and sometimes years with the typical tension headache lasting for 4 to 6 hours.

Causes of Tension-type Headache

There are a number of precipitating factors that might lead to tension-type headaches in susceptible people.

  • Sleep deprivation
  • Eye strain
  • Irregular meal time
  • Bad posture and uncomfortable stressful positions
  • Stress: this is mostly in the afternoon after stressful work hours or an exam.

About 50%of patients with tension headaches have identified hunger or stress as the precipitating factor. In some patients, the headaches might be caused by muscle tension around the neck and head. There is a theory that places teeth clenching as a main cause of tension-type headache and migraine. Teeth clenching can cause chronic temporalis muscle contraction which will lead to a headache.

There is another theory that places malfunctioning pain filter situated in the brain stem as a probable cause of tension headaches. The view in this theory is that of misinterpreted messages from areas such as the temporal muscles and other muscles. The message is interpreted as pain and this is what leads to the headache. Serotonin is one of the neural transmitters that are involved in this misinterpretation. This theory is backed up by the fact that antidepressants such as amitriptyline can be used in the successful treatment of tension-type headaches.

An individual with a tension-type headache has increased skin and muscle pain sensitivity demonstrated by the low mechanical thermal pain and electrical pain thresholds. The nociceptive neurons’ hyperexcitability is believed to be a key aspect in chronic tension-type headache pathophysiology. There is generalized increased hyperalgesia or increased pain sensitivity in chronic tension-type headaches and this suggests that the central nervous system pain processing in this disorder is abnormal. It is also evident that a dysfunction of pain inhibitory systems might be involved in chronic tension-type headaches.


Selective serotonin reuptake inhibitors commonly referred as SSRIs are used in prevention but tricyclic depressants have been found to be more effective though they have more and greater side effects. To date, there is no sufficient evidence of the successful use of muscle relaxants and propranolol in tension headaches prevention.


Episodic tension headaches have been found to respond well to analgesics like aspirin, ibuprofen, and acetaminophen/paracetamol. Sedative and analgesic combinations are widely used in dealing with tension-type headaches. It is important to note that frequent use or abuse of analgesics might lead to more problems such as medication overuse headache.

When all treatment options have failed and the pain experienced is intolerable, barbiturate medication such as fiorinal and fioricet can be used but as drugs of last resort prescription. For this reason, the medications are written as single doses or a dose for a day or two, once after every six hours until the pain ceases. There are cases where the doses are larger but this is highly discouraged due to the probability and the potential of abuse and due to the high toxicity level of this barbiturate drugs. Botulinium is a drug trialled by some people though the results have varied for tension-type headaches.


Acupuncture is listed in the alternative therapies used in the treatment of tension-type headaches and has been found to be useful especially where the tension headache is chronic or frequent.

Manual Therapy

Individuals with tension-type headaches might opt to use myofascial trigger point treatment, soft tissue therapy and spinal manipulation as treatment. A review found weak evidence of chiropractic manipulation effectiveness in the treatment of tension-type headaches. The review also found that this kind of treatment was more effective for tension headache than it was for migraines. Spinal manipulation has been found to be effective for both tension headache and migraine. The same review found that neck exercise combined with spinal manipulation can be effective in dealing with cervicogenic headaches. There have been different reviews targeting the use of manual therapy and though some people report effectiveness of some methods, there are no conclusive reports on the success of manual therapies in the treatment of tension-type headaches.


Tension-type headaches that are not as a result of another symptom might be painful but they are harmless. People suffering from these types of tension headaches can get relief through successful treatment methods. When the tension headache is as a result of an underlying condition it can be treated once the condition has been dealt with.  It is important that patients use the medication under the directions of a qualified physician because frequent use of abuse of pain medications can lead to medication overuse headache or what is referred to as rebound headache.

Despite the fact that tension-type headaches are benign in character, the chronic form can lead to significant disability on the individuals with this disease as well as lead to a burden in the society in general.  It is highly recommended that anyone with recurrent headaches seeks medical attention for further tests and diagnosis.



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