Chronic Headache: Tension

Chronic Headache: Tension
Understanding the Causes, Symptoms, Diagnosis, and Treatment

When an individual experiences a tension headache, they often endure mild to moderate dizziness, commonly likened to a “tight band” encircling the head. Tension-type headache (TTH) ranks as the most prevalent form of headache, yet the precise causes of this condition remain elusive.

Treatment for tension headaches often proves efficacious. Managing tension headaches typically entails striking a balance with a healthy lifestyle, employing non-pharmacological therapies, and administering appropriate drug therapy.


  • Persistent, dull headache.
  • Sensation of “pressure” or tightness across the forehead, sides of the head, and neck.
  • Scalp, neck, and shoulder muscle sensitivity.

Tension headaches are categorized into two primary types – episodic and chronic:

  1. Episodic: These headaches may persist from 30 minutes to a week, occurring fewer than 15 days a month for at least three months. Episodic tension headaches may transition to chronic forms.
  2. Chronic: This variant can endure for several hours and may persist continuously. Headaches that occur 15 days or more a month for at least three months are classified as chronic.

Tension Headache vs. Migraine:
Distinguishing between tension headaches and migraines can sometimes prove challenging. Additionally, individuals experiencing frequent and severe tension headaches may also suffer from migraines.

In contrast to certain migraine manifestations, tension headaches typically lack visual disturbances, nausea, or vomiting. While physical exertion may exacerbate migraine headaches, it typically has minimal effect on tension headaches. Although sensitivity to light or sound may sporadically accompany tension headaches, such symptoms are rare.


The etiology of tension headaches remains incompletely understood. While medical experts once attributed tension headaches to issues within facial, neck, and scalp muscles, linked to heightened emotions, excessive stress, or tension, recent studies suggest otherwise. Instead, prevailing theories point toward heightened pain sensitivity and stress as potential contributors. Increased muscle pain, a hallmark symptom of tension headaches, may stem from an overall heightened sensitivity to pain.

Stress stands out as the predominant trigger for tension headaches.

Risk Factors:
Gender and age serve as prominent risk factors for tension headaches:

  • Gender: Women exhibit a greater susceptibility to tension headaches, with nearly 90% experiencing such headaches during their lifetimes, compared to 70% of men.
  • Age: While the frequency of tension headaches peaks around age forty, they can manifest at any age.

The recurrent nature of tension headaches can substantially impair functional performance and overall quality of life, especially when they transition into chronic forms. Persistent recurrence may significantly disrupt daily activities and general work capacity.

Diagnosing tension headaches primarily relies on the patient’s medical history, symptomatology, and neurological examination findings. Healthcare providers may inquire about various aspects, including symptom onset, triggering factors, symptom severity and frequency, and symptom-alleviating or exacerbating factors.

In addition, attention may be directed towards aspects such as pain characteristics, severity, and location. For cases exhibiting unusual or severe headache symptoms, healthcare providers may recommend additional diagnostic tests, including CT scans and MRI, to rule out more serious causes of headache.

While some individuals attempt to self-treat tension headaches, frequent use of pain relievers may exacerbate severe headaches. Pharmacotherapy options encompass a broad spectrum of medications, ranging from over-the-counter analgesics to prescription drugs. Preventive therapy may be warranted for individuals experiencing frequent or chronic headaches that do not respond adequately to analgesics.

Non-pharmacological interventions, including lifestyle modifications, acupuncture, massage, and relaxation techniques, also play a pivotal role in managing tension headaches. These holistic approaches aim to reduce headache severity and enhance overall well-being.