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Tension Headaches

What is a tension headache?

Tension headaches are the most common type of headache. Stress and muscle tension are often factors in tension type headaches. Tension headaches typically don’t cause nausea, vomiting, or sensitivity to light. They are the most common type of headache. They typically cause a steady ache, rather than a throbbing one, and tend to affect both sides of the head. Tension headaches may be chronic, occurring frequently or every day.

What causes a tension headache?

The exact mechanism that causes a tension headache is not known. Several factors, such as genetics and environment, are thought to be involved. Muscle contractions in the head and neck are considered a major factor in the development of a tension headache. Some people get tension headaches in response to stressful events or hectic days.

What are the symptoms of a tension headache?

While symptoms may differ, the following are common symptoms of a tension type headache:

  • Slow onset of the headache
  • Head usually hurts on both sides
  • Pain is dull or feels like a band or vice around the head
  • Pain may involve the back (posterior) part of the head or neck
  • Pain is usually mild to moderate, but not severe

The symptoms of tension headaches may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.

How are tension headaches diagnosed?

Tension headaches are diagnosed primarily based on the symptoms you report.A thorough medical exam, which may include other tests or procedures, may be used to rule out underlying diseases or conditions.

Tracking and sharing information about your headache with your health care provider helps with the process of making an accurate diagnosis.

Questions commonly asked during the exam may include, but are not limited to, the following:

  • When do headaches occur?
  • What is the location of the headache?
  • What do the headaches feel like?
  • How long do the headaches last?
  • Have there been changes in behavior or personality?
  • Do changes in position or sitting up cause the headache?
  • Do you have trouble sleeping?
  • Do you have a history of stress?
  • Have you had a head injury?

If the history is consistent with tension-type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. However, if the headache is not found to be the primary problem, then other tests may be needed to determine the cause.

Tests which may be used to determine the cause of a tension headache may include:

  • Blood tests. Various blood and other lab tests may be run to check for underlying conditions.
  • Sinus X-rays. A diagnostic imaging procedure to evaluate for congestion, infection, or other problems that may be corrected.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.


How are tension headaches treated?

Specific treatment for headaches will be determined by your health care provider based on:

  • Your age, overall health, and medical history
  • Type of headaches
  • Severity and frequency of the headaches
  • Your tolerance for specific medications, procedures, or therapies
  • Your opinion or preference

The ultimate goal of treatment is to stop headaches from occurring. Adequate headache management depends on reducing stress and tension. Some suggestions for tension headache management include:

  • Going to sleep and waking at the same time each day
  • Exercising regularly each day for at least 30 minutes
  • Eating meals without skipping any, especially breakfast
  • Avoiding headache triggers, such as certain foods and lack of sleep
  • Resting in a quiet, dark environment as needed
  • Stress management (yoga or other relaxation exercises)
  • Medications, as recommended by your health care provider

Can tension headaches be prevented?

Identifying and avoiding headache triggers may prevent a tension headache. Maintaining a regular sleep, exercise, and meal schedule is also beneficial. If tension headaches occur regularly or frequently, therapies such as cognitive-behavioral therapy, relaxation therapy, or biofeedback may reduce or eliminate headaches. Medications are also available to prevention tension headaches and should be discussed with your health care provider.

When should I call my health care provider?

A severe headache that is the “worst headache ever” requires immediate attention.

Key points

  • Tension headaches are the most common type of headache.
  • Tension headaches typically do not cause nausea, vomiting, or sensitivity to light.
  • Tension headaches affect both sides of the head, come on slowly, and are described as a tight band or vice around the head.
  • Lifestyle changes including regular sleep, exercise, and meal schedules can reduce or prevent headaches.
  • Medications to treat or prevent tension headaches should be discussed with your health care provider.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Online Medical Reviewer: Fraser, Marianne, MSN, RN
Online Medical Reviewer: Jones, Niya, MD
Date Last Reviewed: 1/15/2014
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