Tension-type headache is the most common type of headache. Its name indicates the role of stress and mental or emotional conflict in triggering the pain and contracting muscles in the neck, face, scalp, and jaw. Tension-type headaches also may be caused by:

• jaw clenching
• intense work
• missed meals
• depression
• anxiety
• too little sleep

Sleep apnea also may cause tension-type headaches, especially in the morning.

Tension-type headaches affect women slightly more often than men. The headaches usually begin in adolescence and reach peak activity in the 30s. They have not been linked to hormones and do not have a strong hereditary connection.

There are two forms of tension-type headache:

• Episodic tension-type headaches occur between 10 and 15 days per month, with each attack lasting from 30 minutes to several days. Although the pain is not disabling, the severity of pain typically increases with the frequency of attacks.
• Chronic tension-type attacks usually occur more than 15 days per month over a 3-month period. The pain, which can be constant over a period of days or months, strikes both sides of the head and is more severe and disabling than episodic headache pain. Chronic tension headaches can cause sore scalps-even combing your hair can be painful. Most individuals will have had some form of episodic tension-type headache prior to onset of chronic tension-type headache.

Depression and anxiety can cause tension-type headaches. Headaches may appear in the early morning or evening, when conflicts in the office or at home are anticipated. Other causes include physical postures that strain head and neck muscles (such as holding your chin down while reading or holding a phone between your shoulder and ear), degenerative arthritis of the neck, and temporomandibular joint dysfunction (a disorder of the joints between the temporal bone located above the ear and the mandible, or lower jaw bone).

The pain is usually mild to moderate and feels as if constant pressure is being applied to the front of the face or to the head or neck. It also may feel as if a belt is being tightened around the head. Most often the pain is felt on both sides of the head. People who suffer tension-type headaches also may feel overly sensitive to light and sound but there is no pre-headache aura as with migraine. Typically, tension-type headaches usually disappear once the period of stress or related cause has ended.

How and under what circumstances a person experiences a headache can be key to diagnosing its cause. Keeping a headache journal can help a physician better diagnose your type of headache and determine the best treatment. After each headache, note:

• The time of day when it occurred
• Its intensity and duration
• Any sensitivity to light, odors, or sound
• Activity immediately prior to the headache
• Use of prescription and nonprescription medicines
• Amount of sleep the previous night
• Any stressful or emotional conditions
• Any influence from weather or daily activity
• Foods and fluids consumed in the past 24 hours
• Any known health conditions at that time

Women should record the days of their menstrual cycles. Include notes about other family members who have a history of headache or other disorders. A pattern may emerge that can be helpful to reducing or preventing headaches.

Once your doctor reviews your medical and headache history and conducts physical and neurological exams, lab screening and diagnostic tests may be ordered to either rule out or identify conditions that might be the cause of your headaches.

Blood and urine tests can help diagnose brain or spinal cord infections, blood vessel damage, and toxins that affect the nervous system. Testing the fluid that surrounds the brain and spinal cord can detect infections, bleeding in the brain (called a brain hemorrhage), and measure any buildup of pressure within the skull.

Diagnostic imaging, such as with computed tomography (CT) and magnetic resonance imaging (MRI), can detect irregularities in blood vessels and bones, certain brain tumors and cysts, brain damage from head injury, brain hemorrhage, inflammation, infection, and other disorders. Neuroimaging also gives doctors a way to see what's happening in the brain during headache attacks. An electroencephalogram (EEG) measures brain wave activity and can help diagnose brain tumors, seizures, head injury, and inflammation that may lead to headaches.

The first step in caring for a tension-type headache involves treating any specific disorder or disease that may be causing it. For example, arthritis of the neck is treated with anti-inflammatory medication and temporomandibular joint dysfunction may be helped by corrective devices for the mouth and jaw. A sleep study may be needed to detect sleep apnea and should be considered when there is a history of snoring, daytime sleepiness, or obesity.

A physician may suggest using analgesics, nonsteroidal anti-inflammatory drugs, or antidepressants to treat a tension-type headache that is not associated with a disease. Triptan drugs, barbiturates (drugs that have a relaxing or sedative effect), and ergot derivatives may provide relief to people who suffer from both migraine and tension-type headache.

Alternative therapies for chronic tension-type headaches include biofeedback, relaxation training, meditation, and cognitive-behavioral therapy to reduce stress. A hot shower or moist heat applied to the back of the neck may ease symptoms of infrequent tension headaches. Physical therapy, massage, and gentle exercise of the neck also may be helpful.

Most of us get headaches from time to time. Some are mild. Others cause throbbing pain. They can last for minutes or days. There are many different types of headaches. How you treat yours depends on which kind you have.

Headaches might arise because of another medical condition, such as swollen sinuses or head injury. In these cases, treating the underlying problem usually relieves headache pain as well. But most headaches—including tension headaches and migraines—aren’t caused by a separate illness.

A headache may feel like a pain inside your brain, but it’s not. Most headaches begin in the many nerves of the muscles and blood vessels that surround your head, neck, and face. These pain-sensing nerves can be set off by stress, muscle tension, enlarged blood vessels, and other triggers. Once activated, the nerves send messages to the brain, and it can feel like the pain is coming from deep within your head.

Tension headaches are the most common type of headache. They can cause a feeling of painful pressure on the head and neck. Tension headaches occur when the muscles in your head and neck tighten, often because of stress or anxiety. Intense work, missed meals, jaw clenching, or too little sleep can bring on tension headaches.

Over-the-counter medicines such as aspirin, ibuprofen, or acetaminophen can help reduce the pain. “Lifestyle changes to relax and reduce stress might help, such as yoga, stretching, massage, and other tension relievers,” says Dr. Linda Porter, an NIH expert on pain research.

Migraines are the second-most common type of headache. They affect more than 1 in 10 people. Migraines tend to run in families and most often affect women. The pain can be severe, with pulsing and throbbing, and can last for several days. Migraine symptoms can also include blurry vision and nausea.

“Migraines are complex and can be disabling,” Porter says. Certain smells, noises, or bright flashing lights can bring on a migraine. Other triggers include lack of sleep, certain foods, skipped meals, smoking, stress, or even an approaching thunderstorm. Keeping a headache diary can help to identify the specific causes of your migraines. Avoiding those triggers or using prescription medications could help prevent or lessen the severity of future migraines.

Be careful not to overuse headache medications. Overuse can cause “rebound” headaches, making headaches more frequent and painful. People with repeating headaches, such as migraines or tension headaches, are especially at risk. Experts advise not taking certain pain-relief medicines for headaches more than 3 times a week.

A less common but more severe type of headache comes on suddenly in “clusters” at the same time of day or night for weeks. Cluster headaches may strike one side of the head, often near one eye, with a sharp or burning pain. These headaches are more common in men and in smokers.

In rare cases, a headache may warn of a serious illness. Get medical help right away if you have a headache after a blow to your head, or if you have a headache along with fever, confusion, loss of consciousness, or pain in the eye or ear.

“Know what kind of headache you have and, if you can’t manage it yourself, seek help,” Porter says. “Remember there are preventive behavioral steps and medicines that can help manage headaches. But if the pain is severe or lasting, get medical care.”

Prevent Headaches

• Ease stress.
• Get enough quality sleep.
• Eat regularly scheduled, healthy meals.
• Exercise regularly and maintain a healthy weight.
• Ask your doctor if medications might help prevent returning headaches.