Tension Headaches: Who’s at Risk and What to Do

What’s behind these painful headaches, and how to cope

woman covering her face in pain

Nearly 200 million Americans are affected by tension headaches, the most common type of headache in adults. Women are slightly more likely than men to experience them. Many patients diagnosed with tension headaches actually have migraine. Migraine is three times as prevalent in women compared to men.

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“Tension-type headache is considered featureless, meaning it lacks aggravation by light, sound, and smells, and the queasy feeling that usually accompanies migraine,” says headache specialist Deborah Tepper, MD. A recurring headache so severe that it keeps a person from usual activities, is far more likely to be migraine than a tension headache, she says.

Tension headache, often described as a constant band across the front, top or sides the head, while uncomfortable, is not as debilitating as migraine. Since tension headache is rarely disabling, it not commonly seen as a complaint in a doctor’s office.

Types of tension headaches

There are three types of tension headaches:

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  • Episodic – occurs less than once a month with mild to moderate pain
  • Frequent – occurs fewer than 15 days per month, with mild to moderate pain lasting 30 minutes to as long as several days
  • Chronic – occurs more than 15 days per month, with consistent pain that varies in intensity. Less than 3 percent of headache sufferers have this type.

“If headaches are interfering with normal activities, are worsening, or are accompanied by other symptoms such as fever, fatigue, nausea, changes in vision or weakness, the person should seek further evaluation,” recommends Dr. Tepper.

“If the headaches are new — that is, the first headache or worst headache they ever had —  this is another indication for evaluation. Evaluation also is suggested when other medical issues such as high blood pressure, chronic infection, or an immune or rheumatologic disorder are present.”

Even if otherwise healthy, a person should be evaluated if headaches are causing lost time or productivity at work or school, she says.

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Healthy lifestyle is key

A healthy lifestyle can be helpful in treating most headache disorders. “It sounds boring,” says Dr. Tepper, “but a good seven to eight hours of sleep per night, a balanced diet, regular exercise and stress reduction can be very helpful. Maintaining a healthy weight is also beneficial, as obesity is linked to increased frequency of headaches and also makes them more difficult to treat.”

Dr. Tepper cautions against frequent use of over-the-counter medications to treat tension headaches because the medications may cause more headaches. “A good rule of thumb is the ‘Rule of Two’s,’ meaning no more than two doses per day, two days per week,” she says.

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