Tension headaches, also known as tension-type headaches (TTH) or stress headaches, are a primary muscle-related headache disorder characterized by recurrent episodes of head pain.
They are the most common primary headache disorder and the leading cause of chronic recurring head pain. The exact pathophysiology behind tension headaches remains unclear, but it may involve myofascial tender points or autonomic nervous system dysfunction.
- Tension headaches are characterized by pain in the head, neck, and behind the ears, as well as a tight band feeling around the forehead.
- There is no exact known cause of tension headaches, but they can be linked to muscle tension, poor posture, and genetic factors.
- Common triggers include eye strain, stress, dental problems, fatigue, smoking, migraine attacks, sinus infections, poor posture, lack of sleep, and emotional stress.
- Symptoms of tension headaches include pressure around the forehead, dull head pain, and tenderness around the scalp and forehead.
- Treatment options include staying hydrated, getting enough sleep, eating regular meals, taking over-the-counter pain medications, or seeking prescription medications like beta blockers, tricyclic antidepressants, and muscle relaxants.
- Alternative treatments may include stress management classes, biofeedback, cognitive behavior therapy, and acupuncture.
- To prevent tension headaches, identifying triggers is essential. A headache diary can be helpful in finding patterns and connections between daily activities, meals, and stress situations that could be causing the headaches.
Clinical Features
The primary symptom of tension headaches is head pain, which typically presents as a constant, mild to moderate intensity pain with a gradual onset. Key characteristics of tension headache pain include:
- Non-pulsatile: Unlike migraines, tension headache pain is not throbbing or pulsatile.
- Pressing, tightening, or fullness: Pain is often described as band-like, as if a band is being pulled, pressed, or tightened around the head.
- Bilateral: Pain is present on both sides of the head, in contrast to the unilateral pain of migraines and cluster headaches.
- Location: Pain is commonly located in the frontal area, around the eyes, and in the nuchal-occipital area (the back of the neck and head).
- Duration: Tension headaches typically last between 30 minutes and seven days, with an average duration of four to six hours.
- Timing: Some patients may experience less frequent headaches in the morning, with more severe headaches occurring in the evening or at night.
Other symptoms associated with tension headaches include difficulty concentrating, stiff or tight neck muscles, tenderness in the head and scalp, reduced appetite, and mild sensitivity to light or sound. Tension headaches differ from migraines as they do not have a prodrome, nausea, vomiting, or aura symptoms.
Types of Tension Headaches
Tension headaches can be categorized into episodic and chronic types. Episodic tension headaches are further divided into frequent and infrequent subtypes:
- Frequent episodic tension headaches: At least 10 headaches occurring on 1-14 days per month on average for over three months.
- Infrequent episodic tension headaches: At least 10 headaches occurring on fewer than one day per month
In this article, we will discuss various exercises and stretches that can help release muscle tension and alleviate tension headaches. These techniques will target the chest, neck, and head, providing a comprehensive approach to headache relief.
Chest Stretches:
- a. Interlace your fingers behind your back, straighten your arms, pinch your shoulder blades, lift your chest, and tilt your chin upwards. Breathe deeply through your nose, focusing on expanding your chest with each inhale. This stretch can help release tight chest muscles, which can contribute to tension headaches.
- b. Stretch one side of your chest by placing your right hand over your head, grabbing it with your left hand, and leaning to the side. Point your elbow towards the ceiling and pull your opposite elbow towards the ground. Breathe deeply through your nose, focusing on expanding your chest.
Trap and Levator Scapula Stretches:
- a. For the trap stretch, place your right hand over your head, fingertips touching your ear. Place your left hand behind your back. Gently pull your head to the side, bringing your ear closer to your shoulder.
- b. To stretch the levator scapula, angle your nose towards your armpit and pull your head gently at a 45-degree angle. At the same time, pull your opposite shoulder down towards your hip. Breathe deeply through your nose as you stretch.
Neck Stretches:
- a. Interlace your fingers behind your head and pull your chin down towards your chest, bringing your elbows closer together. Breathe deeply, focusing on expanding your upper thoracic spine.
- b. Place your middle fingers under your sub-occipitals, the area between your strong neck muscles, and apply firm pressure. Breathe deeply and observe any sensations or areas of tension in your head.
Jaw and Temporalis Muscle Relief:
- a. To release tension in the masseter (jaw) muscle, make fists and place your knuckles on either side of your zygomatic arches (cheekbones). Gently drag your knuckles downwards, applying pressure to the masseter muscles.
- b. To relieve tension in the temporalis muscles, use your four fingers to apply pressure to your temples. Close your eyes and observe any sensations, then slowly drag your fingers down towards your ears.
Eye Brow Relaxation:
- a. Gently massage the orbicularis oculi muscles, located around your eyes, by performing light circular motions above your eyelids with your eyes closed.
- b. Squeeze and roll your eyebrows, using a technique called skin rolling, to release any adhesions and promote relaxation.
Breathing Exercises:
- a. Stand with your feet shoulder-width apart and your hands behind your back, grabbing your elbows. Engage your abdominal muscles slightly and take deep breaths in and out through your nose. Focus on the expansion and contraction of your chest and shoulders, releasing any remaining tension with each exhale.
Conclusion
Incorporating these stretches and exercises into your daily routine can help alleviate tension headaches and promote overall relaxation.
Treatment for tension headaches includes identifying and avoiding triggers, rest, and medication. For episodic tension headaches, NSAIDs, acetaminophen, and caffeine can be used. For chronic tension headaches, a tricyclic antidepressant like amitriptyline or cognitive-behavioral therapy (CBT) may be helpful.
Remember that it’s important to consult a healthcare professional for personalized advice and recommendations. If you want more information on other types of headaches, be sure to check out related lessons or consult with a medical professional.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.