Health Condition

Tension Headache

About This Condition

A tension-type headache is common and typically experienced as a dull, non-throbbing pain in the back of the neck or in a “headband” distribution.1 It may be associated with tender nodules in the neck called trigger-points,2 or with tenderness in the muscles around the head.3


People with a headache may have symptoms including uncomfortable sensations described as pain, throbbing, aching, dullness, heaviness, and tightness in the head. People with a headache may also experience discomfort that is often worsened by movement or pressure and may be associated with irritability, problems sleeping, and fatigue.

Other Therapies

Healthcare practitioners might recommend application of moist heat to tight neck muscles and light massage.


1. Stevens MB. Tension-type headaches. Am Fam Physician 1993;47:799-806 [review].

2. Davidoff RA. Trigger points and myofascial pain: toward understanding how they affect headaches. Cephalalgia 1998;18:436-48 [review].

3. Jensen R. Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia 1999;19:602-21 [review].

4. Ribeiro CAF. L-5-hydroxytryptophan in the prophylaxis of chronic tension-type headache: a double-blind, randomized, placebo-controlled study. Headache 2000;40:451-6.

5. Edmeads J. Placebos and the power of negative thinking. Headache 1984;24:342-3 [editorial].

6. De Benedittis G, Massei R. Serotonin precursors in chronic primary headache. A double-blind cross-over study with L-5-hydroxytrytophan vs. placebo. J Neurosurg Sci 1985;29:239-48.

7. Longo G, Rudoi I, Iannuccelli M, et al. Treatment of essential headache in developmental age with L-5-HTP (cross over double-blind study versus placebo). Pediatr Med Chir 1984;6:241-5. [in Italian].

8. Prakash S, Shah ND. Chronic tension-type headache with vitamin D deficiency: casual or causal association? Headache 2009;49:1214-22.

9. Göbel H, Schmidt G, Soyka DS. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia 1994;14:228-34.

10. Gobel H, Fresenius J, Heinze A, et al. Effectiveness of Oleum menthae piperitae and paracetamol in therapy of headache of the tension type. Nervenarzt 1996;67:672-81 [in German].

11. Schattner P, Randerson D. Tiger Balm as a treatment of tension headache. A clinical trial in general practice. Aust Fam Physician 1996;25(2):216, 218, 220.

12. Melchart D, Linde K, Fischer P, et al. Acupuncture for recurrent headaches: a systematic review of randomized controlled trials. Cephalalgia 1999;19:779-86.

13. Hansen PE, Hansen JH. Acupuncture treatment of chronic tension headache—a controlled cross-over trial. Cephalalgia 1985;5:137-42.

14. Tavola T, Gala C, Conte G, Invernizzi G. Traditional Chinese acupuncture in tension-type headache: a controlled study. Pain 1992;48:325-9.

15. Ahonen E, Hakumaki M, Mahlamaki S, et al. Effectiveness of acupuncture and physiotherapy on myogenic headache: a comparative study. Acupunct Electrother Res 1984;9:141-50.

16. Carlsson J, Augustinsson LE, Blomstrand C, Sullivan M. Health status in patients with tension headache treated with acupuncture or physiotherapy. Headache 1990;30:593-9.

17. Jensen LB, Melsen B, Jensen SB. Effect of acupuncture on headache measured by reduction in number of attacks and use of drugs. Scand J Dent Res 1979;87:373-80.

18. Loh L, Nathan PW, Schott GD, Zilkha KJ. Acupuncture versus medical treatment for migraine and muscle tension headaches. J Neurol Neurosurg Psychiatry 1984;47:333-7.

19. Dowson DI, Lewith GT, Machin D. The effects of acupuncture versus placebo in the treatment of headache. Pain 1985;21:35-42.

20. Kurland HD. Treatment of headache pain with auto-acupressure. Dis Nerv Syst 1976;37:127-9.

21. Goh BMT. Simple treatment of headaches without drugs. Med J Aust 1978;2:271 [letter].

22. Whittington W, Ellis WB, Molyneux TP. The effect of manipulation (toggle recoil technique) for headaches with upper cervical joint dysfunction: a pilot study. J Manipulative Physiol Ther 1994;17:369-75.

23. Schoensee SK, Jensen G, Nicholson G, et al. The effect of mobilization on cervical headaches. J Orthop Sports Phys Ther 1995;21:184-96.

24. Vernon HT. Manipulative therapy in the chiropractic treatment of headaches: a retrospective and prospective study. J Manipulative Physiol Ther 1982;5:109-12.

25. Mootz RD, Dhami MSI, Hess JA, et al. Chiropractic treatment of chronic episodic tension-type headache in male subjects: a case series analysis. J Can Chiro Assoc 1994;38:152-9.

26. Hoyt WH, Shaffer F, Bard DA, et al. Osteopathic manipulation in the treatment of muscle contraction headache. J Am Osteopath Assoc 1979;78:322-5.

27. Vernon HT. Spinal manipulation and headache of cervical origin. J Manipulative Physiol Ther 1989;12:455-68 [review].

28. Boline PD, Kassak K, Bronfort G, et al. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther 1995;18:148-54.

29. Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997;20:326-30.

30. Bove G, Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. JAMA 1998;280:1576-9.

31. Hammjill JM, Cook TM, Rosecrance JC. Effectiveness of a physical therapy regimen in the treatment of tension-type headache. Headache 1996;36:149-53.

32. Puustjarvi K, Airaksinen O, Pontinen PJ. The effects of massage in patients with chronic tension headache. Acupunct Electrother Res 1990;15:159-62.

33. Jay GW, Brunson J, Branson SJ. The effectiveness of physical therapy in the treatment of chronic daily headaches. Headache 1989;29:156-62.

34. Rokicki LA, Holroyd KA, France CR, et al. Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache. Appl Pschophysiol Biofeedback 1997;22:21-41.

35. Bruhn P, Olesen J, Melgaard B. Controlled trial of EMG biofeedback in muscle contraction headache. Ann Neurol 1979;6:34-6.

36. Holroyd KA, Andrasik F, Noble J. A comparison of EMG biofeedback and a credible pseudotherapy in treating tension headache. J Behav Med 1980;3:29-39.

37. Carrobles JA, Cardona A, Santacreu J. Shaping and generalization procedures in the EMG-biofeedback treatment of tension headaches. Br J Clin Psychol 1981;20:49-56.

38. Janssen K. Differential effectiveness of EMG-feedback versus combined EMG-feedback and relaxation instructions in the treatment of tension headache. J Psychosom Res 1983;27:243-53.

39. Bussone G, Grazzi L, D'Amico D, et al. Biofeedback-assisted relaxation training for young adolescents with tension-type headache: a controlled study. Cephalalgia 1998;18:463-7.

40. Kroner-Herwig B, Mohn U, Pothmann R. Comparison of biofeedback and relaxation in the treatment of pediatric headache and the influence of parent involvement on outcome. Appl Psychophysiol Biofeedback 1998;23:143-57.

41. Blanchard EB, Applebaum KA, Radnitz CL, et al. Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache. J. Consult Clin Psychol 1990;58:210-5.

42. Blanchard EB, Nicholson NL, Taylor AE, et al. The role of regular home practice in the relaxation treatment of tension headache. J Consult Clin Psychol 1991;59:467-70.

43. Larsson B, Melin L, Doberl A. Recurrent tension headache in adolescents treated with self-help relaxation training and a muscle relaxant drug. Headache 1990;30:665-71.

44. Holroyd, KA, Nash JM, Pingel JD, et al. A comparison of pharmacological (amitriptyline HCL) and nonpharmacological (cognitive-behavioral) therapies for chronic tension headaches. J Consult Clin Psychol 1991;59:387-93.

45. Melis PML, Rooimans W, Spierings ELH, Hoogduin CAL. Treatment of chronic tension-type headache with hypnotherapy: a single-blind time controlled study. Headache 1991;31:686-9.

46. Reich BA. Non-invasive treatment of vascular and muscle contraction headache: a comparative longitudinal clinical study. Headache 1989;29:34-41

47. Keller E, Bzdek VM. Effects of therapeutic touch on tension headache pain. Nurs Res 1986;35:101-6.

48. Launso L, Brendstrup E, Arnberg S. An exploratory study of reflexological treatment for headache. Altern Ther Health Med 1999;5:57-65.

49. Walach H. Classical homeopathic treatment of chronic headaches. Cephalalgia 1997;17:119-126.

50. Rasmussen BK. Migraine and tension-type headache in a general population: psychosocial factors. Int J Epidemiol 1992;21:1138-43.

51. Donias SH, Peioglou-Harmoussi S, Georgiadis G, Manos N. Differential emotional precipitation of migraine and tension-type headache attacks. Cephalalgia 1991;11:47-52.

52. Wittrock DA, Myers TC. The comparison of individuals with recurrent tension-type headache and headache-free controls in physiological response, appraisal, and coping with stressors: a review of the literature. Ann Behav Med 1998;20:118-34 [review].

53. Myers TC, Wittrock DA, Foreman GW. Appraisal of subjective stress in individuals with tension-type headache: the influence of baseline measures. J Behav Med 1998;21:469-84.

54. DeBenedittis G, Lorenzetti A, Pieri A. The role of stressful life events in the onset of chronic primary headache. Pain 1990;40:65-75.

55. DeBenedittis G, Lorenzetti A. The role of stressful life events in the persistence of primary headache: major events vs. daily hassles. Pain 1992;51:35-42.

56. Ficek SK, Wittrock DA. Subjective stress and coping in recurrent tension-type headache. Headache 1995;35:455-60.

57. Holroyd KA, Stensland M, Lipchik GL, et al. Psychosocial correlates and impact of chronic tension-type headaches. Headache 2000;40:3-16.

58. Serrano-Duenas M. Chronic tension-type headache and depression. Rev Neurol 2000;30:822-6 [in Spanish].

59. Hatch JP, Schoenfeld LS, Boutros NN,et al. Anger and hostility in tension-type headache. Headache 1991;31:302-4.

60. Rugh JD, Hatch JP, Moore PJ et al. The effects of psychological stress on electromyographic activity and negative affect in ambulatory tension-type headache patients. Headache 1990;30:216-9.

61. Hatch JP, Moore PJ, Borcherding S, et al. Electromyographic and affective responses of episodic tension-type headache patients and headache-free controls during stressful task performance. J Behav Med 1992;15:89-112.

62. Payne TJ, Stetson B, Stevens VM, et al. The impact of cigarette smoking on headache activity in headache patients. Headache 1991;31:329-32.

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.