Headache, Tension
BASICS
DESCRIPTION
- A bilateral mild to moderate, nonthrobbing head pain or pressure, without other associated symptoms
- Tension-type headache (TTH) replaced the older terms muscle contraction headache; stress, ordinary, or essential headache; idiopathic headache; and psychogenic headache.
EPIDEMIOLOGY
It is the most common type of primary headache, and the second-most prevalent headache disorder in the world.
Prevalence
- Peak age of prevalence in the United States is in the 4th decade.
- Prevalence of episodic TTH decreases with age, whereas the prevalence of chronic TTH increases with age.
ETIOLOGY AND PATHOPHYSIOLOGY
- Not well understood, multifactorial etiology with both peripheral and central nervous system mechanisms triggering TTH
- Activation of peripheral nociceptors leads to myofascial pain in episodic TTH.
- Prolonged stimulation of nociceptors sensitizes the central pain pathways leading to chronic TTH.
- Nitric oxide may play an important role in TTH.
RISK FACTORS
Associated with triggers/precipitating factors:
- Stress (mental or physical)
- Change in sleep regimen
- Skipping meals, dehydration
- Certain foods (caffeine, alcohol, chocolate)
- Environmental factors (sun glare, odors, smoke, noise, lighting)
- Female hormonal changes
- Medications (e.g., nitrates, SSRIs, antihypertensives)
- Overuse of abortive headache medication
GENERAL PREVENTION
Lifestyle factors to promote headache prevention include avoiding triggers, increasing exercise, keeping regular sleep patterns, decreasing caffeine and alcohol, and staying adequately hydrated.
COMMONLY ASSOCIATED CONDITIONS
- 83% of patients with migraine headaches also suffer from TTHs.
- Possible increased prevalence of comorbid anxiety and depression
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Citation
Domino, Frank J., et al., editors. "Headache, Tension." 5-Minute Clinical Consult, 34th ed., Wolters Kluwer, 2026. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache_Tension.
Headache, Tension. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2026. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache_Tension. Accessed July 16, 2025.
Headache, Tension. (2026). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (34th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache_Tension
Headache, Tension [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2026. [cited 2025 July 16]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache_Tension.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Headache, Tension
ID - 1688872
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache_Tension
PB - Wolters Kluwer
ET - 34
DB - Medicine Central
DP - Unbound Medicine
ER -