Tension headache - wikipedia Tension headache Tension headache A woman experiencing a tension headache Specialty Neurology ( edit on Wikidata ) Tension headache, also known as tension - type headache, is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body typically affecting both sides of the head. Tension - type headaches account for nearly 90 % of all headaches. Pain medication, such as aspirin and ibuprofen, are effective for the treatment of tension headache. Tricyclic antidepressants appear to be useful for prevention. Evidence is poor for SSRIs, propranolol, and muscle relaxants. As of 2013 tension headaches affect about 1.6 billion people ( 20.8 % of the population ) and are more common in women than men ( 23 % to 18 % respectively ). Contents 1 Signs and symptoms 2 Cause 3 Prevention 3.1 Lifestyle 3.2 Medications 4 Treatment 4.1 Medications 4.2 Manual therapy 5 Epidemiology 6 Prognosis 7 References 8 External links Signs and symptoms Tension - type headache pain is often described as a constant pressure, as if the head were being squeezed in a vise. The pain is frequently present on both sides of the head at the same time. Tension - type headache pain is typically mild to moderate, but may be severe. According to the third edition of the International Classification of Headache Disorders, the attacks must meet the following criteria : A duration of between 30 minutes and 7 days. At least two of the following four characteristics : bilateral location pressing or tightening ( non-pulsating ) quality mild or moderate intensity not aggravated by routine physical activity such as walking or climbing stairs Both of the following : no nausea or vomiting no more than one of photophobia ( sensitivity to bright light ) or phonophobia ( sensitivity to loud sounds ) Tension - type headaches may be accompanied by tenderness of the scalp on manual pressure during an attack. Based on frequency, tension - type headaches can be sub-classified as Infrequent episodic : occurring less than once per month on average, or less than 12 episodes a year ; Frequent episodic : occurring between 1 - 14 times per month on average for at least 3 months ; Chronic : occurring 15 times a month for at least 3 months ( CTTH - chronic tension - type headache ). Cause Various precipitating factors may cause tension - type headaches in susceptible individuals : Stress : usually occurs in the afternoon after long stressful work hours or after an exam Sleep deprivation Uncomfortable stressful position and / or bad posture Irregular meal time ( hunger ) Eyestrain Tension - type headaches may be caused by muscle tension around the head and neck. Another theory is that the pain may be caused by a malfunctioning pain filter which is located in the brain stem. The view is that the brain misinterprets information -- for example from the temporal muscle or other muscles -- and interprets this signal as pain. One of the main neurotransmitters that is probably involved is serotonin. Evidence for this theory comes from the fact that chronic tension - type headaches may be successfully treated with certain antidepressants such as nortriptyline. However, the analgesic effect of nortriptyline in chronic tension - type headache is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved. Recent studies of nitric oxide ( NO ) mechanisms suggest that NO may play a key role in the pathophysiology of CTTH. The sensitization of pain pathways may be caused by or associated with activation of nitric oxide synthase ( NOS ) and the generation of NO. Patients with chronic tension - type headache have increased muscle and skin pain sensitivity, demonstrated by low mechanical, thermal and electrical pain thresholds. Hyperexcitability of central nociceptive neurons ( in trigeminal spinal nucleus, thalamus, and cerebral cortex ) is believed to be involved in the pathophysiology of chronic tension - type headache. Recent evidence for generalized increased pain sensitivity or hyperalgesia in CTTH strongly suggests that pain processing in the central nervous system is abnormal in this primary headache disorder. Moreover, a dysfunction in pain inhibitory systems may also play a role in the pathophysiology of chronic tension - type headache. If other treatment is not working, a health care provider may use an MRI to confirm a more complicated diagnosis ( i.e. New daily persistent headache ). Prevention Lifestyle Drinking water and avoiding dehydration helps in preventing tension headache. Using stress management and relaxing often makes headaches less likely. Drinking alcohol can make headaches more likely or severe. Good posture might prevent headaches if there is neck pain. People who have jaw clenching might develop headaches, and getting treatment from a dentist might prevent those headaches. Biofeedback techniques may also help. Medications People who have 15 or more headaches in a month may be treated with certain types of daily antidepressants which act to prevent continued tension headaches from occurring. In those who are predisposed to tension type headaches the first - line preventative treatment is amitriptyline, whereas mirtazapine and venlafaxine are second - line treatment options. Tricyclic antidepressants appear to be useful for prevention. Tricyclic antidepressants have been found to be more effective than SSRIs but have greater side effects. Evidence is poor for the use of SSRIs, propranolol, and muscle relaxants for prevention of tension headaches. Treatment Treatment for a current tension headache is to drink water and confirm that there is no dehydration. If symptoms do not resolve within an hour for a person who has had water, then stress reduction might resolve the issue. Medications Over-the - counter drugs, like acetaminophen, aspirin, or ibuprofen, can be effective but tend to only be helpful as a treatment for a few times in a week at most. Analgesic / sedative combinations are widely used ( e.g., analgesic / antihistamine combinations like Syndol, Mersyndol and Percogesic, analgesic / barbiturate combinations such as Fiorinal ). Frequent use of analgesics may, however, lead to medication overuse headache. Botulinum toxin does not appear to be helpful. Manual therapy Though evidence for acupuncture is slight, some suggest it may be useful in those with frequent or chronic tension headaches. People with tension - type headache often use spinal manipulation, soft tissue therapy, and myofascial trigger point treatment. Studies of effectiveness are mixed. A 2006 systematic review found no rigorous evidence supporting manual therapies for tension headache. A 2005 structured review found only weak evidence for the effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine. A 2004 Cochrane review found that spinal manipulation may be effective for migraine and tension headache, and that spinal manipulation and neck exercises may be effective for cervicogenic headache. Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of spinal manipulation. A 2012 systematic review of manual therapy found that hands - on work may reduce both the frequency and the intensity of chronic tension - type headaches. Epidemiology As of 2013 tension headaches affect about 1.6 billion people ( 20.8 % of the population ) and are more common in women than men ( 23 % to 18 % respectively ). Despite its benign character, tension - type headache, especially in its chronic form, can impart significant disability on patients as well as burden on society at large. Prognosis Tension headaches that do not occur as a symptom of another condition may be painful, but are not harmful. It is usually possible to receive relief through treatment. Tension headaches that occur as a symptom of another condition are usually relieved when the underlying condition is treated. Frequent use of pain medications in patients with tension - type headache may lead to the development of medication overuse headache or rebound headache. References ^ Jump up to : Derry, S ; Wiffen, PJ ; Moore, RA ; Bendtsen, L ( 31 July 2015 ). `` Ibuprofen for acute treatment of episodic tension - type headache in adults ''. The Cochrane database of systematic reviews. 7 : CD011474. doi : 10.1002 / 14651858. CD011474. pub2. PMID 26230487. ^ Jump up to : Loder, E ; Rizzoli, P ( 12 January 2008 ). `` Tension - type headache ''. BMJ ( Clinical research ed. ). 336 ( 7635 ) : 88 -- 92. doi : 10.1136 / bmj.39412.705868.AD. PMC 2190284. PMID 18187725. ^ Jump up to : Jackson JL, Shimeall W, Sessums L, et al. ( 2010 ). `` Tricyclic antidepressants and headaches : systematic review and meta - analysis ''. BMJ. 341 : c5222. doi : 10.1136 / bmj. c5222. PMC 2958257. PMID 20961988. ^ Jump up to : Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW ( April 2010 ). `` Lack of benefit for prophylactic drugs of tension - type headache in adults : a systematic review ''. Fam Pract. 27 ( 2 ) : 151 -- 65. doi : 10.1093 / fampra / cmp089. PMID 20028727. ^ Jump up to : Banzi, R ; Cusi, C ; Randazzo, C ; Sterzi, R ; Tedesco, D ; Moja, L ( 1 May 2015 ). `` Selective serotonin reuptake inhibitors ( SSRIs ) and serotonin - norepinephrine reuptake inhibitors ( SNRIs ) for the prevention of tension - type headache in adults ''. The Cochrane database of systematic reviews. 5 : CD011681. doi : 10.1002 / 14651858. CD011681. PMID 25931277. ^ Jump up to : Global Burden of Disease Study 2013, Collaborators ( 22 August 2015 ). `` Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990 - 2013 : a systematic analysis for the Global Burden of Disease Study 2013 ''. Lancet. 386 ( 9995 ) : 743 -- 800. doi : 10.1016 / s0140 - 6736 ( 15 ) 60692 - 4. PMC 4561509. PMID 26063472. ^ Jump up to : Vos, T ; Flaxman, A.D. ; Naghavi, M ; Lozano, R ; Michaud, C ; Ezzati, M ; Shibuya, K ; Salomon, J.A. ; Abdalla, S ; Aboyans, V ; Abraham, J ; Ackerman, I ; Aggarwal, R ; Ahn, S.Y. ; Ali, M.K. ; Alvarado, M ; Anderson, H.R. ; Anderson, L.M. ; Andrews, K.G. ; Atkinson, C ; Baddour, L.M. ; Bahalim, A.N. ; Barker - Collo, S ; Barrero, L.H. ; Bartels, D.H. ; Basáñez, M.G. ; Baxter, A ; Bell, M.L. ; Benjamin, E.J. ; et al. ( Dec 15, 2012 ). `` Years lived with disability ( YLDs ) for 1160 sequelae of 289 diseases and injuries 1990 - 2010 : a systematic analysis for the Global Burden of Disease Study 2010 ''. Lancet. 380 ( 9859 ) : 2163 -- 96. doi : 10.1016 / S0140 - 6736 ( 12 ) 61729 - 2. PMID 23245607. Jump up ^ Headache Classification Committee of the International Headache Society ( IHS ) : The International Classification of Headache Disorders, 3rd edition. Cephalalgia 33 ( 9 ) 629 -- 808 Jump up ^ Muscle Contraction Tension Headache at eMedicine Jump up ^ Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J ; Lassen ; Bendtsen ; Jensen ; Olesen ( January 1999 ). `` Effect of inhibition of nitric oxide synthase on chronic tension - type headache : a randomised crossover trial ''. Lancet. 353 ( 9149 ) : 287 -- 9. doi : 10.1016 / S0140 - 6736 ( 98 ) 01079 - 4. PMID 9929022. CS1 maint : Multiple names : authors list ( link ) Jump up ^ Ashina S, Bendtsen L, Ashina M ; Bendtsen ; Ashina ( December 2005 ). `` Pathophysiology of tension - type headache ''. Curr Pain Headache Rep. 9 ( 6 ) : 415 -- 22. doi : 10.1007 / s11916 - 005 - 0021 - 8. PMID 16282042. CS1 maint : Multiple names : authors list ( link ) Jump up ^ Pielsticker A, Haag G, Zaudig M, Lautenbacher S ; Haag ; Zaudig ; Lautenbacher ( November 2005 ). `` Impairment of pain inhibition in chronic tension - type headache ''. Pain. 118 ( 1 -- 2 ) : 215 -- 23. doi : 10.1016 / j. pain. 2005.08. 019. PMID 16202520. CS1 maint : Multiple names : authors list ( link ) ^ Jump up to : Consumer Reports ( 28 April 2016 ). `` Tension Headache Treatment and Prevention ''. Consumer Reports. Retrieved 25 May 2016. Jump up ^ Nestoriuc Y, Rief W, Martin A ; Rief ; Martin ( June 2008 ). `` Meta - analysis of biofeedback for tension - type headache : efficacy, specificity, and treatment moderators ''. J Consult Clin Psychol. 76 ( 3 ) : 379 -- 96. doi : 10.1037 / 0022 - 006X. 76.3. 379. PMID 18540732. CS1 maint : Multiple names : authors list ( link ) Jump up ^ Rains JC ( May 2008 ). `` Change mechanisms in EMG biofeedback training : cognitive changes underlying improvements in tension headache ''. Headache. 48 ( 5 ) : 735 -- 6 ; discussion 736 -- 7. doi : 10.1111 / j. 1526 - 4610.2008. 01119_1. x. PMID 18471128. ^ Jump up to : Bendtsen L, Jensen R ; Jensen ( May 2011 ). `` Treating tension - type headache -- an expert opinion ''. Expert Opin Pharmacother. 12 ( 7 ) : 1099 -- 109. doi : 10.1517 / 14656566.2011. 548806. PMID 21247362. Jump up ^ Derry, S ; Wiffen, PJ ; Moore, RA ( 13 January 2017 ). `` Aspirin for acute treatment of episodic tension - type headache in adults ''. The Cochrane database of systematic reviews. 1 : CD011888. doi : 10.1002 / 14651858. CD011888. pub2. PMID 28084009. Jump up ^ Simpson, D.M. ; Hallett, M. ; Ashman, E.J. ; Comella, C.L. ; Green, M.W. ; Gronseth, G.S. ; Armstrong, M.J. ; Gloss, D. ; Potrebic, S. ; Jankovic, J. ; Karp, B.P. ; Naumann, M. ; So, Y.T. ; Yablon, S.A. ( 18 April 2016 ). `` Practice guideline update summary : Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache : Report of the Guideline Development Subcommittee of the American Academy of Neurology ''. Neurology. 86 : 1818 -- 1826. doi : 10.1212 / WNL. 0000000000002560. PMC 4862245. PMID 27164716. Jump up ^ Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin BC, Vickers A, White AR ; Linde ; Allais ; Brinkhaus ; Fei ; Mehring ; Shin ; Vickers ; White ( 2016 ). `` Acupuncture for the prevention of tension - type headache ''. Cochrane Database Syst Rev. 1 ( 4 ) : CD007587. doi : 10.1002 / 14651858. CD007587. pub2. PMC 4955729. PMID 27092807. CS1 maint : Multiple names : authors list ( link ) Jump up ^ Fernández - de-las - Peñas C, Alonso - Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA ; Alonso - Blanco ; Cuadrado ; Miangolarra ; Barriga ; Pareja ( 2006 ). `` Are manual therapies effective in reducing pain from tension - type headache ? : a systematic review ''. Clin J Pain. 22 ( 3 ) : 278 -- 85. doi : 10.1097 / 01. ajp. 0000173017.64741. 86. PMID 16514329. CS1 maint : Multiple names : authors list ( link ) Jump up ^ Biondi DM ( 2005 ). `` Physical treatments for headache : a structured review ''. Headache. 45 ( 6 ) : 738 -- 46. doi : 10.1111 / j. 1526 - 4610.2005. 05141. x. PMID 15953306. Jump up ^ Bronfort G, Nilsson N, Haas M ; et al. ( 2004 ). Brønfort, Gert, ed. `` Non-invasive physical treatments for chronic / recurrent headache ''. Cochrane Database Syst Rev ( 3 ) : CD001878. doi : 10.1002 / 14651858. CD001878. pub2. PMID 15266458. CS1 maint : Multiple names : authors list ( link ) CS1 maint : Explicit use of et al. ( link ) Jump up ^ Ernst E, Canter PH ; Canter ( 2006 ). `` A systematic review of systematic reviews of spinal manipulation ''. JR Soc Med. 99 ( 4 ) : 192 -- 6. doi : 10.1258 / jrsm. 99.4. 192. PMC 1420782. PMID 16574972. Jump up ^ Chaibi, A ; Russell, MB ( July 2012 ). `` Manual therapies for cervicogenic headache : a systematic review ''. The journal of headache and pain. 13 ( 5 ) : 351 -- 9. doi : 10.1007 / s10194 - 012 - 0436 - 7. PMC 3381059. PMID 22460941. Jump up ^ Lenaerts, M.E. ( 2006 ). `` Burden of tension - type headache ''. Current Pain and Headache Reports. 10 ( 6 ) : 459 -- 62. doi : 10.1007 / s11916 - 006 - 0078 - z. PMID 17087872. External links Classification V T D ICD - 10 : G44. 2 ICD - 9 - CM : 307.81, 339.1 MeSH : D018781 DiseasesDB : 12554 External resources MedlinePlus : 000797 eMedicine : article / 1142908 American Council for Headache Education National Headache Foundation World Headache Alliance Diseases of the nervous system, primarily CNS ( G04 -- G47, 323 -- 349 ) Inflammation Brain Encephalitis Viral encephalitis Herpesviral encephalitis Limbic encephalitis Encephalitis lethargica Cavernous sinus thrombosis Brain abscess Amoebic Spinal cord Myelitis : Poliomyelitis Demyelinating disease Transverse myelitis Tropical spastic paraparesis Epidural abscess Both / either Encephalomyelitis Acute disseminated Myalgic Meningoencephalitis Brain / encephalopathy Degenerative Extrapyramidal and movement disorders Basal ganglia disease Parkinsonism PD Postencephalitic NMS PKAN Tauopathy PSP Striatonigral degeneration Hemiballismus HD OA Dyskinesia Dystonia Status dystonicus Spasmodic torticollis Meige 's Blepharospasm Athetosis Chorea Choreoathetosis Myoclonus Myoclonic epilepsy Akathisia Tremor Essential tremor Intention tremor Restless legs Stiff person Dementia Tauopathy Alzheimer 's Early - onset Primary progressive aphasia Frontotemporal dementia / Frontotemporal lobar degeneration Pick 's Dementia with Lewy bodies Posterior cortical atrophy Vascular dementia Mitochondrial disease Leigh disease Demyelinating autoimmune Multiple sclerosis Neuromyelitis optica Schilder 's disease hereditary Adrenoleukodystrophy Alexander Canavan Krabbe ML PMD VWM MFC CAMFAK syndrome Central pontine myelinolysis Marchiafava -- Bignami disease Alpers ' disease Episodic / paroxysmal Seizure / epilepsy Focal Generalised Status epilepticus Myoclonic epilepsy Headache Migraine Familial hemiplegic Cluster Tension Cerebrovascular TIA Amaurosis fugax Transient global amnesia Acute aphasia Stroke MCA ACA PCA Foville 's Millard -- Gubler Lateral medullary Medial medullary Weber 's Lacunar stroke Sleep disorders Insomnia Hypersomnia Sleep apnea Obstructive Congenital central hypoventilation syndrome Narcolepsy Cataplexy Kleine -- Levin Circadian rhythm sleep disorder Advanced sleep phase disorder Delayed sleep phase disorder Non-24 - hour sleep -- wake disorder Jet lag CSF Intracranial hypertension Hydrocephalus / NPH Choroid plexus papilloma Idiopathic intracranial hypertension Cerebral edema Intracranial hypotension Other Brain herniation Reye 's Hepatic encephalopathy Toxic encephalopathy Hashimoto 's encephalopathy Spinal cord / myelopathy Syringomyelia Syringobulbia Morvan 's syndrome Vascular myelopathy Foix -- Alajouanine syndrome Spinal cord compression Both / either Degenerative SA Friedreich 's ataxia Ataxia - telangiectasia MND UMN only : Primary lateral sclerosis Pseudobulbar palsy Hereditary spastic paraplegia LMN only : Distal hereditary motor neuronopathies Spinal muscular atrophies SMA SMAX1 SMAX2 DSMA1 Congenital DSMA SMA - PCH SMA - LED SMA - PME Progressive muscular atrophy Progressive bulbar palsy Fazio -- Londe Infantile progressive bulbar palsy both : Amyotrophic lateral sclerosis Headache ( G43 -- G44, 339, 346 ) Primary ICHD 1 Migraine Familial hemiplegic Retinal migraine ICHD 2 Tension ICHD 3 Cluster Chronic paroxysmal hemicrania SUNCT ICHD 4 Hemicrania continua Thunderclap headache Sexual headache New daily persistent headache Hypnic headache Secondary ICHD 5 Migralepsy ICHD 7 Ictal headache Post-dural - puncture headache ICHD 8 Hangover Medication overuse headache ICHD 13 Trigeminal neuralgia Occipital neuralgia External compression headache Cold - stimulus headache Optic neuritis Postherpetic neuralgia Tolosa -- Hunt syndrome Other Vascular Retrieved from `` https://en.wikipedia.org/w/index.php?title=Tension_headache&oldid=812129846 '' Categories : Headaches Hidden categories : CS1 maint : Multiple names : authors list CS1 maint : Explicit use of et al. Infobox medical condition ( new ) All articles with failed verification Articles with failed verification from July 2017 Talk Contents About Wikipedia Azərbaycanca Български Català Deutsch Eesti Español Français Galego Հայերեն हिन्दी Hrvatski Bahasa Indonesia Italiano עברית Nederlands 日本 語 Norsk Norsk nynorsk Português Русский Simple English Slovenščina Srpskohrvatski / српскохрватски Svenska Українська Edit links This page was last edited on 26 November 2017, at 04 : 01. Text is available under the Creative Commons Attribution - ShareAlike License ; additional terms may apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia ® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization. About Wikipedia

Question: what cause headache at the back of the head
Answer: Stress: usually occurs in the afternoon after long stressful work hours or after an exam