June 10, 2020

A Vanderbilt neurologist walks us through common tension headaches, identifies possible causes and provides promising treatment options.

Maybe you get a dull headache every now and again, or maybe they’re becoming chronic. Either way, you’re not the only one suffering from a tension headache.

“I’d say about 50 percent of our practice is headaches,” said Dr. Kirk Kleinfeld, a neurologist with Vanderbilt Neurosciences. “And we see a wide spectrum of people in our clinic. We see 18-year-olds, 70-year-olds — headaches can really affect you at any age.”

And they can affect us in different ways, from full-on migraines to periodic dull, throbbing pain. If you’ve been suffering with headache pain, here’s some insight from Dr. Kleinfeld on one of the most common headaches, a tension headache — what they feel like, how you can prevent them and some promising developments on how to treat them.

What is a tension headache, and what does it feel like?

When you’re suffering from a headache, it can be hard to discern its type, and therefore its cause. First, it’s important to understand the difference between migraines and tension headaches. Migraines, Kleinfeld explains, are usually moderate to severe and often involve sensitivity to light, vision issues and nausea. They’re often “unilateral” and felt on one side of your head. Tension headaches are often dull to moderate and are usually felt on both sides of your forehead, forming a “band.” They might come on late in the day as a result of eyestrain, poor posture or — you guessed it — tension, among other things. Also, many individuals can have both forms of headaches.

The good news is that tension headaches often come on slowly, giving you time to either ease the pain or release tension.

How can I prevent a tension headache?

  • Evaluate your environment. Are your headaches coming on at the end of a long day in front of a computer screen? Do you feel any tension in your back or neck as a result of staying in an uncomfortable desk chair for too long? Perhaps you need to work mini-breaks into your workday or make an effort to change positions and incorporate some movement to avoid unnecessary tension and strain.
  • Reduce emotional stress. Tension headaches are often called “stress headaches” for a reason! To mitigate stress, incorporate activities like meditation, yoga, stretching or walking into your daily routine, and be sure to practice good sleep hygiene.
  • Get some aerobic exercise. Keep that blood flowing! Kleinfeld said that light aerobic activity — walking, jogging, cycling, swimming — can not only prevent headaches but can also help relieve headache pain. A regular exercise routine can also help keep your back and neck strong and flexible, which will prevent muscle tension.
  • Try supplements. Kleinfeld said that he’s seen success with magnesium and riboflavin supplements, backed by evidence that they help prevent headaches. However, please consult your physician, especially if you have a medical condition, take medications or are pregnant.

How can I treat a tension headache?

  • It’s OK to take an over-the-counter medication — but only in moderation. Taking analgesics (pain relievers) for the odd headache is OK, Kleinfeld said, as is using caffeine to relieve the pain. (In fact, many analgesics contain caffeine). A problem arises, however, when you start turning to caffeine or analgesics as a preventive —that’s when the “rebound headaches” begin, Kleinfeld said, noting that the medicine or caffeine become a trigger rather than a cure: when they wear off, the pain returns. “A lot of times, for rebound headache management, we’ll either wean people off the medication or stop them cold turkey,” he said. “Sometimes that’s all it takes to stop the pain.”
  • Talk to your provider about new treatment options. If you’ve seen a neurologist in the past and found little relief, here’s some good news: Over the past two years, new treatments have become available that Kleinfeld said are helping patients who’d had little luck with other methods. “We’ve had three injectable preventatives come out, called CGRPs,” Kleinfeld explained. “And this past year, there’s also been the approval of several as-needed analgesic-type options. So if you’ve gone the medicine route before and had no luck, it’s important to know about new options that are working.”
Smiling African American woman in glasses and bright yellow top

If you have headaches that are interfering with your quality of life and that haven’t responded well to other treatments, the Headache Program at Vanderbilt can help. We’ll figure out why you’re having frequent headaches, then find the best way to relieve the pain.  We help you live life with less pain and more joy. Request an appointment online, or by calling 615-936-0060.

Kirk Kleinfeld, M.D., is an Assistant Professor of Clinical Neurology at Vanderbilt University Medical Center. As a general neurologist, he evaluates and treats a wide array of neurological conditions primarily in the outpatient clinical setting in Franklin, TN. Dr. Kleinfeld is certified in both Neurology and Clinical Neurophysiology by the American Board of Psychiatry and Neurology, and is a member of the American Academy of Neurology.