Tension-type headache typically causes pain that radiates
in a band-like fashion bilaterally from the forehead to the occiput.

Although headache pain sometimes can be severe, in most cases it's not the result of an underlying disease. The vast majority of headaches are so-called primary headaches. These include migraines, cluster headaches and tension-type headaches. Nearly 90 percent of primary headaches are tension-type.

Tension-type headaches generally produce a diffuse, usually mild to moderate pain over your head. Many people liken the feeling to having a tight band around their head. These headaches may also cause pain in the back of your neck at the base of your skull.

The possible triggers range widely and may include stress, poor posture, depression and even sexual activity. In many cases there's no clear cause. Doctors once believed the cause to be chronic tension in your scalp, neck and jaw muscles.

• Depression

Signs and symptoms

Tension-type headaches can last from 30 minutes to an entire week. You may experience them occasionally, or nearly all the time. If your headaches occur 15 or more days a month for several months, they're considered chronic. Unfortunately, chronic tension-type headaches may sometimes persist for years.

A tension-type headache may cause you to experience one or more of the following symptoms:

• A diffuse, usually mild to moderate pain over the top of your head that may produce a feeling of fullness or pressure, as if a constricting band is around your head

• Associated pain in the back of your neck at the base of your skull

• Difficulty sleeping

Headache symptoms in children
Most young people have had some type of headache by the time they reach high school. In fact, even very young children can experience head pain. But if your child is too young to tell you what's wrong, headaches can be difficult to diagnose. That's because the signs of headache pain, such as crying, paleness and vomiting, may also indicate a number of other conditions. Sometimes very young children with headaches will hold their head or bang it on the floor.

• Anxiety

• vomiting

• Headache

Causes

Until a few years ago, researchers believed tension-type headache pain was the result of contracted muscles in your face, neck and scalp and an inability to deal with stress. But more recent research has altered this view.

Although much about headaches still isn't understood, researchers now believe changes in serotonin and endorphin levels in the brain may play a role in tension-type headaches. Serotonin is a brain chemical (neurotransmitter) that regulates pain messages moving through the trigeminal nerve pathway — a major pathway for pain. Endorphins are natural painkillers produced by your brain and spinal cord.

Doctors don't completely understand what causes changes in these brain chemicals, but there seem to be a number of factors that can trigger tension-type headaches, including poor posture, working in awkward positions, stress, depression and anxiety.

• Anxiety

• Depression

• Headache

Headaches in children
Chronic tension-type headaches in children are similar to headaches in adults and are often caused by stress, anxiety or depression. Although adults may not always realize it, children can experience tremendous stress — ranging from peer pressure and unreasonable parental expectations to difficulty in school and physical or sexual abuse. And all children, even very young ones, can suffer from depression.

When to seek medical advice

Pain is often one of your body's ways of signaling illness. But headache pain, even when it's severe, usually isn't the result of an underlying disease.

Occasionally, however, headaches may indicate a serious medical condition, such as a brain tumor or rupture of a weakened blood vessel (aneurysm). Always be sure to tell your physician about any headache that concerns you. Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

• Brain tumor

In addition, see your doctor or go to the emergency room immediately if you have any of these warning signs and symptoms:

• Abrupt, severe headache, often like a thunderclap

• Headache with a fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties

• Headache after a head injury, especially if it gets worse

• Chronic, progressive headache that worsens after coughing, exertion, straining or a sudden movement

• Onset of new headache pain after age 40

Call your doctor if your child has head pain that's severe or that causes him or her to miss school or other activities. Children who are too young to tell you what's wrong may cry and hold their head to indicate severe pain.

Screening and diagnosis

If you're like most people, you probably don't go to your doctor with a headache. In many cases a couple of pain relievers, a few moments to relax and a good night's sleep are enough to give you relief.

But even when the pain is severe or disabling, you may hesitate to admit you're bothered by headaches. After all, the old notion that headaches are purely psychological is a difficult one to put to rest.

But headaches are now widely recognized as biological disorders. If you suffer from headaches, don't hesitate to seek help — especially if you're concerned about what's causing them.

If you have chronic or recurrent headaches, your physician may try to pinpoint the type and cause of your headache using these approaches:

• Getting a description of your pain. Your doctor can learn a lot about your headaches from your description of the type of pain, including its severity, location, frequency and duration, and any other symptoms you may have.

• Conducting tests. If you have unusual or complicated Headaches, your physician may order tests to rule out serious causes of head pain, such as a tumor or an aneurysm. Two common tests used to image your brain are computerized tomography (CT) and magnetic resonance imaging (MRI) scans. A CT scan is a diagnostic imaging procedure that uses a series of computer-directed X-rays to provide a comprehensive view of your brain. An MRI doesn't use X-rays. Instead, it combines magnetism, radio waves and computer technology to produce clear images of your brain.

• Asking you to keep a headache calendar. One of the most helpful things you can do is keep a Headache calendar for at least a 2-month period. Each time you get a headache, jot down a description of the pain, including how severe it is, where it's located and how long it lasts. Also note any medications you take. A headache calendar can offer valuable clues that may help your doctor diagnose your particular kind of headache and discover possible headache triggers.

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