What are the basic causes of a headache

Tension Headaches: Causes, Symptoms & Therapy

Of the over 200 types of headache worldwide, tension headache is the most common type of headache. They are also known as tension-type headaches. Here you can find out what you can do against tension headaches, what causes, triggers and symptoms there are.

What is tension headache?

A general distinction is made between primary and secondary headaches. Tension-type headache is, like migraine and cluster headache, a disorder in its own right - that is, a primary headache. Secondary headaches, on the other hand, are characterized by the fact that they are symptoms of another disease such as a head injury, vascular disease, infectious disease or medication overuse. Secondary headache is not a disorder in its own right, whereas tension headache is one.

What are the symptoms of tension headaches?

Tension headaches are episodic, mild to moderate headaches that last from a few hours to several days. The pain usually feels pressing, pulling, or dull. Many sufferers find it difficult to clearly localize the pain. If it does, the pain usually occurs on both sides in the temporal region. It feels like having a helmet that is too small or a scarf that is too tight around your head.

Migraines or tension headaches?

The distinction between a headache and a migraine headache or a tension headache is often not that easy. Unlike migraines, there are usually no side effects and pain does not worsen with movement. On the contrary: sometimes the headache gets even better with a long walk!

In addition, migraines are often accompanied by symptoms such as nausea or sensitivity to light and noise, and many sufferers also experience a migraine aura. Our headache and migraine app M-sense can be used to test whether it is a tension headache or a migraine. If you enter the symptoms accompanying an attack, it is divided into migraines or tension headaches according to a binding classification scheme (ICHD: International Classification of Headache Disorders).

Frequency of tension headaches

Around a third of the German population has tension headaches at least once a month, and three percent of them even suffer from chronic tension headaches. Similar to migraines, women are more often affected than men. The headache is most commonly diagnosed by the age of 19. Almost 20 percent of women and 14 percent of men in this age group are affected by tension headaches. The number of 18 to 27 year olds with a headache diagnosis increased by 42 percent between 2005 and 2015.

Duration of tension headaches

In the diagnosis of tension headache, a distinction is made between three different forms of progression, which can also merge into one another. The easiest form is calledSporadic episodic tension-type headache designated. The pain should not occur more than once a month and 12 times a year. Ultimately, this form does not require treatment. AsCommon episodic tension headache a frequency of 2-14 times per month applies. Ofchronic tension headacheOne speaks when the complaints occur on average more than 15 days a month for at least 3 months, or in other words: at least 180 days a year.

Tension headache triggers

Tension-type headaches are multifactorial, i.e. caused by several different triggers. Stress plays a crucial role in this. In line with this, tension headaches were also called "stress headaches" in the past. Prolonged psychosocial stress, such as stress at work or partnership conflicts, weakens the body's own sensitive pain defense system. Our brain actually tries to regulate the sensation of pain in such a way that not every tug is consciously perceived as pain.

The pain information from the nerve tracts of the entire body converge in the brain. There, the processing can be controlled and filtered via chemical and electrical mechanisms - similar to a good radio, where we can also adjust the highs and lows. The opening and closing of the filters is mainly regulated in the brain by various messenger substances. The neurotransmitter serotonin plays a special role in this.

However, stress can lead to a deficiency in these important messenger substances, which means that pain regulation no longer works well enough. It is important to know that general changes in our pain regulation have the greatest impact in the head and neck area, as the nerve tracts are particularly sensitive there. This of course promotes headaches.

Stress-related lifestyle changes such as less exercise, irregular sleep, irregular meals or increased alcohol consumption and smoking also seem to trigger headaches.

Another, often overlooked cause can be jaw and tooth misalignments, nocturnal teeth grinding and the resulting tense chewing muscles. To prevent this, regular checks by the dentist or orthodontist are useful. He or she can make an adapted bite splint to relieve the temporomandibular joint or correct misaligned teeth.

Causes of tension headaches

The exact scientific causes of tension-type headaches have not yet been clearly clarified.

Of course, it is interesting to ask whether the headache can also be traced back to muscle tension in the neck and shoulder area. The answer is: yes and no! The majority of those affected actually have significant shoulder and neck tension, just not everyone.

Reasons for tense muscles can be poor physical posture, such as an unfavorable posture at the computer workstation, or a weakness in the back muscles. Permanent tension in the muscles makes the blood flow to the muscles more difficult and so-called "trigger points" can form.

Trigger points, which can sometimes even be felt as small, hardened nodules, are muscle areas with a particularly high sensitivity to pressure and pain. Active trigger points can radiate in many different directions, including the head.

What can be done about tension headaches?

In general, the prophylaxis of tension headaches should be of particular importance. Strategies for reducing stress play a special role here. In addition to a more conscious and balanced everyday life, regular relaxation procedures (progressive muscle relaxation according to Jacobson, breathing therapy, autogenic training) are recommended. In addition to relaxing the muscles, these also cause a breakdown of stress hormones and a regeneration of the body's own pain defense systems.

Another important factor is regular endurance training. Endurance sports such as cycling, jogging or swimming are recommended, ideally 3x 30 minutes per week.

Specific physiotherapeutic exercises to stretch and loosen the muscles and work on the trigger points can also help against tense neck and shoulder muscles. These exercises can have a positive effect on the headache and instructions for this can therefore also be found in our headache & migraine app M-sense.

Warmth and cold applications also have a positive effect on the blood circulation in the muscles and can relieve tension. In order to eliminate the cause of muscular tension, care should be taken to ensure that the height relation of the table and chair, the ergonomic arm and backrests and the viewing angle of the screen are individually adapted to the user. These and many other tips can also be found in the detailed knowledge section of the headache app.

Mild to moderate headaches can also be treated with over-the-counter pain medication such as acetylsalicylic acid (aspirin), paracetamol, or ibuprofen. However, you should make sure that you do not take these drugs too often and that you do not run the risk of drug overuse headache (MÜK).

If headache medication is taken for more than 10 days per month for a period of three months, there is a risk of developing MCI. Drug-induced headache has symptoms similar to tension headache and for this reason is often not diagnosed early enough.

Especially on hot summer days, lack of fluids is a common cause of tension headaches, which is why it is important to drink at least 2 liters a day.

In order for the doctor to find an effective treatment for the individual, it is essential to find out what causes the tension headache. For this purpose, the person concerned usually keeps a headache diary as an aid in diagnosis and to monitor treatment. You can also do this with our headache app M-sense.

This has the advantage that you always have it with you and that, if necessary, a doctor's report with all the information entered can be printed out or forwarded for the doctor. In addition, after entering the symptoms, the app automatically distinguishes whether it is a migraine attack, cluster headache or tension headache.

Every third person has tension headaches at least once a month, and twelve percent of Germans suffer from migraines.

Many sufferers feel helplessly exposed to the painful attacks and often do not know that there are other very effective drugs as well as drugs
Treatment methods there. With our headache & migraine app M-sense, we want to help to better understand one's own illness and to find individually effective treatment methods.


Tension headaches are the most common headache around the world. It is a primary headache disorder, the symptoms of which are episodic, mild to moderate headaches that can last from a few hours to a few days and are described by those affected as dull, pulling or pressing. In contrast to migraines, there are usually no side effects and the pain can improve with movement.

There are various forms of tension headache and the causes of this disease are largely unexplained. However, various triggers can promote tension-type headaches, such as prolonged stress, increased alcohol or nicotine consumption, lack of exercise or tension.

The consistent keeping of a headache diary, physiotherapeutic exercises, the regular performance of relaxation exercises and endurance sports and the general reduction of stress help with diagnosis and therapy. Modern apps like our headache & migraine app M-sense can be helpful.