Muscle Contraction Tension Headache Clinical Presentation

Updated: May 21, 2019
  • Author: Syed M S Ahmed, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Tension-type headaches (TTHs) are characterized by pain that is usually mild or moderate in severity and bilateral in distribution. Unilateral pain may be experienced by 10-20% of patients. Headache is a constant, tight, pressing, or bandlike sensation in the frontal, temporal, occipital, or parietal area (with frontal and temporal regions most common).

  • Ulrich et al reported that 82% of TTHs last less than 24 hours. [3]

  • The deep steady ache differs from the typical throbbing quality of migraine headache.

    • Prodrome and aura are absent.

    • Occasionally, the headache may be throbbing or unilateral, but most patients do not report photophobia, sonophobia, or nausea, which commonly are associated with migraine.

  • Some patients may have neck, jaw, or temporomandibular joint discomfort.



Patients with TTH have normal findings on general and neurologic examinations.

Some patients may have tender spots or taut bands in the pericranial or cervical muscles (trigger points).



Various precipitating factors may cause TTH in susceptible individuals. One half of patients with TTH identify stress or hunger as a precipitating factor.

  • Stress - Usually occurs in the afternoon after long stressful work hours

  • Sleep deprivation

  • Uncomfortable stressful position and/or bad posture

  • Irregular meal time (hunger)

  • Eyestrain