This headache may last from 30 minutes to a week. It is non-pulsating, mild to moderate in severity, generally on both sides of the head, not affected by physical exertion and not associated with other symptoms. The pain can be described as "muscle contracting" and may extend down the neck and into the shoulders. Its causes include anything which causes anxiety or tension for that particular patient. These may include:
(1) Physical and environmental Causes: poor posture; poor work conditions; arthritis, particularly cervical arthritis; abnormalities in neck muscles, bones or discs; eye strain; misaligned teeth or jaws; or noise
(2) Emotional factors: grief, job or family conflicts
(3) Depression; and
(4) Side effects of certain medications
There are two types of tension headache: episodic and chronic. Generally, episodic headaches occur randomly and are often the result of temporary stress, anxiety, fatigue or anger. However they may also be rebound headaches, which are medication-induced and both aggravate and mask other headaches. Chronic tension-type headaches may be the result of chronic stress or fatigue, but they can usually be attributed to physical problems, psychological issues or depression. Chronic tension-type headaches are characterised by nearly daily headache and are difficult to manage in primary practice.
Tension headaches are much more common in women than men. They may be associated with hormonal changes during the menstrual cycle or after menopause; also with the use of birth control pills. Postnatal and postpartum headaches are very common for mothers. Postpartum headaches correlate with the sharp fall in oestrogen and progesterone levels that follow labour and delivery. This sharp decline is often avoided by women who breast-feed.