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WHAT IS IT?
If you have a head, you have felt it ache. In fact, headaches are one of the most common human ailments. People get many types of headaches, but most-90 percent-are tension headaches. When you have one, you get a dull, steady pain in the scalp, temples (the flat areas on either side of the forehead), or back of the head. The people who get headaches most are in their twenties through fifties, women more than men.Tension headaches are often mild, and most people get them only once in a while. They tend to go away with rest and a dose of an over-the-counter painkiller, such as aspirin. But if you are one of the millions of people with chronic tension headaches, you get a devilish ache in your head at least two or three times a week. The headaches may last for more than 24 hours, but the pain waxes and wanes.

You can do much, though, to prevent tension headaches with exercise, stress reduction, and other home treatment. If you already have chronic headaches, you and your doctor can work together to ease the pain.
WHAT IS HAPPENING?
Scientists don’t fully understand what causes tension headaches. They do know that during tension headaches, brain tissues themselves never hurt; they can’t feel pain. Instead, we feel pain in the membranes that cover the brain, as well as in skin, muscles, and blood vessels that cover the skull.

Most experts agree that tension headaches result when tendons and muscles in the back of the head and neck contract, sometimes when we’re under stress. Then these muscles touch on pain-sensitive nerves covering the scalp and cause a headache. If you have chronic headaches, it takes less muscle tension to trigger pain than it does in people who only have headaches once in a while.

Some studies, though, suggest that tension headaches actually start deep within the brain, caused by abnormal levels of a brain chemical called serotonin. Changes in serotonin levels also cause depression, which is why doctors believe some tension headaches are related to feeling “blue.”

Other researchers propose that tension headaches are really a mixture of tension and migraine headaches. They think that blood vessels in the head narrow and then widen, as in migraines, causing pain. Then tense muscles make it worse.
WHAT CAUSES IT?
No one can say exactly why one person gets tension headaches and another doesn’t, but researchers have found many factors that can increase the risk. Some-such as your sex-are outside your control. But you can do plenty about other factors such as stress, posture, and eyestrain.

THINGS YOU CAN’T CHANGE

Gender
You have a higher risk of getting frequent headaches if you are a woman. These headaches occur more in women because of changes in female hormone levels during menstruation. But researchers aren’t sure how this leads to headaches.

Family history
If you have a parent, brother, or sister who has frequent headaches, especially migraines, your risk of tension headaches may be higher.

THINGS YOU CAN CHANGE

Stress
That last-minute project your boss dumped on your desk or the fight you had with your spouse or children can give you a headache. The more tense and anxious you are about your problems, the greater your risk of bringing on that aching pain.

Fatigue
When you are tired, you may tighten your head and neck muscles and wind up with a tension headache.

Depression
A recent study of 245 people with chronic tension headaches found that nearly half also had symptoms of depression, anxiety, or other forms of mental distress. But researchers aren’t sure which comes first-the depression or the headache.

Poor posture
A posture with tense head and neck muscles increases your risk for tension headaches. Keeping your neck bent over for hours at a time doing paperwork is a special danger.

Grinding your teeth
Some people grind their teeth, most often when sleeping. The habit can lead to tension headaches as well as other problems such as toothaches.

Eyestrain
Straining your eyes by reading in dim light or working at a computer for long hours increases your risk.

Tensing during sex
When some people tense their head and neck muscles during sex, they may get a headache.
WHAT YOU CAN DO FOR YOURSELF
You can help prevent chronic headaches by making smart choices about resting, good posture, and reducing stress. If you already have chronic headaches, you can take these same steps to ease pain.

TO PREVENT HEADACHE:
Practice correct posture
When you work or read, sit up straight and don’t bend your neck for long stretches. Use a typing stand to hold papers when you are working at the computer.

Don’t strain your eyes
When you do paperwork or read, make sure you have enough light. If you feel you are straining your eyes, take 10-minute rest breaks every hour.

Rest
Take rest breaks every hour if you’re doing strenuous physical activities.

Cut down on stress
Try exercise, meditation, or relaxation methods to ease stress. To learn meditation, you don’t need a high-priced class. Try this easy technique:

Sit comfortably in a chair in a quiet place, with your feet flat on the floor and your hands in your lap. Close your eyes, and after a minute or so, let your mind begin to say a simple phrase or word. Researchers often suggest the word one. When thoughts come to mind, ignore them and keep going back to your chosen word. Don’t feel you have to repeat the word all the time; let it come and go. Make it the focus of your attention, but don’t work at it too hard. After 20 minutes (it’s okay to open your eyes to check the time), stop saying the word and sit quietly with your eyes closed for a couple of minutes.

Also, try this relaxation method: Starting with your feet, slowly tighten and relax each part of your body, one part at a time: feet, lower legs, upper legs, abdomen, hands, arms, chest, neck, and face.

Studies show that practices such as meditation can prevent headaches or relieve pain once a headache starts.

To ease headache pain:
Take over-the-counter pain relievers
Most over-the-counter pain relievers can ease a mild headache or those you get every once in a while. If you have headaches over and over, however, these pain relievers do more harm than good. Using them too much (for weeks at a time) may be habit-forming. You may even get more headaches. Ask your doctor about prescription medicines and preventive treatment instead.

Lie down in the dark
A brief nap or rest in a dark, quiet room can relieve the pain. Place a cold, wet cloth or, if it feels more comforting, a warm, dry cloth over your forehead.

Try massage
Massage your scalp for 10 minutes. Place both middle fingers on your forehead at your hairline; using gentle pressure, slowly work them down the sides of your forehead and onto your temples. Massage your temples for a few minutes. Then massage both sides of your skull to release tension.

Imagine the pain away
Sometimes your own mind can quell the pain. Close your eyes and imagine that your headache is liquid filling a jar. Now imagine “pouring” your headache pain into a slightly smaller jar, without letting any of the liquid spill out. Keep pouring the liquid into smaller and smaller jars, and you may feel the pain reduce.
WHAT YOUR DOCTOR CAN DO FOR YOU
Medication
If you have frequent tension headaches, your doctor can prescribe medicines to prevent future attacks. The best option may be amitriptyline (brand names include Elavil and Limbitrol), an antidepressant. The drug probably won’t cure your headaches, but you should have fewer bouts of pain.

On the downside, amitriptyline can cause drowsiness and weight gain. If this becomes a problem, your doctor may prescribe nortriptyline (available in generic form), a similar antidepressant with fewer side effects. Another antidepressant, protriptyline (Vivactil), has also shown promise for preventing tension headaches.

Amitriptyline, nortriptyline, and protriptyline, all known as tricyclic antidepressants, can help ease your pain even if you aren’t depressed. Newer antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), seem to be less effective at warding off headaches. Other drugs that may help prevent tension headaches include antianxiety medications such as buspirone (BuSpar) and antiseizure medications such as divalproex (Depakote).

Biofeedback
Your doctor may also suggest biofeedback. Biofeedback is a technique for gaining some control over body functions (for instance, heart rate, muscle tension, and temperature) that most people regard as involuntary. The feedback-a signal from a thermometer or a blood pressure cuff, for instance-tells you when your mental control is having an effect on your body. Recent studies show that biofeedback can help prevent or relieve headache pain by teaching people to control muscle tension and other signs of stress.

Bite guard (for TMD headaches)
If grinding your teeth during sleep causes pain that radiates out from the temporomandibular joint of your jaw, your dentist can prescribe a bite guard that may stop the problem-and relieve your headaches.