Tension-Type Headache
Overview
Tension-type headache is the most common primary headache, presenting as a bilateral, pressing or band-like, mild-to-moderate head pain without nausea, often related to stress, anxiety, poor sleep, neck-shoulder muscle tension, and prolonged screen posture. Chinese medicine classifies chronic recurrent cases as 'head wind' (tou feng), commonly involving liver qi stagnation, upward disturbance of wind-phlegm, or qi-blood deficiency failing to nourish the head and orifices.
TCM disease & pathogenesis
In TCM this is 'headache' (tou tong); chronic recurrent cases are called 'head wind' (tou feng) or 'head wind disease', named as 'head wind' already in the Plain Questions (Su Wen, Feng Lun); later texts note that superficial recent cases are called headache while deep, enduring, recurrent ones are head wind. The head is the confluence of all yang and the mansion of clear yang, where the essence of the five zang and clear yang of the six fu ascend. Common causes are emotional frustration, worry, and tension that impair the liver's free-coursing so qi constrains and transforms into fire, disturbing the clear orifices; or overstrain injuring the spleen so qi-blood production falters, clear yang fails to rise, and the head loses nourishment; phlegm-turbidity or static blood may also block the collaterals. Tension-type headache mainly presents as liver-constraint qi stagnation (distending or migrating pain) and qi-blood insufficiency (dull, heavy pain worsened by fatigue). treatment soothes liver and regulates qi, harmonizes qi and blood, nourishes heart and spleen, and frees the collaterals to stop pain.
Pattern differentiation (clinical patterns)
Liver Qi Stagnation
Distending or wandering headache worsened by emotional stress, with chest and flank oppression, sighing, irritability and insomnia, pale red tongue with thin white coating, wiry pulse.
Soothe the liver and resolve stagnation; regulate qi and stop pain.
Qi-Blood Deficiency
Dull headache that appears or worsens after exertion, with dizziness and palpitations, fatigue and lackluster complexion, pale tongue with thin coating, fine weak pulse.
Boost qi and nourish blood; nourish the brain and stop pain.
Connections
Daily care & prevention
Keep regular sleep and meals; manage stress with breathing, walking, or tai chi; take screen breaks and correct neck posture; warm and stretch the neck and shoulders; keep hydrated. Press Taiyang (EX-HN5), Fengchi (GB20), Baihui (GV20), Hegu (LI4), and Taichong (LR3). Seek care for a sudden severe or progressively worsening headache or one with neurologic symptoms.
When to seek medical care
Seek urgent care for a sudden 'worst-ever' thunderclap headache, headache after head injury, fever with stiff neck, new neurologic deficit, confusion, vision loss, or headache with raised blood pressure and chest symptoms.