Is Nausea Common with Tension headaches? (5 facts)

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Nausea is not frequent with Tension-type headaches. It is more common as a classical presentation of migraine headaches (the second most primary headache).

Today, We will take a deep dive into the possible explanations and connections between headache and nausea.

1. The incidence of nausea with tension-type headaches.

Nausea is not a feature of Tension-type headache (TTH). If you constantly have nausea and headaches, TTH is unlikely.

According to the International Headache Society (IHS), The absence of nausea and vomiting is one of the diagnostic criteria for TTH (see the screenshot below).

Unlike migraines and cluster headaches, tension-type headaches are often low to moderate intensity, and patients often don’t seek medical advice.

However, Other reports state that the chronic type of TTH may have mild nausea. In addition, other earlier studies from the 1990s claimed that nausea is common with TTH (reference).

The exact incidence of Nausea with TTH is not known. However, It is generally rare, and its presence may indicate an alternative type of headache or associated gastrointestinal disease.

The main characteristics of TTH:

  • Unlike migraine and cluster headaches, The characteristics of TTH are generally non-specific (Called the featureless headache).
  • Location: Often bilateral and diffuse in nature (surround the head or neck as a cap.
  • Severity: Mild to moderate (often not severe as migraine and cluster headache.
  • Character: Dull constant ache in the head (not throbbing or pulsating).
  • Duration of the single attack: It is highly variable, but it is often at a lead of 30 minutes duration and may last for several days (in a single episode).
  • Frequency of attacks: described above for the different subtypes of TTH (episodic frequent, episodic infrequent, and chronic types).
  • Associated symptoms such as nausea, vomiting, intolerance to light, or sounds are absent or very minimal.
  • Tenderness over the head or neck muscles at the headache location is common.
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2. Possible explanations of nausea with tension-type headaches.

Different scenarios can explain nausea with Tension-type headache:

  • As a part of Tension-type headache.
    Some studies found that mild nausea can be a part of tension-type headaches.
  • Misdiagnosis of the type of headache.
    As we explained before, nausea is very common with migraine headaches. Therefore, constant nausea with every headache attack may indicate that you have migraine rather than TTH (see the differences in the table below).
  • Medication overuse.
    The abuse of headache medications, especially NSAIDs such as ibuprofen, may induce stomach inflammation (gastritis), which can cause nausea.
  • Severe forms of TTH.
    TTH is often mild to moderate in severity. However, it can be severe or prolonged. More severe forms of TTH are more likely to cause nausea as a reflex to pain.
  • Secondary headaches.
    Secondary headaches refer to all types of headaches that occur due to a disease or condition, such as sinus headaches, brain tumors, etc. Many of the conditions of secondary headaches can cause both nausea and headache.
  • Anxiety and stress.
    People with stress or anxiety may have tension headaches and nausea solely due to anxiety.
    In such a case, The degree of headache and nausea are often.
  • Caffeine overuse.
    Caffeine is one of the solid headache-relieving substances. However, headaches can result from too much caffeine or caffeine withdrawal. Caffeine also causes nausea and gastric upset.
  • Food intolerances.
    About 2-5% of people have a food intolerance. Intolerances to certain foods or food constituents can produce headaches similar to the TTH and gastric upset in the form of nausea and diarrhea. Learn more.
  • Infections (such as stomach flu).
    Mild or early forms of infections such as influenza, stomach flu, common cold, and others may cause nausea together with headaches (similar to TTH).

People with migraine and nausea often experience nausea just before or during the onset of a headache.

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In conclusion, nausea shouldn’t be used to differentiate tension headaches from migraine and other types. The differentiation between both types of headaches is explained in the next section.

3. Nausea in tension-type headache Vs. Migraine.

Nausea, phonophobia (intolerance to sounds), and photophobia (intolerance to bright light) are more frequent with migraine headaches.

However, nausea alone shouldn’t be used to differentiate between the two types of headaches. As it also occurs with TTH but to a lesser extent.

A broader closer look at all features of headache that you have will make it easier to figure out the type of headache and the cause of nausea.

Type
Tension-type HeadacheMigraine
PrevalenceMore common, affecting up to 86% of peopleCommon, affecting up to 15% of people.
uni- or bilateralOften bilateralAdults: 70% unilateral, 30% bilateral.
Children & Adolescents: often bilateral
LocationDiffuse (as a cap or tight band surrounding the head).Front and sides of the head, around the eye.
CharacterDull, non-throbbing.Throbbing or pulsation.
Severity++ or ++++++ or +++++
Duration.
At least 30 minutes, up to seven days in a single attack.

At least 4 hours, up to several days.

Associated symptoms
Less prevalent.Common as visual changes, photophobia, phonophobia, decreased appetite, exhaustion, etc.
Physical activityNo effect (often doesn’t interfere with daily activity).Worsens the headache (such as walking or climbing stairs).
Nausea or vomiting
rareCommon
Tenderness over facial or neck muscles
Common.Rare.

 

Tension headaches are mild to moderate in nature. Typically, the attacks of tension-type headache (TTH) don’t cause nausea.

However, if the attack is unusually painful (a severe form of tension headache), you may experience nausea.

Intense pain during an occasional severe attack of a tension headache may result in nausea as a reflex to pain. Pain and nausea are closely related and arise from closely related areas inside your brain (reference).

Tension headaches are often mild to moderate in nature in most cases. That is why nausea is rare with this type of headache.

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Features of tension headache-associated nausea:

For nausea to be a result of a tension headache attack, it must fulfill some features or criteria:

  • Associated with an abnormally severe attack of tension headache.
  • Occasional (it doesn’t come with every attack of headache).
  • After the onset of headache. Nausea that comes before the onset of a headache is a feature of a migraine rather than a tension headache.
  • Nausea is mild in nature.
  • Nausea isn’t associated with vomiting.
  • Absence of symptoms suggestive of migraine or cluster headache.
  • The nausea goes away as soon as the headache improves (resolution of the pain which caused nausea).

If nausea comes before or persists for a long time after the tension headache attack, consider an alternative cause of nausea. 

 

4. When to see a doctor for nausea and headaches.

  • Frequent unusually severe headache and nausea attacks without a clear cause.
  • Trouble seeing or speaking.
  • Confusion or trouble understanding speech.
  • Associated with frequent vomiting.
  • Fever.
  • Stiff neck.
  • Fainting.
  • Trouble walking.
  • Numbness or weakness at one side of your body.
  • The ringing of the ear or vertigo.
  • Severe anorexia (lack of appetite).
  • Photophobia or phonophobia.