Can Sciatica Cause Tension Headaches?
No, sciatica does not cause tension headaches—these are separate conditions affecting different anatomical regions of the spine with distinct pathophysiological mechanisms.
Anatomical and Pathophysiological Distinction
Sciatica and tension headaches are fundamentally different conditions:
Sciatica involves the lumbosacral spine with pain radiating down the leg below the knee in a dermatomal distribution, typically caused by nerve root compression from lumbar disc herniation 1, 2.
Tension-type headaches originate from cervical musculature and cranial structures, not from lumbar pathology 3.
The American College of Physicians classifies sciatica as "back pain potentially associated with radiculopathy or spinal stenosis," which is anatomically confined to the lower spine and lower extremities 1, 2.
Shared Features Do Not Imply Causation
While both conditions share certain characteristics as muscular pain syndromes along the spine, this does not establish a causal relationship 3:
Both may demonstrate tender points, EMG hyperactivity, and motor control dysfunction in their respective regions 3.
Both have female preponderance and risk of chronicity 3.
However, these shared features reflect parallel pathophysiological patterns (termed "spinal dyssynergia") affecting different spinal segments independently, not a direct cause-and-effect relationship 3.
Clinical Implications
When evaluating a patient with both lower back pain/sciatica and headaches:
Treat each condition independently according to established guidelines 4, 1.
For sciatica: Focus on activity modification, NSAIDs or acetaminophen, and self-care education 4.
For tension headaches: Standard tension headache management applies (not influenced by lumbar pathology).
Consider alternative diagnoses if symptoms are atypical, as both conditions can be mimicked by other pathology 5.
Important Caveat
Post-lumbar puncture headache can occur after diagnostic procedures for back pain evaluation, but this is a procedural complication (occurring within 5 days of LP), not a consequence of sciatica itself 4. The incidence ranges from 0.9% to 9.0%, typically presenting as orthostatic frontal headache 4.