What is a tension-type headache?

What it feels like

The NHS describes tension headaches as very common. Typical symptoms are pain on both sides of the head, face or neck, a feeling that something is pressing on the head or being tightened around it, and sometimes tenderness, so that the head hurts more when touched. The NINDS adds that the pain is usually mild to moderate and may feel like a belt tightening around the head.

People can usually keep going with daily activities, according to the NHS. The NINDS says that unlike migraine, tension-type headache has no pre-headache aura (visual or sensory warning symptoms), nausea or vomiting, and it does not get worse with routine physical activity such as walking or climbing stairs. Some people are sensitive to light or sound, but the NINDS says one of the two, not both.

How long it lasts and how often it happens

Headaches last at least 30 minutes and can go on for several days, says the NHS. The NINDS gives a range of 30 minutes to 7 days. The International Classification of Headache Disorders, 3rd edition (ICHD-3), divides the condition by frequency: infrequent episodic (less than once a month), frequent episodic and chronic. ICHD-3 says the infrequent type occurs in almost the entire population, usually has very little impact and in most cases needs no medical attention.

ICHD-3 reports that lifetime prevalence in the general population ranges from 30% to 78% depending on the study. The NINDS says tension-type headache is the most common headache condition. It usually begins around puberty and peaks in a person's 30s, and it is more likely in women, younger people, those with tiredness and sleep problems, and those with a history of migraine or depression.

Causes and triggers

The exact reasons are unknown. ICHD-3 states that the exact mechanisms are not known, and that it was once thought to be mainly psychological but later studies suggest a biological basis, at least for the more severe forms. The NINDS says a person's genes, brain signals and muscle tenderness appear to play important roles. ICHD-3 notes that increased tenderness of the muscles around the skull is the most significant abnormal finding.

Stress appears in both of the lists that follow. The NHS lists stress, sleep problems and caffeine as common causes, and the NINDS adds mental strain, alcohol, dehydration, sunlight, and postures that strain the head or neck, such as reading or looking at a phone screen. The NHS also says taking painkillers too often or for a long time can itself cause headaches (overuse or rebound headaches), and that tension headaches are not a sign of an underlying condition.

Telling it from other headaches

ICHD-3 says the diagnostic difficulty seen most often is separating tension-type headache from mild migraine, partly because people with frequent headaches often have both. The NHS says a throbbing pain at the front or on one side of the head, or feeling sick and finding light or noise painful, can be signs of a different type, such as migraine. Headaches that start in the neck are a separate question, discussed on can a problem in the neck cause headaches?, and ICHD-3 itself says some headaches linked to neck muscle pain overlap with this category and can be hard to classify.

Tension-type headache can come with a sore neck, so what causes neck pain? may also help, and related questions are gathered in the neck and headaches section.

What the NHS describes for treatment

The NHS says tension headaches can be treated with over-the-counter painkillers such as paracetamol, aspirin and ibuprofen, and with relaxation activities such as exercise, yoga and massage. A GP may suggest a headache diary, and an antidepressant called amitriptyline is sometimes recommended for prevention. People may be referred to a specialist if these do not help or if the cause is unclear. This describes what the NHS says, not advice for any one person.

When to get help

The NHS advises seeing a GP if headaches come several times a week or are severe, if painkillers and relaxation do not help, or if the pain is throbbing or one-sided or comes with sickness and sensitivity to light or noise. It says to get an urgent GP appointment or call 111 for a severe headache with jaw pain when eating, blurred or double vision, a sore scalp, or numbness or weakness in the arms or legs. It says to call 999 or go to A&E for a headache that follows a head injury or comes on suddenly and is extremely painful. The NINDS also lists two or more headaches a week among the reasons to see a doctor. Practice varies by country and by clinician.