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Want to know more about tension headaches? Find out all you need to know about tension headaches, what causes them, and ways to get rid of them.
Most of us will have experienced a tension headache at some point; it’s one of the most common types of headaches, with up to 78% of people experiencing one in their lifetime, and approximately 26% of us suffering at least once a year.1,2
What is a tension headache?
Sometimes referred to as a stress or muscle contraction headache, this condition is characterised by two or more of the following:
- a continuous, steady, and non-throbbing type of pain. This can feel like a band squeezing the head, not a sharp or stabbing pain, but rather a consistent feeling of pressure1
- a vice-like sensation of pressure and discomfort that wraps around the head. Many people with tension headaches report feeling pain across their forehead or temples, as well as a dull, aching sensation at the back of the head1
- a mild to moderate intense pressure that wraps around the head, and this sensation is usually symmetrical, affecting both sides equally. This bilateral nature of tension headaches distinguishes them from some other types of headaches, like migraines, which can often be unilateral, affecting only one side of the head 1
- typically, doesn’t worsen or become more severe when engaging in physical activities or movements, which again, sets tension headaches apart from other types of headaches like migraines. 1
Tension headaches can vary in their frequency and intensity, and clinically fall into one of three categories: infrequent episodic, frequent episodic and chronic.1
1. Infrequent Episodic
These are occasional headaches, with individuals experiencing at least ten episodes per year, but less than once a month (on average).1
People with infrequent episodic tension-type headaches (TTH) often have long periods of time without a headache but can still find them uncomfortable and disruptive when they do occur.3
The pain can be disruptive but is generally manageable with over-the-counter medications.4
2. Frequent Episodic
Defined by having at least ten headache episodes within a year, on a more frequent basis, ranging from one to 14 days per month, for more than three months, totalling between 12 and 180 days annually.1
Frequent episodic TTH can have a more significant impact on daily life due to their higher frequency.
3. Chronic Chronic
TTH is the most severe form, often causing consistent discomfort. These headaches occur on more than 15 days each month, for more than three months, which adds up to 180 days or more in a year.1
Tension headache symptoms
Tension headaches manifest with a range of symptoms, including:
- a persistent, non-pulsating ache on both sides of the head or face.1 This sensation can range from mild to moderate in intensity and is usually described as dull and aching
- tenderness in the neck and shoulder muscles6,7,8
- feeling like something is pressing on your head or being tightened around it1
- either light sensitivity (photophobia) or noise sensitivity (phonophobia) can also accompany these headaches, but not at the same time • unlike migraines, physical activity typically doesn’t worsen tension headache symptoms1
If you feel sick or nauseous, it’s very unlikely to be a tension headache. Please speak to your GP if you’re unclear about any of your symptoms.1
What can trigger a tension headache?
The exact cause of tension headaches isn’t clear, but there are certain common triggers that have been identified including:
- stress: high stress levels and emotional tension are often major triggers for tension headaches9,10
- muscle tension: prolonged muscle tension, especially in the neck, shoulders, and upper back, can contribute to tension headaches. Poor posture, overuse of muscles, or muscle strain can all be factors11
- eye strain: extended periods of focusing on a computer screen, reading, or other close-up tasks can strain the eye muscles and lead to tension headaches12
- caffeine intake: both excessive caffeine consumption and caffeine withdrawal can trigger tension headaches. It's essential to maintain a consistent caffeine intake if you're sensitive to it13
- sleep patterns: irregular sleep patterns, or poor sleep quality can contribute to tension headaches. Adequate and consistent sleep is crucial in preventing them.14,15
- dietary factors: certain foods have been known to trigger tension headaches in some individuals.16 There‘s some limited research into certain deficiencies, including vitamin D, and their potential role in triggering tension headaches.17,18
- environmental factors: sensitivity to bright lights, loud noises, or certain odours can trigger tension headaches in some individuals19
- hormonal changes: some women may experience tension headaches related to hormonal fluctuations, particularly during their menstrual cycle20,21,22
How do I know if it’s a tension headache or migraine?
Tension headaches and migraines can be difficult to differentiate as they feel quite similar. Here are a few of the differences to help you find out which one you’re having:1
| Migraine | Headache |
|---|---|
| Intense pulsing and throbbing sensation | Constand mild, dull pressure, non-pulsating |
| Mainly felt on one side of the head | Bi-lateral band of pressure |
| Nausea | Still able to exercise and carry out daily activities |
| Dizziness | |
| Seeing flashing lights | |
| Blind spots |
Handpicked content: The difference between a migraine and a headache
Tension headache relief
As tension-type headaches can vary in their frequency and severity, here's a breakdown of appropriate relief strategies for individuals experiencing infrequent episodic, frequent episodic, and chronic tension-type headaches:
Infrequent episodic tension headache
Relaxation techniques: deep breathing, meditation, and progressive muscle relaxation can be effective for managing occasional tension headaches. Employ these methods as needed to relieve stress-induced headaches.23
Stay hydrated: ensure you maintain good hydration, especially on those days you feel a headache coming on.24
Over-the-counter medications: non-prescription pain relievers like ibuprofen or paracetamol (acetaminophen) can provide quick relief on an as-needed basis.25 Research has revealed that paracetamol (1000mg) on its own has a lower efficacy and, therefore should only be taken if NSAIDS (like ibuprofen or Aspirin) cannot be taken.11
Frequent episodic tension-type headache
In addition to the above strategies, consider the following:
Regular exercise: tension-type headaches are more frequently experienced by individuals with a sedentary lifestyle compared to those who engage in regular physical activity.11 Exercise can help manage stress and muscle tension more effectively.
Adequate sleep: maintain a consistent sleep schedule and prioritise good sleep hygiene to reduce the likelihood of frequent headaches.23
Chronic tension headache
Prophylactic medications: their primary goal is to reduce the likelihood of developing a headache and thereby prevent headaches from even occurring.11 Your GP can guide you in choosing the right medication.
Physiotherapy: a physical therapist can evaluate your posture, muscle imbalances, and movement patterns, and provide exercises and techniques to correct these issues, reducing headache triggers.26
Acupuncture: The National Institute of Health and Care Excellence have issued guidelines that state that a course of up to ten acupuncture sessions could help to reduce future tension-type headaches.27
FAQs
Does heat help tension headache?
The NHS recommends applying a warm flannel to the back of your neck or a cool flannel to your forehead to help relieve stress-induced tension headaches.26
Does massage help tension headaches?
A lot of people find massage relaxing. Indulging in one can be a great way to de-stress and help ease the symptoms of some tension headaches.26
The final say
- Tension headaches are common, affecting up to 78% of people in their lifetime, with 26% experiencing them at least once a year2
- They’re characterised by continuous, steady, non-throbbing pain, often described as a band-like pressure that wraps around the entire head1
- They can be categorised into infrequent episodic (up to ten episodes per year), frequent episodic (one to 14 days per month for more than three months), and chronic (more than 15 days per month)1
- Common triggers include stress, muscle tension, sleep patterns, and dietary factors
- Relief strategies vary based on the frequency of tension headaches. These can include pain medication and good sleep hygiene, to physiotherapy and acupuncture
The advice in this article is for information only and should not replace medical care. Please check with your GP or healthcare professional before trying any treatments, or remedies.
1. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808. doi:10.1177/0333102413485658 pg.659-664
2. Onan, D., Younis, S., Wellsgatnik, W.D. et al. Debate: differences and similarities between tension-type headache and migraine. J Headache Pain 24, 92 (2023). https://doi.org/10.1186/s10194-023-01614-0
3. Headache - tension-type | Health topics A to Z | CKS | NICE [Internet]. Nice.org.uk. 2022 [cited 2023 Oct 30]. Available from: https://cks.nice.org.uk/topics/headache-tension-type/
4. Steiner, T. J., Jensen, R., Katsarava, Z., Linde, M., MacGregor, E. A., Osipova, V., Paemeleire, K., Olesen, J., Peters, M. and Martelletti, P. (2019) The Journal of Headache and Pain, 20(1). doi: 10.1186/s10194-018-0899-2.
5. Tension Headaches [Internet]. NHS choices. NHS; 2022 [cited 2023 Oct 27]. Available from: https://www.nhs.uk/conditions/tension-headaches/
6. Ashina S, Mitsikostas DD, Lee MJ, Yamani N, Wang SJ, Messina R, Ashina H, Buse DC, Pozo-Rosich P, Jensen RH et al (2021) Tension-type headache. Nat Rev Dis Primers 7(1):24. Available from: https://www.nature.com/articles/s41572-021-00257-2
7. Blaschek A, Milde‐Busch A, Straube A, Schankin C, Thyra Langhagen, Jahn K, et al. Self-reported muscle pain in adolescents with migraine and tension-type headache. Cephalalgia [Internet]. 2012 Jan 16 [cited 2023 Oct 31];32(3):241–9. Available from: https://pubmed.ncbi.nlm.nih.gov/22250208/
8. Sollmann, N., Schandelmaier, P., Weidlich, D., Stelter, J., Joseph, G. B., Börner, C., … Bonfert, M. V. (2023). The Journal of Headache and Pain, 24(1). doi:10.1186/s10194-023-01626-w
9. Hassan, M., Asaad, T. Tension-type headache, its relation to stress, and how to relieve it by cryotherapy among academic students. Middle East Curr Psychiatry 27, 20 (2020). https://doi.org/10.1186/s43045-020-00030-3
10. Gazieva, S., Prokhorova, A. & Rashidova, N. EHMTI-0185. “Perceived stress index among school adolescents with primary headaches (tension-type headache or migraine) in Tashkent”. J Headache Pain 15 (Suppl 1), B8 (2014). https://doi.org/10.1186/1129-2377-15-S1-B8
11. Steiner TJ, Rigmor Højland Jensen, Zaza Katsarava, Linde M, MacGregor A, Осипова ВВ, et al. Aids to management of headache disorders in primary care (2nd edition). Journal of Headache and Pain [Internet]. 2019 May 21 [cited 2023 Oct 31];20(1). Available from: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0899-2#MOESM22
12. Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement, and amelioration. BMJ open ophthalmology [Internet]. 2018 Apr 1 [cited 2023 Oct 27];3(1):e000146–6. Available from: https://bmjophth.bmj.com/content/3/1/e000146
13. Zduńska A, Cegielska J, Zduński S, Izabela Domitrz. Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature. Nutrients [Internet]. 2023 Jul 17 [cited 2023 Oct 30];15(14):3170–0. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385675/
14. César Fernández‐de‐las‐Peñas, Juan José Fernández-Muñóz, María Palacios‐Ceña, Parás‐Bravo P, Cigarán‐Méndez M, Navarro‐Pardo E. Sleep disturbances in tension-type headache and migraine. Therapeutic Advances in Neurological Disorders [Internet]. 2017 Dec 6 [cited 2023 Oct 30];11:175628561774544-175628561774544. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784553/
15. Sullivan DP, Martin PR, Mark Justin Boschen. Psychological Sleep Interventions for Migraine and Tension-Type Headache: A Systematic Review and Meta-Analysis. Scientific Reports [Internet]. 2019 Apr 23 [cited 2023 Oct 30];9(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478829/
16. Mei‐Ling Sharon Tai, Jun Fai Yap, Cheng Beh Goh. Dietary trigger factors of migraine and tension-type headache in a South East Asian country. Journal of Pain Research [Internet]. 2018 Jun 1 [cited 2023 Oct 30];Volume 11:1255–61. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029602/
17. Nowaczewska M, Wiciński M, Osiński S, Kaźmierczak H. The Role of Vitamin D in Primary Headache-from Potential Mechanism to Treatment. Nutrients. 2020 Jan 17;12(1):243. doi: 10.3390/nu12010243. PMID: 31963460; PMCID: PMC7019347. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019347/
18. NHS Choices. 10 headache triggers [Internet]. 2023 [cited 2023 Oct 30]. Available from: https://www.nhs.uk/conditions/headaches/10-headache-triggers/
19. Zivadinov R, Willheim K, Sepic-Grahovac D, et al. Migraine and Tension-Type Headache in Croatia: A Population-Based Survey of Precipitating Factors. Cephalalgia. 2003;23(5):336-343. doi:10.1046/j.1468-2982.2003.00544.x
20. NHS Choices. Hormone headaches [Internet]. 2023 [cited 2023 Oct 30]. Available from: https://www.nhs.uk/conditions/hormone-headaches/
21. Lifting The Burden in official relations with the World Health Organization [Internet]. [cited 2023 Oct 31]. Available from: https://static-content.springer.com/esm/art%3A10.1186%2Fs10194-018-0899-2/MediaObjects/10194_2018_899_MOESM25_ESM.pdf
22. Kumar S, Raje A. Effect of progressive muscular relaxation exercises versus transcutaneous electrical nerve stimulation on tension headache: A comparative study. Hong Kong Physiotherapy Journal [Internet]. 2014 Dec 1 [cited 2023 Oct 31];32(2):86–91. Available from: https://www.sciencedirect.com/science/article/pii/S1013702514000244
23. Arca KN, Halker B. Dehydration and Headache. Current Pain and Headache Reports [Internet]. 2021 Jul 15 [cited 2023 Oct 31];25(8). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280611/
24. Fernández-de-las-Peñas, C., Palacios-Ceña, M., Castaldo, M. et al. Variables associated with use of symptomatic medication during a headache attack in individuals with tension-type headache: a European study. BMC Neurol 20, 43 (2020). https://doi.org/10.1186/s12883-020-1624-8
25. Chowdhury D. Tension type headache. Annals of Indian Academy of Neurology [Internet]. 2012 Jan 1 [cited 2023 Oct 31];15(5):83–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444224/
26. NHS Choices. Tension headaches [Internet]. 2023 [cited 2023 Oct 31]. Available from: https://www.nhs.uk/conditions/tension-headaches/
27. Fan X, Fu GJ, Wang L, Shen W, Zhang Y. A bibliometric analysis and visualization of tension-type headache. Frontiers in Neurology [Internet]. 2022 Aug 31 [cited 2023 Oct 31];13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9471986/
28. Ángela Repiso-Guardeño, Moreno-Morales N, María Angeles Armenta-Pendón, Carmen del, Pino-Lozano R, Juan Antonio Armenta-Peinado. Physical Therapy in Tension-Type Headache: A Systematic Review of Randomized Controlled Trials. International Journal of Environmental Research and Public Health [Internet]. 2023 Mar 2 [cited 2023 Oct 31];20(5):4466–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10001815/
29. Данилов АБ, Danilov АB, Курушина ОВ, Shestel EA, Живолупов СА, Латышева НВ. Real-World Surveillance Program. Pain and Therapy [Internet]. 2020 Oct 16 [cited 2023 Oct 31];9(2):741–50. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648782/
30. Treatments for tension type headache | Information for the public | Headaches in over 12s: diagnosis and management | Guidance | NICE [Internet]. Nice.org.uk. NICE; 2012 [cited 2023 Oct 31]. Available from: https://www.nice.org.uk/guidance/cg150/ifp/chapter/Treatments-for-tensiontype-headache
31. Supplements - The Migraine Trust [Internet]. The Migraine Trust. 2022 [cited 2023 Oct 31]. Available from: https://migrainetrust.org/live-with-migraine/healthcare/treatments/supplements/
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