Headache, tension-type

Page last reviewed: 13/07/2011

A headache is a pain or discomfort in the head or neck, and is extremely common.

Headaches can either be:

  • primary headaches, which are not caused by an underlying condition. They can be a symptom of stress, squinting or poor posture, for example. Examples of primary headaches are tension-type headaches, cluster headaches and migraines
  • secondary headaches, which are caused by an underlying condition such as meningitis or a brain tumour

These pages will focus on tension-type headache, which is the most common type of primary headache. The other types of headache are summarised in the box, bottom left.

What are tension-type headaches?

Tension-type headaches are felt as a constant ache that affects both sides of the head. There is also tightening of the neck muscles and a feeling of pressure behind the eyes (see Symptoms of tension-type headaches).

Tension-type headaches are more frequent in women than men.

The headaches usually last for one to six hours, but some people may have more persistent headaches that last for several days.

How common are they?

Many people have one or two tension-type headaches every month. Sometimes they develop more frequently, typically during times of stress.

Approximately 3% of people have a tension-type headache on most days. When this happens, the headaches are called chronic tension-type headaches.

Outlook

Tension-type headaches, like most primary headaches, are not life threatening and are usually relieved by medicines or changes in lifestyle (see Treatment of tension-type headaches).

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Page last reviewed: 13/07/2011

The pain of a tension-type headache is:

  • usually mild or moderate
  • felt as a pressure on both sides of the head (it can be described as a tight band around the head)
  • constant
  • not aggravated by routine physical activity
  • not associated with nausea or vomiting
  • sometimes associated with sensitivity to light or noise

There may also be a feeling of pressure behind the eyes and a tightening of the neck muscles.

A tension-type headache normally comes on during the day and can build gradually throughout the day. In most cases, it lasts a few hours and does not prevent you from doing everyday activities.

Chronic (persistent) tension-type headache occurs on more than 15 days a month, for more than three months.

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Page last reviewed: 13/07/2011

The cause of tension-type headaches is not clear. However, they are thought to be triggered by certain situations, such as:

  • stress, emotional tension, depression or anxiety
  • poor posture, which causes scalp and neck muscles to tense up
  • squinting to read, which causes scalp muscles to tense up
  • certain foods
  • bright sunlight
  • tiredness
  • noise
  • caffeine
  • certain smells
  • menstrual periods
  • changes in the weather
  • daily use of painkillers (the body gets used to the painkillers and a withdrawal headache may occur if painkillers are not taken every day)

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Page last reviewed: 13/07/2011

Usually, there is no need to visit your GP if you only get occasional headaches. However, see your GP if:

  • your headaches are frequent or severe
  • your headaches come on suddenly and are unlike anything you have had before
  • your headaches are accompanied by a very stiff neck, fever, nausea, vomiting and confusion
  • your headaches followed an accident, especially if it involved a blow to your head
  • you also experience weakness, numbness, slurred speech or confusion

Diagnosis

Your GP will ask you about your family history, diet and lifestyle. They will also ask you how long your headaches last, how frequent and severe they are, where they are located and when they occur.

Your GP may diagnose tension-type headache if the following apply:

  • The headaches last from 30 minutes to seven days.
  • The headaches have at least two of the following characteristics:
    - the pain affects both sides of the head
    - the pain is pressing or tightening
    - the pain is mild or moderate
    - the pain is not aggravated by routine physical activity, such as walking
  • There is no nausea or vomiting.
  • The headache is not caused by another condition.

The frequency of tension-type headaches varies from person to person.

Referral

Most tension-type headaches (and other headaches not caused by an underlying condition) can be managed by your GP and investigations are rarely needed.

However, you may be referred to a neurologist (specialist in the nervous system) if you symptoms are difficult to control or if your GP thinks there may be a serious underlying cause.

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Page last reviewed: 13/07/2011

Tension-type headaches can usually be soothed using relaxation techniques or over-the-counter painkillers taken at the time of the headache.

More persistent or recurring tension-type headaches can be treated with amitriptyline (see below). If this is not effective, you should be referred to a neurologist (specialist in diseases of the nervous system) or a pain clinic. 

Painkillers

Taking a painkiller such as paracetamol usually works well to relieve a tension-type headache. It is best to take a full dose as soon as a headache starts. A second dose can be taken after four hours if necessary.

Taking ibuprofen (an anti-inflammatory painkiller) is an alternative. Anti-inflammatories may be more effective than paracetamol for some people.

Codeine should be used with caution because of the increased chance of causing medicine-overuse headache and addiction. A short course can be used for a severe headache.

As with all medicines, always follow the instructions on the packet.

Prolonged use of painkillers will eventually cause withdrawal headaches, so they should not be taken for more than a few days at a time and should not be taken to prevent a headache, but taken at the time of the headache. Overuse of painkillers is a common cause of chronic daily headache (medication overuse headache)

Amitriptyline

Amitriptyline can be prescribed to treat chronic (persistent) tension-type headaches. Evidence has shown that this medication significantly reduces their duration and frequency.

Occipital nerve stimulation

Occipital nerve stimulation (ONS) is a new treatment for tension-type headaches that are difficult to manage and not treatable with medication.

ONS involves implanting electrodes, an impulse generator and connecting wires under the skin. The electrodes are implanted near the occipital nerve at the base of the head and the impulse generator is implanted somewhere in the body. The patient uses a remote control to deliver electrical impulses to the occipital nerve, with the aim of masking the pain.

However, the National Institute for Health and Clinical Excellence (NICE) has not yet assessed this treatment and its safety and effectiveness is not yet known.

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Relaxation techniques

Tension-type headaches can be soothed by:

  • applying a hot flannel to your forehead or neck
  • exercise, yoga or relaxationtechniques
  • massaging your shoulders and neck

Medication overuse

If your tension-type headache is caused by medication overuse, the medication should be stopped (it is not known whether stopping abruptly or gradually is best). This will initially cause your headaches to get worse, before an improvement is seen within several weeks.

Page last reviewed: 13/07/2011

Avoiding known triggers

Keeping a diary may be useful to determine a pattern of triggers for your tension-type headaches. Avoiding these triggers may reduce the number of headaches.

Triggers may include:

  • certain foods
  • hunger
  • eye strain
  • poor posture
  • stress
  • anxiety
  • anger
  • depression

Coping strategies

Breathing and relaxation exercises or other coping strategies may help in stressful situations to prevent a headache.

Regular exercise often eases stress and tension and can reduce the frequency of your headaches.

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Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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