Tension-type headache

A tension-type headache is the most common type of headache and the one we think of as a normal, everyday headache. 

It may feel like a constant ache that affects both sides of the head. You may also feel the neck muscles tighten and a feeling of pressure behind the eyes.

A tension headache normally won't be severe enough to prevent you doing everyday activities.

It usually lasts for 30 minutes to several hours, though can last for several days.

Who gets tension headaches?

Most people are likely to have experienced a tension headache at some point. They can develop at any age, but are more common in teenagers and adults. They are also more common in women than men.

It is estimated that about half the adults in the UK experience tension-type headaches once or twice a month, and about 1 in 3 get them up to 15 times a month.

About 2 or 3 in every 100 adults experience tension-type headaches more than 15 times a month for at least three months in a row. This is known as having chronic tension-type headaches.

When to seek medical help

There is usually no need to see your GP if you only get occasional headaches. However, you should see your GP if you get headaches several times a week or your headaches are severe.

Your GP will ask questions about your headaches, family history, diet and lifestyle to help diagnose the type of headache you have.

You should seek immediate medical advice for headaches that:

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

These symptoms suggest there could be a more serious problem, which may require further investigation and emergency treatment.

What causes tension headaches?

The exact cause of tension-type headaches is not clear but certain things have been known to trigger them, including:

• stress and anxiety
• squinting
• poor posture
• tiredness
• dehydration
• missing meals
• lack of physical activity
• bright sunlight
• noise
• certain smells

Tension-type headaches are known as primary headaches, which means they are not caused by an underlying condition. Other primary headaches include cluster headaches and migraines.

How are tension headaches treated?

Tension-type headaches aren't life-threatening and are usually relieved by painkillers or changes in lifestyle.

Relaxation techniques such as yoga, massage, exercise or applying a hot flannel to your forehead and neck can help with stress-related headaches.

Painkillers such as paracetamol or ibuprofen can be used to help relieve pain. Aspirin may also sometimes be recommended. 

If you are taking these medications, you should always follow the instructions on the packet. Pregnant women should not take ibuprofen during the third trimester as it could risk harming the baby and children under 16 should not be given aspirin.

Medication should not be taken for more than a few days at a time or it can cause medication-overuse headaches and medication containing codeine, such as co-codamol, should be avoided unless recommended by a GP.

Preventing tension headaches

If you experience frequent tension-type headaches, you may wish to keep a diary to try and identify what could be triggering them. It may then be possible to alter your diet or lifestyle to help prevent them occurring as often.

Regular exercise and relaxation are also both important to reduce stress and tension that may be causing headaches. Maintaining good posture and ensuring you are well rested and hydrated can also help.

Guidelines from the National Institute for Health and Care Excellence (NICE) states that a course of up to 10 sessions of acupuncture over a 5-8 week period may be beneficial in preventing chronic tension-type headaches.

In some cases, an antidepressant medication called amitriptyline may be prescribed to help prevent chronic tension-type headaches, although there is only limited evidence of its effectiveness. This medication does not treat a headache instantly, but must be taken daily for several months until the headaches lessen.