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The commonest headache there is — a tight band around the head, on both sides, dull rather than throbbing. Most respond well to measures you can take yourself. A few turn out to be something else.
Tension headache is the most common type of headache. It produces mild to moderate pain in the head, neck and sometimes behind the eyes. Most people describe it as a tight band around the forehead, or a vice pressing from both sides.
It comes on slowly rather than suddenly, affects both sides rather than one, and is usually not made worse by moving about — which is why people tend to carry on working through it. It often involves the back of the head and the neck as well.
The distinction matters more than it sounds, because the two are managed differently.
Tension headache is the label most commonly applied to a headache that has not been examined, and a good proportion of headaches carrying it are something else. Two in particular:
This matters because the treatments differ. Someone treating migraine as tension headache will usually find that nothing works, and conclude they have to live with it.
Compare all four types side by side.
Nausea and vomiting are not features of tension headache — if they are present, migraine is more likely. Mild sensitivity to light or noise can occur but is uncommon.
The pain of tension headache comes from the muscles covering the skull and the upper neck — across the forehead, over the temples, at the back of the head, and the muscles running up from the shoulders.
That distribution is why the headache is felt as a band rather than in one spot, and why it so often involves the neck at the same time. It is also why an examination involves pressing on these areas: tenderness in the scalp, temple, neck and shoulder muscles is one of the few objective findings in a condition with no test.
In some people a few of those points are distinctly more tender than the rest. Those are the ones that can be injected, which is why the examination is worth more than it appears.
Tension headache is one of the few headaches where self-management makes a substantial difference, and it is worth working through these properly before assuming medication is the answer.
Enough sleep, on a consistent schedule. Do not skip meals. Drink enough. Pace the day rather than sprinting at it. These sound trivial and they account for a surprising proportion of headaches.
Heat to the neck and shoulders relaxes the muscles. Stretching and strengthening them helps more durably. If you work at a desk, the height of your screen and whether your forearms are supported matter more than any of it.
Physical and psychological relaxation techniques reduce how often tension headaches occur — but only if practised routinely rather than reached for during an attack. Guided attention through the body, releasing each area in turn, is one accessible method.
Most people can eventually recognise the muscle tension building before the headache arrives, and interrupt it. Biofeedback — where muscle activity is measured so you can see what relaxing actually feels like — is a structured way of learning that skill.
This is the most important thing on the page. Ordinary painkillers taken more than two or three days a week can begin causing headaches of their own — a dull daily headache that worsens as each dose wears off, prompting another dose.
It is the commonest reason a manageable tension headache becomes a daily one, it is frequently missed, and it is reversible. If your painkiller use has crept up, that is worth saying out loud at a consultation rather than leaving out.
Diagnosis is made from the history and a physical and neurological examination — the pattern, the character of the pain, what accompanies it, and tenderness in the scalp, neck and shoulder muscles. There is no test for tension headache.
Investigation is used to exclude other causes where the presentation is unusual, has changed, or the examination raises a question:
For episodic tension headache, the measures above plus occasional painkillers are usually enough. Where headaches are frequent or have become chronic, treatment moves on:
A sudden, severe headache unlike any you have had before, a headache with fever and a stiff neck, or one with new weakness, numbness, confusion or visual loss needs same-day assessment at an emergency department rather than a clinic appointment.
Short of that, a headache that has become daily, has changed in character, or no longer responds to what used to work is worth having assessed properly rather than continuing to treat.
Stress is a common trigger, but so are poor sleep, skipped meals, sustained posture and eye strain. Many people find the headache arrives after a stressful period rather than during it, once they relax.
Tension headache is dull, on both sides, and not usually worse on movement. Migraine throbs, tends to one side, worsens with movement and often brings nausea or light sensitivity. If yours matches the second description, it is worth having reassessed.
Yes, and this is the commonest trap. Taken more than two or three days a week they can begin causing a daily headache of their own. It is reversible once recognised.
Not for tension headache — there is nothing for it to show. Imaging is used to exclude other causes when something in the history or examination warrants it, not to confirm the diagnosis.
When headaches occur on fifteen or more days a month, when your painkiller use has been climbing, when the pattern has changed, or when you have been treating it as tension headache for years without improvement.
No. You can book directly. Bring a record of your headaches if you have kept one, and a note of what you have been taking and how often.
Headaches (all types) · Migraine · Cervicogenic headache · Cluster headache · Silent migraine · Neck pain · Myofascial pain · Rhomboid pain
If headaches have become a daily fact of life, or the painkillers have stopped working, that is worth looking at properly.
