Tension Headache: Causes, Relief and How to Prevent It

5 min read · Conditions · By the Asthra Health Care team

What is a tension headache?

Tension-type headache is the most common headache. Most people have one at some point, often after a long day at work, a stressful exam period or hours in front of a screen. The pain is usually mild to moderate and feels like a tight band, pressure or heaviness around the forehead, the sides or the back of the head.

Unlike migraine, it does not usually throb, is not made worse by walking or climbing stairs, and rarely causes vomiting. It can last from half an hour to several days. When it happens on more than half the days of the month for months, it is called chronic tension-type headache.

Common causes and triggers

The exact cause is not fully understood, but tight muscles in the neck, shoulders and scalp, and how the brain processes pain, play a role. Daily habits often set it off. Common triggers include: Tension headaches are more common during busy or stressful periods, such as exams, deadlines or family events, and during hot weather when people drink too little water.

• Stress, worry and anxiety
• Poor sleep or too little sleep
• Long hours at a computer or phone with the neck bent forward
• Skipped meals and not drinking enough water
• Eye strain, or needing new glasses
• Too much caffeine, or suddenly stopping it
• Low mood or depression

Symptoms of tension headache

The pain is dull, steady and pressing, usually on both sides of the head. The neck and shoulders may feel tight or tender when pressed. Some people are mildly sensitive to light or sound, but not both, and nausea is usually absent. You can usually carry on with daily activities, although you may feel tired and irritable.

If your headaches have migraine features, such as throbbing pain on one side, vomiting or visual aura, talk to your doctor, as the treatment plan may be different. Many people have both types. A tension headache does not cause weakness, confusion or fever.

How tension headache is diagnosed

A doctor diagnoses tension-type headache from your description and a normal examination. There is no specific blood test or scan for it, and most people do not need a CT or MRI. Your doctor may check your blood pressure, eyes, neck and teeth, since problems there can also cause head pain.

Keeping a headache diary for a few weeks, noting the time, sleep, meals, screen use, stress and any medicines taken, helps your doctor understand your pattern and spot triggers. Bring a list of all the painkillers and other medicines you take, and how often you take them.

Relief for a tension headache

Many tension headaches ease with simple measures. Take a break from screens, drink water, eat something if you have skipped a meal, and rest in a quiet place. Gently stretch and massage the neck and shoulders, or place a warm towel on the back of the neck. A short walk in fresh air can help.

Over-the-counter painkillers such as paracetamol or ibuprofen can help; follow the label or your pharmacist's advice. Do not use painkillers on many days each month, as this can lead to medication overuse headache, where the medicine itself keeps the headache going. People with stomach ulcers, kidney disease, asthma triggered by painkillers, or who are pregnant should ask a doctor before using ibuprofen.

Preventing tension headaches

Regular habits are the best prevention. Sleep and wake at the same times, eat regular meals, and drink enough water, especially in the hot summer months. Set up your workspace so the screen is at eye level, and take a short break every half hour to stretch your neck and shoulders. Get your eyes tested if you squint or strain to read.

Exercise regularly, such as brisk walking, cycling, swimming or yoga, which reduces stress and muscle tension. Relaxation techniques, deep breathing and good time management also help. Keep caffeine moderate and steady rather than in large amounts. Cut back slowly if you drink a lot of tea or coffee.

When headaches are frequent

If you get headaches on many days a month, see a doctor. For chronic tension-type headache, doctors may prescribe a daily preventive medicine, such as a low dose of amitriptyline, only on a doctor's prescription, taken for a few months and reviewed regularly. Treating anxiety, depression or sleep problems often reduces headaches too.

Children with frequent headaches should see a doctor, and should not be given aspirin. Physiotherapy for neck and shoulder muscles and relaxation training can also help. For any doubts about pain relief or new headaches, speak to your doctor or pharmacist.

This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.