Learn about this common type of headache, its symptoms and how it is diagnosed and treated.
Tension-type headache is one of the most common types of headache, estimated to affect 2 in 3 adults in the U.S. They can range from the occasional mild headache to daily headaches in some cases.
People who experience tension-type headache often describe their pain as “a tight band around the forehead” or a dull, steady ache on both sides of the head. While the root cause of this type of headache is unknown, some research suggests that they occur more often in people with heightened sensitivity to pain.
In addition to inadequate sleep and poor posture, stress is the most frequently reported trigger for tension-type headache. Regular exercise and relaxation techniques can help reduce the frequency of tension-type headache, but over-the-counter medications may also be necessary if headache pain is especially frequent or long-lasting.
Other names for tension-type headache include contraction headache, psychomyogenic headache and stress headache. However, “tension-type headache” is the most widely accepted term today.
Symptoms of Tension-Type Headache
Tension-type headache most commonly last from 30 minutes to seven days. Signs and symptoms may include:
- A mild-to-moderate headache
- Dull, achy pain felt in both sides of the head
- Tightness or pressure around the forehead
- Muscle tenderness in the scalp, neck or shoulders
- Head pain that usually improves with over-the-counter medications
- Head pain in response to stress, lack of sleep or poor posture
Pain from a tension-type headache is generally mild to moderate and does not get worse with routine physical activity. This means that most people with tension-type headache are able to continue their normal daily activities despite the headache pain they’re experiencing.
A tension-type headache is not accompanied by nausea or vomiting. It may be accompanied by increased sensitivity to light or sound, but typically not both. In some people, it may be associated with tenderness in the head and neck muscles, particularly with an increase in the frequency of tension-type headache attacks.
Types of Tension-Type Headache
Tension-type headache is broken down into three types:
- Infrequent episodic-type tension-type headache – One or fewer episodes per month.
- Frequent episodic-type tension-type headache – More than one but fewer than 15 episodes per month for three or more months.
- Chronic tension-type headache – More than 15 episodes per month for three or more months. This type of tension-type headache may also be accompanied by mild nausea.
Do I have a tension-type headache?
Like migraine, there are no diagnostic tests to confirm a tension-type headache. Doctors make a diagnosis by reviewing a patient’s personal and family medical history, evaluating their symptoms and conducting a physical examination. During an evaluation, a patient may be asked about the frequency and duration of their symptoms, their sleeping patterns and the amount of sleep they’ve been getting and their stress levels.
Symptoms similar to those of a tension-type headache can in some cases be attributed to more serious underlying causes or conditions, so doctors should consider this possibility when patients suspect they have tension-type headache. This is particularly important if a person develops new or different headache symptoms or has progressive headaches that are increasing in frequency. Secondary causes may include other diseases or structural brain lesions.
At times, it can be difficult to distinguish between a tension-type headache and a migraine attack. Unlike a migraine attack, a tension-type headache is not made worse by physical activity. It is not accompanied by vomiting, and if nausea is present, it is typically very mild. A migraine attack may be accompanied by increased sensitivity to both light and sound, while only one of these—if any—accompanies a tension-type headache. It is, however, possible for a tension-type headache to trigger a migraine attack in people with a history of migraine.
How to Relieve a Tension-Type Headache
Infrequent episodic tension-type headache only require acute treatment as needed to relieve symptoms during individual episodes. Simple over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen or aspirin, are reasonable choices. Sometimes combination pain relievers including caffeine can be more effective, but frequent use should be avoided as it may make headaches worse in the long run.
It is important to include your doctor in your treatment plan to avoid harmful medication interactions and side effects. For example, use of combination therapies containing either butalbital or opioids for treatment of tension-type headache is generally not recommended because of the risk of tolerance, dependency, toxicity and the development of medication overuse headache. Acute treatments should be limited to no more than twice per week—otherwise, they can produce medication overuse headache and may cause undesirable effects on the liver, kidneys, stomach and other organs.
If tension-type headaches are frequent, long-lasting or create significant disability, then preventive treatment may be recommended. Commonly used preventive strategies include medications like amitriptyline and non-medication headache treatments such as biofeedback, relaxation, cognitive-behavioral therapy, acupuncture, massage therapy or physical therapy. Patients should always consult their doctor first before trying any new preventive strategies.
Resources for Managing Tension-Type Headache
Unless they become especially frequent, tension-type headache is typically not disabling. It can often be treated with over-the-counter medications and a bit of rest. Still, to be on the safe side, a doctor should always diagnose headaches. More frequent tension-type headaches may require daily preventive medications or complementary therapies to restore health and quality of life.
For more information on managing tension-type headache, including recommended medication types, lifestyle changes and more, visit the American Migraine Foundation’s free Resource Library.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.