Patient information from BMJ

Tension-type headache

Last published:Apr 16, 2024

Many people get headaches from time to time and tension-type headaches are the most common.

These headaches often cause mild to moderate pain. Most people can get rid of them by taking over-the-counter painkillers such as paracetamol or ibuprofen. However, if you get these headaches frequently, you may need other treatments.

What are tension-type headaches?

Tension-type headaches are the most common type of headache. They often happen when you're feeling stressed or tired. Some doctors think the pain is caused by tension in the muscles of your neck or your head. But tension-type headaches can also be caused by other triggers e.g., consuming caffeine, being dehydrated, or not eating regularly.

For most people, these headaches don't happen often and are more of a nuisance than a problem. However, tension-type headaches can become an issue if you get them frequently.

Tension-type headaches can last anywhere from 30 minutes to several days.

What are the symptoms of tension-type headaches?

A tension-type headache usually feels like an ordinary headache. Some people describe it as a tight band around their head. The pain isn't usually throbbing.

Tension-type headaches are different from migraines. For example, unlike migraines, tension-type headaches don't tend to get worse if you move around or cause nausea and vomiting.

What treatments work for tension-type headaches?

Many people take over-the-counter painkillers to help with a tension-type headache. These include paracetamol, ibuprofen, and aspirin. Another option is naproxen, but this is only available on prescription.

If these don’t work for you, your doctor may suggest taking painkillers that have caffeine in them. Caffeine-containing painkillers can help relieve these types of headaches for some people.

Sometimes, taking painkillers more than a few times a week can actually lead to more headaches. You might hear these being called rebound headaches.

So you need to be cautious about how often you use these medicines if you get frequent headaches. If you take painkillers regularly, talk to your doctor for advice.

Preventing tension-type headaches

Lifestyle changes

To try and prevent tension-type headaches, it’s important you identify what might be triggering them. You can do this by keeping a headache diary.

This can help you spot the things that trigger your symptoms, so you can try to avoid them.

Stress and mental tension are common triggers. Other possible triggers include caffeine, being hungry, or using a computer for a long period of time.

If you get regular headaches, there are lifestyle changes that may help. These include:

• regular exercise

• managing your stress

• staying hydrated

• eating a healthy diet

• having good sleeping habits.

Medicines to prevent headaches

If you get frequent tension-type headaches, (i.e., more than 7 to 9 times a month or more) and painkillers and lifestyle changes haven't helped, your doctor may recommend taking prescription medicines to help prevent them.

Antidepressants are one type of medicine that your doctor may suggest. They can help prevent headaches and also work to relieve any headaches that you do get.

If you have this treatment, your doctor will start you on a low dose and increase it gradually if needed. Tricyclic antidepressants are usually the first choice of treatment.

You'll likely need to take an antidepressant for about 3 or 6 months. After this time, your doctor may want to see how you get on without the drug. If your headaches come back, you may need to start treatment again.

Antidepressants can cause side effects. These include:

• drowsiness

• dry mouth

• weight gain.

Speak to your doctor if you are concerned about any side effects with your treatment.

Medicines called muscle relaxants may also be tried for tension-type headaches, but there is much less evidence that they work. So your doctor will only suggest them if other treatments haven’t helped.

If the source of pain with your headaches is very specific, local shots of anesthetic can sometimes work. Your doctor will let you know if you are likely to benefit from this type of treatment.

Non-drug treatment to prevent headaches

There are several non-drug treatments that you can try to prevent tension-type headaches. 

Cognitive behaviour therapy is a talking treatment that is sometimes used to help people cope with stress. If your tension-type headaches are triggered by stress, this therapy could help.

Relaxation training and biofeedback are treatments that teach you how to relax. This might help relieve any tension triggering your headaches.

In biofeedback, you wear an electrical device that tells you how tense your muscles are. When you relax, you get a signal, such as a beep. Eventually, you learn to relax without the device.

Some research suggests a treatment called mindfulness therapy might also help. This often involves combining meditation, body awareness, and yoga to reduce stress.

Another treatment option is myofascial trigger point-focused massage which involves massaging areas in your face or neck that feel tight or stiff. This can help to relieve any tension.

Other options include acupuncture, physiotherapy, and spinal manipulation. However, there's less good research on whether these can help. 

What will happen to me?

Tension-type headaches usually cause only mild to moderate pain. But if they happen a lot, they may interfere with your work or your social life. Getting treatment can help. If you are worried about the frequency or severity of your headaches, speak to your doctor.

Tension-type headaches tend to happen less often as people get older.