Seventy-five per cent of all headaches are tension headaches

Tension headache is an episodic or chronic form of headache that is often triggered by stress and anxiety.

It is not the same as a migraine, but about ten per cent of people who experience tension headaches also suffer from migraine.

Another common cause of headache is medication side effects. Such headaches can resemble tension headaches, but they are not the same thing.

Like a band around your head

The pain is often described as feeling like a tight band or hat around your head and across the forehead. Tension headaches often affect both sides of the head with a sense of tightness or pressure.

Such headaches are normally not aggravated by physical activity.

Tension headaches can be episodic or chronic. The condition is defined as chronic if a person has experienced such headaches for more than 15 days per month on average over the past three months.

Tension headaches are often associated with anxiety or depression.


Tension headaches usually affect both sides of the head with a sense of tightness or pressure. It is not a throbbing pain like, for example, migraine.

It is unusual to have a tension headache in the morning, but it will often gradually worsen through the day and evening. Some describe additional symptoms such as nausea and sensitivity to sound and light, but it is rare to experience more than one such symptom.

This cannot be compared to a migraine, where these symptoms are much more pronounced, and tension headaches do not cause vomiting, which is common in connection with a migraine. Some people describe feeling dizzy in connection with this form of headache.

Tension headaches can be associated with anxiety disorders or depression. Some people describe pain and tenderness in the muscles around the skull.

On examination, the range of motion in the neck is usually normal or slightly reduced, which distinguishes a tension headache from a cervicogenic headache. The range of motion in the neck is usually more reduced in people who suffer from cervicogenic headache.

Treatment and prevention

The treatment goals for tension headaches include to provide information about the condition and to rule out serious illness. Other goals are to alleviate symptoms and prevent further episodes.

Many people who suffer from tension headaches are afraid that they may be a sign of serious illness. It is therefore an important part of their treatment to talk about and inform the patient about what tension headaches are, as well as ruling out any serious illness.


The doctor will also try to reduce symptoms and prevent further episodes. Regular exercise has been proven to be an effective way of preventing or reducing this type of headache.

Walking on uneven terrain and spending time in nature often create a sense of calm that, combined with relaxation techniques, produce a good result in many cases. Good sleep is also an important factor in relieving stress headaches.

Speak to a doctor

It may be a good idea to speak to a doctor, or perhaps a psychologist, about the headache. A conversation about the causes of these headaches, such as mental health problems, stress and how these factors may be related to physical problems, can be helpful in understanding how to avoid future headaches.

Many people will benefit from seeing a psychologist to learn techniques to cope with stress. It may be useful to keep what is known as a headache diary before the consultation. In a headache diary, you record when you get a headache, how long it lasts and any triggers.

This will make it easier to determine the cause of the headache and decide on the best course of treatment.


Painkillers such as paracetamol or NSAIDs such as ibuprofen can be used to relieve short-term or acute episodes of tension headache.

It is important to be aware that overuse of painkillers can actually cause headaches, known as medication-induced headache. For this reason, these painkillers are not recommended for patients with chronic tension headaches.

It is also important to avoid stronger painkillers, as they may be addictive.

Amitriptyline is the best documented medication for treating chronic tension headaches. It is a tricyclic antidepressant that was previously used to treat depression.

Physical therapy

Other forms of treatment include physical therapy with massage, heating pads and ice packs, and relaxation techniques. Some people benefit from such treatment, while it has little or no effect for others.

Relaxation training and biofeedback are another form of treatment. Biofeedback involves a device that uses signals to make you aware of when you relax, and, in time, you will be able to relax on your own. There is little research that actually proves this form of treatment to be effective.

The same is true of acupuncture, for which there is also insufficient documentation to prove that it works.

Nor has chiropractic and osteopathic manipulation been proven to be effective. It is therefore often up to the individual patient to find their own way of relieving these headaches and try out several forms of treatment to achieve a result.

  • Relaxation
  • Physical activity
  • Stress management
  • Therapy with a psychologist
  • Painkillers
  • Amitriptyline
  • Physiotherapy
  • Biofeedback
  • Chiropractics
  • Osteopathy

Examination and diagnosis

Tension headaches are usually diagnosed on the basis of a patient’s history of characteristic headaches.

The basis for the diagnosis is a case history of typical symptoms, including headaches that affect both sides of the head and are characterised by a feeling of tightness or pressure.

The range of motion in the neck will also be examined, as this could help to distinguish a tension headache from, for example, a cervicogenic headache, which usually originates in the cervical vertebrae. On examination, the range of motion will often be normal or slightly reduced.

Some people may experience tenderness in the neck muscles or their insertions, but this is not a criterion for the diagnosis.


A clear connection has been observed between tension headaches and stress, but the causal relationship remains unclear. There are several different theories.

What causes tension headaches remains unclear. It is believed to be related to increased tension of the head and neck muscles, but there is no conclusive evidence that this is the case.

It is not particularly common to experience pain and tenderness in the muscles and muscle insertions of the neck and the back of the head.

The most common trigger of tension headaches is mental stress. Tension headaches have been found to be linked to stress, life circumstances and mental health problems.

These factors make people particularly vulnerable to tension headaches.


Tension headaches can be episodic or of a chronic nature with daily pain for a prolonged period. They will often decrease over the years.

Tension headaches are usually quite mild, and can be episodic or of a chronic nature. Chronic tension headache causes daily pain for a prolonged period.

Many people will benefit from receiving information about the condition. It may be easier to focus on coping with the situation if you know that the headache is caused by stress and anxiety.

This form of headache is not aggravated by movement, so regular physical activity is recommended. Tension headaches will often improve with age.

Facts about tension headache

  • Tension headache, also known as stress headache, is a type of episodic or chronic headache that is usually triggered by stress.
  • It is the most common form of headache, and accounts for about 75 per cent of all headaches.
  • Tension headaches are more common among women, and about three in four sufferers are believed to be women.
  • The pain is often described as feeling like a tight band around the head and across the forehead.
  • Tension headaches often affect both sides of the head with a sense of tightness or pressure.
  • Such headaches are normally not aggravated by physical activity. On the contrary, physical activity is a recommended form of treatment, as is relaxation and stress management.