Tension Headaches

Tension-type headache (TTH) is the most common type of primary headache, with up to 78 percent of the general population experiencing a headache episode in their lifetime. An estimated 38 percent of people with TTH have experienced a headache within the past year, and studies suggest that most people with TTH experience headache once or twice each month and describe the head pain as moderate in intensity. Like migraine, TTH is more common in women than in men.

The pain of a tension-type headache is often described as a tight band encircling the top of the head, mild to moderate in severity. It differs from migraine and cluster headache in that it is felt on both sides of the head and there is no nausea involved. While a TTH may infrequently cause hypersensitivity to light or sound, as a migraine does, only one of these symptoms usually occurs (not both together as happens frequently with migraine).

A TTH lasts from 30 minutes to seven days and has at least two of the following characteristics:

  • Bilateral (both sides of the head)

  • Pain is tightness or pressure (“viselike”), not pulsating

  • Mild to moderate intensity

  • Not made worse by routine physical activity

In some cases, the head may be tender to the touch (called pericranial tenderness). Pain may be felt in the back of the neck and at the base of the skull. The headache itself may cause sleep problems, irritability, difficulty concentrating, and fatigue.

If tension-type headaches are occurring for fewer than 15 days a month, they are considered episodic tension-type headaches. When tension-type headaches last for hours and are continuous during 15 or more days of the month for a period of longer than three months, they are considered chronic tension-type headaches.


A large U.S. study published in the Journal of the American Medical Association found that men and women with higher levels of education were more likely to experience tension-type headache. The opposite trend has been found in migraine, where lower socioeconomic levels seem to be linked to higher migraine occurrence.

Triggers and Treatment

A headache diary can be useful in diagnosing tension-type headache and in identifying headache trends and triggers. Triggers for TTH can include:

  • Stress and anxiety

  • Sleep problems

  • Poor posture

  • Fasting or skipping meals

  • Overuse of certain medications (e.g., analgesics, cold medications)

  • Hormonal changes

  • Teeth grinding (bruxism)

In addition, TTH can be a symptom of an underlying medical condition. Dental problems, depression, temporomandibular joint dysfunction (TMJ), respiratory tract infections, hypothyroidism, arthritis, and allergies can all be associated with tension-type headache. In most cases, appropriate treatment of the medical condition can resolve tension-type headaches.



OTC and prescription pain relievers should be used in the minimum dosage no more than twice a week to avoid what is known as “rebound headache,” or headache caused by medication overuse. Chronic overuse of these drugs can also cause serious gastrointestinal problems and liver damage.

Over-the-counter (OTC) pain relievers such as aspirin, ibuprofen (Motrin, Advil), naproxen sodium (Aleve), and acetaminophen (Tylenol) are all very effective in treating occasional and episodic tension-type headaches. Analgesics combined with caffeine (Excedrin), which constricts blood vessels, may also be useful. When TTH doesn't respond to OTC analgesics, prescription pain relievers may be used.

Some studies have also indicated that acupuncture and biofeedback may be useful in relieving TTH pain. Lifestyle changes are also encouraged to help prevent tension-type headache episodes. Because sedentary lifestyle is a risk factor for developing TTH, starting an exercise routine can help. So can healthy sleep and nutrition habits and stress management and relaxation techniques.

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