Tension headaches (tension-type headaches) are the most common type of primary headaches.

The pain can radiate from the neck, back, or eyes.

Tension-type headaches account for nearly 90% of all headaches.

Frequency and duration

Tension-type headaches can be episodic or chronic.

Episodic tension-type headaches are defined as tension-type headaches occurring less than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months.

Tension-type headaches can last from minutes to days or even months, though a typical tension headache lasts 4-6 hours.


Tension-type headache pain is often described as a constant pressure, as if the head were being squeezed in a vise. The pain is frequently bilateral which means it is present on both sides of the head at once. Tension-type headache pain is typically mild to moderate, but may be severe. In contrast to migraine, the pain does not increase during exercise.

Pain arising from tension in the neck can often be identified by comparing any pain caused by coughing or sneezing normally with that which arises while pressing with one's hand against the forehead (which reduces the tension placed on the muscles at the back of the neck). If the pain is less it suggests that muscular tension in the neck is the cause of the headache.

The exact cause of tension-type headaches is still unknown.


Episodic tension-type headaches generally respond well to over-the-counter analgesics, such as paracetamol, ibuprofen or aspirin. The effect of the analgesic is boosted if either caffeine (a cup of coffee) or a dose of the sedative antihistamine diphenhydramine (Benadryl, 25mg) is taken at the same time.

Chronic tension-type headaches are more difficult to treat. Some therapies that are suggested for chronic tension-type headaches include:

Pharmacological therapy:

  • Amitriptyline
  • Mirtazapine

Non-pharmacological therapy:

  • Swimming two to three times a week
  • Acupuncture
  • Biofeedback
  • Massage
  • Heat pillow
  • Relaxation techniques

Avoiding triggers

Tension headaches are exacerbated by states or activities that induce muscle tension, such as stress. Avoiding such states can lessen the frequency of tension headaches. Tension headaches can also be provoked by other conditions, such as an upper respiratory infection. Often the best treatment for a mild tension headache that does not impair a person's ability to function is simple endurance. Many tension headache sufferers receive relief from sleep. However, it is always best to see your physician for a full work-up of the headaches.


Tension headaches that do not occur as a symptom of another condition are painful and annoying, but not harmful. It is usually possible to receive relief from treatment. Tension headaches that occur as a symptom of another condition are usually relieved when the underlying condition is treated.

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