Tension headaches, or stress headaches, are the most common type of primary headache. A primary headache is a headache that does not stem from another condition. A person may feel tightness or pressure like a band around the head. The pain may spread to or from the neck.

The World Health Organization (WHO) states that more than 70% of some populations report experiencing tension-type headaches.

This article will look at the symptoms, causes, and treatment options for tension headaches. It will also compare them with other types of headache, such as migraine and sinus headaches.

A men with a tension headache.Share on Pinterest
Rialto Images/Stocksy

Tension-type headaches may involve:

  • pain on both sides of the head
  • pain that is dull and feels like a vice or a band around the head
  • pain that affects the neck or back of the head
  • mild to moderate pain
  • a slow onset

The pain does not worsen with physical activity.

To help doctors classify tension headaches, the International Headache Society (IHS) classifies them as either episodic or chronic.

There are also subcategories, including:

  • Infrequent episodic tension headache: The IHS notes that a person will experience this type of headache fewer than 1 day a month on average. The headache may last as short as 30 minutes or as long as a week. Nausea and vomiting do not occur.
  • Frequent episodic tension headache: The IHS states that a person will experience no fewer than 10 headaches a month, lasting between 1–14 days per month, for 3 months or more. The headaches can last for 30 minutes to 7 days. A person may also be sensitive to light or sound.
  • Chronic tension-type headache: A person experiences a headache for 15 days or more, lasting for 3 or more months. The pain can last hours or days, or be constant. A person may also experience light sensitivity, sound sensitivity, or mild nausea.

People can usually relieve the pain of a tension headache with over-the-counter pain medications, such as:

However, the overuse of such pain medications can increase the risk of episodic tension headaches developing into chronic tension headaches. This can happen because rebound headaches may occur after each medication dose wears off.

Home and alternative remedies

Some people find that home remedies may be enough to relieve their headaches.

These include:

Alternative remedies may include:

These treatment options are not always helpful for everyone, and it is best to check with a doctor before using nutraceuticals or supplements.

Learn more about essential oils that may help relieve headaches here.

Counseling for stress

Counseling, including cognitive behavioral therapy (CBT), may help people who have chronic tension headaches due to stress.

A 2015 systematic review notes that those experiencing chronic headaches or migraine may benefit from CBT. However, more research may be necessary.

Learning new ways to cope with stress and anxiety may lead to a reduction in headaches.

To discover more evidence-based information and resources for headache and migraine, visit our dedicated hub.

Primary headaches are not normally due to an underlying medical condition. Headaches are a physiological disorder and are not a psychological condition.

Research is ongoing to find the causes of tension-type headaches.

According to the National Health Service (NHS), possible reasons for a tension-type headache may include:

  • stress
  • anxiety
  • lack of exercise
  • eyestrain or squinting
  • tiredness
  • missing meals
  • dehydration
  • regular exposure to loud noise
  • bright sunlight
  • poor posture
  • certain smells, such as perfumed products

Stress, anxiety, and depression may trigger jaw clenching, lack of sleep, or lack of exercise which could worsen the problem.

Triggers can differ between individuals.

Keeping a headache diary can help people identify and avoid headache triggers and patterns.

Frequent episodic tension-type headaches can coexist with migraine. An additional contributing factor includes the overuse of analgesics, or pain relievers, which can create rebound headaches.

Chronic tension-type headaches can evolve from the episodic headaches. The headache may occur daily or may evolve into a continuous headache. Depression can also be a contributing factor.

The WHO notes that tension headaches are the most common primary headache disorder, affecting more than 70% of people. For 1–3% of adults, these headaches can be chronic, which means they occur more than 15 days per month.

Tension headaches often begin during adolescence and affect females more than males.

People often describe tension headaches as a pressing or tightening pain of mild to moderate intensity that affects both sides of the head.

The headaches tend to develop slowly and increase in intensity. Sometimes a person will have a sensitivity to light or sound. People can occasionally feel nausea with a chronic tension-type headache.

The pain from tension headaches causes discomfort, but it is not usually severely disabling, as migraine headaches can be.

The pain does not worsen with physical activity, such as walking or climbing stairs, but physical or mental stress can make it more severe.

Maintaining a health-promoting lifestyle may help prevent tension headaches.

Tips include:

  • getting enough sleep
  • avoiding alcohol
  • managing stress
  • reducing caffeine
  • practicing good posture when sitting, standing, and doing other daily activities
  • taking regular breaks when working at a desk
  • stretching regularly and exercising neck and shoulder muscles during office work
  • engaging in exercise, which may also help with sleep patterns
  • having regular eye checks and using the correct glasses
  • drinking enough fluids, and especially water
  • wearing sunglasses on bright days
  • eating regular meals but avoiding food that may trigger a headache
  • reducing the use of perfumed products
  • monitoring for side effects of any medications

There are links between migraine and chronic tension-type headaches. A person with migraine may also experience tension-type headaches.

A migraine headache presents with the following symptoms:

  • may reoccur occasionally or frequently
  • occurs on one side
  • can feel like it is pulsating
  • can worsen with normal physical activity
  • makes a person feel nauseous and sensitive to light or sound
  • is moderate to severe in pain

Migraine headaches can also occur alongside an aura, which includes the following symptoms:

  • blind spots
  • flashing and flickering lights
  • zigzag patterns
  • colored lines and spots
  • dizziness
  • muscle weakness

A tension-type headache:

  • can reoccur occasionally, frequently, or daily
  • is felt in both sides of the head
  • is a dull ache
  • is not affected by physical activity
  • does not usually involve a person feeling nauseous unless it is a chronic type
  • usually involves mild to moderate pain

Learn more about migraine here.

Q:

At times of tension, I can get a severe headache, which I thought was a migraine.

It includes nausea and vomiting — which can be severe — and sensitivity to light. Sometimes I need 1–2 days in bed to recover. However, if I take over-the-counter migraine tablets at the first sign, it stays away. It happens about twice a year.

Is this a tension headache or a migraine?

Anonymous

A:

It sounds like you have migraines that are triggered by stress, which is a very common trigger. Often, migraines are relieved by OTC medication that is taken right when the symptoms start. Since the medication relieves them, make sure you always have it on hand in case your symptoms start so you can avoid the 2 days of misery.

Deena Kuruvilla, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

A sinus headache is due to a viral or bacterial sinus infection.

A sinus headache:

  • involves sinus and nasal congestion
  • involves mucus
  • results in pain, usually around the sinus area at the top of the nose and under the eyes
  • can result in watery eyes

Learn more about sinus headaches here.

Sometimes a headache can have a serious underlying cause that needs medical treatment.

A person should see a medical professional about their headaches if:

  • the headache becomes so severe it affects everyday activities
  • a change occurs in the severity and frequency of tension headaches
  • a person is over 50 years of age and has no previous history of headaches or has a medical condition that might result in headaches
  • speech difficulty, vision loss or blurred vision, and movement problems accompany headaches
  • a headache develops suddenly and feels like the worst headache they have ever had
  • a person has a new type of headache and a history of cancer
  • a person becomes pregnant, as some medications may not be safe to use during pregnancy
  • medication may be causing side effects
  • a person needs medication to relieve pain more than 3 times a week, or previously effective medication no longer works
  • changes in level of consciousness, personality, thinking, behavior, or slurred speech
  • there is a fever or rash

To diagnose tension headaches, a medical professional will ask questions about the frequency and intensity of the headaches, as well as questions about overall health and other lifestyle factors.

Common questions they may ask include:

  1. When do the headaches occur and how long do they last?
  2. Where is the location of the pain?
  3. What do the headaches feel like?
  4. Is there difficulty sleeping?
  5. Is there a history of stress?
  6. Has there been a head injury?
  7. Are there any changes in personality or behavior?
  8. Does the headache occur with a change of position?

A person living with tension-type headaches can find that they range in:

  • intensity
  • frequency
  • symptoms

Infrequent headaches are not usually debilitating. Each type of headache can lead into a more severe or frequent type of headache. A person with a chronic tension-type headache may also experience migraine.

A person can take pain relievers to help reduce tension headaches. If possible, a person should aim to lessen stress and anxiety.

Some self-help methods can reduce the frequency and intensity of headaches, including:

  • using a cold compress
  • reducing alcohol and caffeine intake
  • improving sleep patterns
  • staying hydrated

A person should see a medical professional if headaches become more severe or result in vision disturbances or speech or movement difficulties.