Tension headache: do I have it and how do I treat it?​


Written by tapGP Clinical Team

10 November 2023

Headaches can be a nuisance, even more so when you’re trying to get things done. The easy thing to do would be to take a painkiller and get on with your day, but after a while the constant headaches make you wonder if there’s anything you can do about them, the great news is…. there is!

Firstly it’s useful to note that headaches come in various forms and can be characterised by where the pain is experienced. A tension headache is often described as a band of pain around your head and can often be felt as far down as your neck and shoulders. Some people even describe it as a weight on top of their head. You can experience the symptoms for as little as 30 mins to several days and in some severe cases, it can become chronic.

Tension headaches are the most common type of headaches and are known under several other names such as ordinary headache, stress headache, psychogenic headache and muscle contraction headache. Nearly 90% of headaches fall into this category.

Is it a migraine?

Tension headaches and migraines are known to have overlapping symptoms, so it is easy to confuse the two.

However, there are distinguishing features that help with differentiating between them. It is unlikely to experience visual disturbances, nausea or vomiting with a tension headache, whereas this is characteristic of a migraine.

Although it is possible to have increased sensitivity to light and sound these are rare symptoms. Unlike migraines, there is also no change in intensity upon taking part in physical activity.

Where do tension headaches come from?

It was originally believed that tension headaches were caused by muscle contractions on the face, neck and scalp due to intensified emotions, tension or stress. However, research has confirmed that muscle contractions are not the cause.

Despite numerous studies the exact pathophysiology of a tension headache remains unknown. It is believed that they are experienced due to the way that the nerves of the head, neck and shoulders sense pain. It has also been suggested that they can be triggered by stress, anxiety, poor posture, dehydration and tiredness. These suggestions mean that it can actually, easily be managed by the individual, with many only seeking professional help once it becomes severe.

How are tension headaches diagnosed?

There are no specific tests used for the diagnosis of tension headaches. A consultation with your primary physician will usually involve the explanation of your symptoms. Following the reporting of your symptoms, the medical practitioner will ask a few questions to rule out any sinister or underlying suspicions such as:

  1. Where do you feel the headache ?
  2. When does it occur?
  3. How often do you experience headaches?
  4. Is the onset sudden or do you get a warning before it happens?
  5. How long is the headache for?
  6. Do you experience any intensity in pain when doing certain activities?
  7. What other symptoms occur when you experience these headaches?

These questions demonstrate the importance of tracking your headaches to ensure that your diagnosis is accurate. Following these questions the physician will decide if the symptoms are in line with a tension headache. If it is found that there may be some differences, further testing may be required to ensure that nothing more severe is occurring.

In the event of this happening you may have to undertake further testing to identify the cause of the tension headache such as:

  • Blood tests – this could help to identify any chemical imbalances or deficiencies present
  • Sinus X-rays – this could identify if there are problems with congestion that need to be corrected
  • MRI scan – this provides a detailed image of your body and can also be used as a diagnostic tool
  • CT scan – another diagnostic tool which produces detailed images of your body to help with diagnosis

What type of tension headache do I have?

Tension headaches can be classified into 3 categories, based on how frequently they occur:

Category 1:
Infrequent episodes – this is for individuals who have 12 episodes or less a year. Their headaches tend to last between 30 minutes and 7 days.

Category 2:
Frequent episodes – this is for individuals who have 1-14 episodes in one month with each episode lasting from 30 minutes to 7 days also.

Category 3:
Persistent episodes – individuals have at least 15 episodes a month and these can last for hours and are often continuous. In some cases these episodes are accompanied by nausea.

Over the counter pain relief such as paracetamol and ibuprofen tend to be used for the treatment of category 1 and 2. They are effective and quick methods to allow individuals to resume their day. It is important to note that use of these methods should only be for 2 – 3 times a week. Extended use can result in what is known as a rebound headache and these occur on days where medication is not taken.

Individuals who are experiencing category 3 headaches may find it more difficult to treat and there is a higher chance of experiencing rebound headaches. Therefore it is better to use methods that prevent the headache rather than relying on painkillers. Chronic tension headaches often involve seeking help from a professional, where a prescription of Naproxen may be administered to help break the cycle.

Preventative measures can also be taken in the form of antidepressant Amitriptyline. Unlike the other medication listed, this does not stop the pain that comes with a headache. It is meant to be taken daily with the aim of reducing headaches rather than treating depression. It is a slower method of treatment as individuals need to start with a low dose to allow their body to acclimate to it. Once there has been a positive effect consistently for 4 – 6 months, they can be stopped.

It is possible to treat tension headaches without the use of medication. Methods such as applying an ice compress on the head and heat to tight areas in the neck and shoulder area have proven to be effective.

Can I prevent tension headaches?

Adopting a holistic approach to the treatment of tension headaches is a great way to tackle chronic onset. There are several things that you can do to make the process easier.

1. Keep a journal – if you are experiencing frequent headaches a journal will be very helpful. Making a note of when, where it occurs, how bad your headaches are and for how long they take place can help you to establish a pattern. This could assist in understanding what some of your key triggers may be. It can also be useful to document other details of your day including what you were doing, what you ate and how you felt. Writing these details provides a concrete starting point to initiate a sustainable treatment plan.

2. Regular exercise – it goes without saying introducing daily physical activity can be life-changing. Exercise can take place in many different forms and does not have to be vigorous for you to feel the positive impact. It can be as simple as a daily brisk walk or even 15 minutes of high-intensity interval training (HIIT). Exercise releases endorphins which are known as feel-good chemicals due to the effect they have in reducing stress and pain. This mechanism can be beneficial for the treatment of tension headaches.

3. Stay hydrated – drinking water regularly can prevent you from being dehydrated which can trigger the headaches.

4. Relaxation and breathing techniques – There are several methods that you can implement in your daily or weekly routine. Examples of this are breathing exercises, relaxing music, mental imagery relaxation and muscle relaxation.

Deep breathing exercises work well because of how the nervous system functions. During times of heightened stress or anxiety, your body activates your autonomic nervous system, which is responsible for the involuntary actions within your body. This system is split further into sympathetic and parasympathetic. The former controls your fight or flight response, whereas the latter controls your rest and relax response.

The way our bodies function means that both systems cannot be active at the same time. Therefore if you suppress one, the other is activated. Deep breathing causes more CO2 to enter your blood which can reduce your anxiety response and also help with synchronising your heartbeat and breathing.

5. Acupuncture – according to the National Institute for Health and Care Excellence (NICE) 10 sessions over a period of 8 weeks can be a useful way of preventing chronic tension headaches. This technique comes from traditional Chinese medicine and used for centuries for therapeutic and preventive measures. It’s paired as a complementary treatment and works through the insertion of fine needles into the body.

It is most effective over several sessions rather than a one-off treatment. Its mechanism of action is the stimulation of the sensory nerves beneath the skin and in the muscles. As a result, there is a release in natural pain-relieving endorphins. The process itself has minimal pain but is known to produce long-lasting effects.

6. Stress management – stress is known to be a common trigger. Knowledge on how to effectively manage it can be very beneficial. Cognitive behavioural therapy is a non-medical therapy commonly prescribed and is proven to be very effective in conjunction with medication. It helps to identify and manage triggers through relaxation and stress management training. It aids in gaining control over bodily functions and equipping users with problem-solving skills.

You may find that you have to perform some of the activities despite your symptoms, which is necessary for successful treatment. Beyond the reduction of symptoms, CBT aims to improve patient functioning.


Although the exact causes of tension headaches are unknown, there are numerous ways in which you can still maintain control over your symptoms. By carefully tracking your symptoms it is possible to identify patterns and triggers which may cause you to experience tension headaches in the first place.

As with many conditions, lifestyle changes can contribute to reducing the frequency and severity of tension headaches. The benefit of this is that it will produce an overall improvement in your health. It is important to seek professional medical help if your symptoms get worse or do not improve once you’ve made the necessary changes.

The most important thing to note when it comes to treating any condition is having an understanding of your body and how it reacts. The changes implemented do not need to occur all at once, but gradual implementation will lead to long-lasting change.

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