What is Tension-type headache?
Tension-type headache causes a pressing or tightening pain, usually on both sides of the head. People often describe it as “a tight band around my head” or “like wearing a helmet”. Unlike migraine, it is not throbbing, does not get much worse with physical activity and usually does not cause nausea.
It used to be called “muscle contraction headache” because it was blamed solely on muscle tension. We now know that, alongside tenderness in the scalp, neck and shoulder muscles, changes in the way the brain processes and filters pain also play a role. Stress, poor sleep, long hours at a screen, poor posture, eye strain and skipping meals are common triggers.
When headaches occur on a few days a month we speak of episodic tension-type headache; when they occur on 15 or more days a month for more than three months, it is chronic. Chronic tension-type headache is often accompanied by poor sleep, anxiety or low mood, which need attention too.
Common triggers
- Long hours bent over a laptop or phone
- Irregular or insufficient sleep
- Work pressure, anxiety and emotional stress
- Skipping meals and not drinking enough
- Teeth clenching or grinding, jaw joint problems
- Uncorrected vision problems and eye strain
- Too much caffeine, or suddenly cutting it out
Symptoms of Tension-type headache
- Pressing or tightening pain on both sides of the head, the forehead, temples or the back of the head
- Pain lasting from 30 minutes to several days
- Tight, tender neck and shoulder muscles
- Mild sensitivity to light or sound (but not both)
- Pain that builds during the day, especially in the afternoon and evening
- Tiredness, poor concentration and disturbed sleep
Tension-type headache and migraine can occur in the same person. Describing each type of headache carefully helps to choose the right treatment for each.
When should you see a neurologist?
- Headache on more than 10–15 days a month
- Frequent painkiller use with headaches continuing anyway
- A headache that is new or has changed
- Headache together with poor sleep, anxiety or low mood
- Headache present on waking (sleep apnea may need to be considered)
A sudden, very severe headache, or headache with fever, vomiting, visual loss, weakness or confusion needs urgent medical assessment.
How is Tension-type headache diagnosed?
The diagnosis is made from a careful description of the headaches and a neurological examination, which also looks at tenderness in the head, neck and shoulder muscles, posture and the jaw joint.
When the headaches are typical and the examination is normal, scans are usually not needed. An MRI is requested if the headache is new, has changed or if the examination shows anything unusual. Blood tests for anaemia, thyroid problems or vitamin D deficiency may be useful, and morning headaches with snoring may lead to an assessment for sleep apnea.
Knowing how often painkillers are used is particularly important: taking simple painkillers on more than 15 days a month can cause medication-overuse headache and make the problem worse.
Conditions that should not be missed
Some conditions mimic tension-type headache but need different treatment. Headaches present on waking and easing during the day may be linked to sleep apnea or high blood pressure; temple pain worse on chewing may come from the jaw joint; and a new temple headache after the age of 50 can be due to inflammation of the temporal arteries. These possibilities are considered during the consultation.
How is Tension-type headache treated?
Treating an episode
For occasional headaches, paracetamol or an anti-inflammatory medicine is usually enough — but these should not be taken on more than 10–15 days a month.
Preventive treatment
For frequent or chronic headaches a preventive plan is made. The medicines most often used are certain antidepressants in low doses — much lower than those used for depression — that raise the pain threshold. The effect builds over a few weeks and treatment is usually continued for 6–12 months.
Non-drug treatment
- Regular sleep and meal times
- Aerobic exercise (walking, swimming) at least three times a week
- Neck and shoulder stretches and posture correction
- Relaxation, breathing exercises and cognitive behavioural therapy
- Physiotherapy and, in selected cases, dry needling
- Short breaks every 45–60 minutes at the screen
If muscle tenderness is marked, trigger-point injections or an occipital nerve block may be added.
If painkillers are being overused
If painkillers are taken on more than 15 days a month, the first step is a controlled reduction. Headaches may temporarily worsen during this period; preventive treatment and short-term support make it easier. Once overuse stops, many people find their headache days fall considerably.
Treatment timeline and your stay in Istanbul
The first consultation lasts 30–45 minutes. If preventive treatment is started, the first review is after 4–8 weeks, using your headache diary to measure headache days and painkiller use.
For patients from abroad, the consultation and any tests usually fit into one day in Istanbul; follow-up can continue online.
Follow-up after treatment
Lasting improvement depends on keeping up the lifestyle changes. When headache days fall, preventive medicine is reduced gradually under supervision rather than stopped suddenly.
- Keep your headache diary
- Keep painkillers to fewer than 10 days a month
- Build sleep, stress and posture advice into daily life
- Come back sooner if the character of your headaches changes
Risks and what to watch for
Tension-type headache itself is not dangerous. However, frequent painkiller use can upset the stomach, strain the kidneys and liver and cause medication-overuse headache. Preventive medicines can cause dry mouth, drowsiness, constipation or weight gain; the dose is adjusted for each person and side effects are reviewed at follow-up.
Frequently asked questions about Tension-type headache
Is tension-type headache caused by stress?
Stress is one of the most common triggers, but not the only one. Poor sleep, posture, long screen time, eye strain, skipped meals and dehydration also play a part, together with increased sensitivity of the brain’s pain systems.
What is the difference between tension-type headache and migraine?
Tension-type headache is usually on both sides, pressing, mild to moderate and not worsened by activity, without nausea. Migraine is usually one-sided, throbbing, more severe and comes with nausea and sensitivity to light and sound.
Is taking painkillers every day harmful?
Yes. Taking painkillers on more than 10–15 days a month can cause medication-overuse headache and also affects the stomach, kidneys and liver. Frequent headaches should be treated with preventive therapy instead.
Can a neck problem cause headaches?
Problems in the neck can cause pain that starts in the neck and spreads to the back of the head (cervicogenic headache). However, not every finding on a neck MRI explains headaches; the distinction is made by examination.
Do massage and exercise help?
Regular aerobic exercise and neck and shoulder stretching can reduce how often headaches occur. Massage and physiotherapy also help many people and can be combined with medication.
Can not wearing my glasses cause headaches?
Uncorrected vision problems and long periods of close work can cause eye strain and pressing headaches around the forehead and temples. An eye test, a better screen distance and regular breaks can help.
Does teeth grinding cause headaches?
Yes. Clenching or grinding at night tightens the chewing muscles and can cause temple pain on waking. A dentist can advise on a night guard alongside muscle-relaxing techniques.
This page is for general information only and does not replace a medical consultation. Please consult a physician for diagnosis and treatment. Results vary from person to person.
