Headache and facial pain

Tension-type headache

Often a pressing or tightening headache on both sides—but the name does not mean that tension is always the cause.

Not blame and not a simple stress diagnosis. Tension-type headache is a recognised primary headache disorder and can also occur in someone who experiences little stress.

In plain language

What is tension-type headache?

Tension-type headache is a primary headache disorder: the headache itself is the condition and is not better explained by another disorder. Pain is usually mild to moderate, but chronic symptoms can place a heavy burden on everyday life.

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Often on both sides

For example at the temples, forehead, back of the head or neck, sometimes described as a tight band around the head.

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Pressing or tightening

Not typically throbbing. Routine movement such as walking or climbing stairs does not usually make it worse.

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From short to several days

An episode can last 30 minutes to 7 days. Frequency determines whether it is infrequent episodic, frequent episodic or chronic tension-type headache.

The complete pattern

How does it differ from migraine?

More typical of tension-type headache

pain on both sides;
pressing or tightening;
mild to moderate;
not worsened by routine physical activity;
no nausea or vomiting;
at most sensitivity to light or sound, but not both.

More typical of migraine

often one-sided and throbbing, but not always;
moderate to very severe;
worsened by activity;
nausea or vomiting;
sensitivity to both light and sound;
sometimes preceded by aura.

You can have both

When patterns coexist, recognising each one matters. It helps target acute medication and reduce the risk of medication overuse.

How many days?

Not every tension-type headache is chronic

Infrequent

day per month on average.

Frequent episodic

1–14

days per month for at least 3 months.

Chronic

≥15

days per month on average for more than 3 months.

These thresholds help classify the disorder. They do not show how disabling a single episode may be for one person.

The name can mislead

Is it caused by stress or tense muscles?

Tension-type headache is probably multifactorial. Stress can contribute or maintain symptoms for some people, but it is not automatically the cause. Muscle tenderness can be a cause, a consequence or simply an accompanying feature.

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Pain processing

Changes in pain processing may play a role in chronic tension-type headache. This does not mean the pain is imaginary or “all in the mind”.

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Load and context

Sleep, working posture, worries, recovery and everyday demands may influence symptoms, but the effect differs between people.

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Other causes remain possible

New or changing headache, jaw or eye symptoms, fever or neurological symptoms should not automatically be dismissed as tension-type headache.

Treatment

What may help?

Start with a clear explanation, realistic adjustments and recognition of the pattern. Not every intervention works for everyone, and treatment does not have to prove that stress was the cause.

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A healthy foundation

Adequate sleep, regular activity, meals and recovery time may help. Choose one achievable change instead of aiming for a perfect lifestyle programme.

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Managing demands

Exercise-based or psychological support can be considered when behaviour or psychosocial factors clearly contribute, or with marked disability, avoidance, anxiety or low mood.

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Work and posture

Occupational support may help when symptoms occur at work. Ergonomic adjustment alone is not always sufficient, but can form part of a broader plan.

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Stay active without denying the pain

Continuing suitable activities may stop headache from taking up progressively more space. This does not mean ignoring symptoms or pushing through without limits.

Use acute medication carefully

Painkillers may help and may worsen the pattern

Occasionally

If explanation and practical measures are not enough, short-term paracetamol or an NSAID may be considered. Discuss safety, other medicines and health conditions with a doctor or pharmacist.

Very frequently

Using paracetamol or NSAIDs on 15 or more days per month can contribute to medication-overuse headache. For chronic tension-type headache, a doctor may sometimes discuss preventive treatment with amitriptyline.

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New, sudden or clearly different?

Have a new or changed pattern assessed. Seek urgent help for a sudden extremely severe headache, weakness or other neurological loss, drowsiness, neck stiffness or appearing seriously ill.

Share your experience

Was your headache labelled “stress” too quickly?

We would like to hear what explanation, treatment and recognition did to your care pathway.