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Tension-type headache is the most common form of headache. Painkillers taken as required work well in most cases. Attention to lifestyle factors such as stress, posture, and exercise may help to prevent headaches. Medication to prevent headaches may help if you have frequent tension-type headaches.

What is tension-type headache and whom does it affect?

Tension-type headache is the common type of headache that most people have at some time. One study has reported:

  • About half of adults have a tension-type headache every now and then - less than one a month. This is called infrequent episodic tension-type headache.

  • About a third of adults have two or more tension-type headaches per month, but fewer than 15 a month. This is called frequent episodic tension-type headache.

  • About 3 in 100 adults have a tension-type headache 15 or more times per month - that is, on most days. This is called chronic tension-type headache (sometimes called chronic daily headache).

Symptoms of Tension-type headache

  • Typically, the pain is like a tightness around the hat-band area. Some people feel a squeezing or pressure on their head. It usually occurs on both sides of your head, and often spreads down your neck, or seems to come from your neck. Sometimes it is just on one side. The pain is usually moderate or mild, but sometimes it can be severe.

  • A tension-type headache can last from 30 minutes to 7 days. Most last a few hours or so.

  • The headache normally comes on during the day, and gets worse as the day goes on.

  • Some people don't like bright lights or loud noises, and don't feel like eating much when they have a tension-type headache.

What causes tension-type headaches?

Some, but probably not most, may be due to tension. This is why the term tension-type headache rather than tension headache. Many tension-type headaches develop for no apparent reason. Some may be triggered by:

  • Emotional tension, anxiety, tiredness or stress.

  • Physical tension in the muscles of the scalp and neck. For example, poor posture at a desk may cause the neck and scalp muscles to tense.

  • Physical factors such as bright sunlight, cold, heat, noise, etc. Your genetic make-up may be a factor. Some people may inherit a tendency to be more prone to develop tension-type headaches more easily than others when stressed or anxious.

Treatments for tension-type headache?


A walk, some exercise, or simply taking a break from the normal routine may help. A neck and shoulder massage may help. A hot flannel on your neck or a warm bath may also help.


Painkillers often work well to ease a tension-type headache. But note: you should not take painkillers for headache for more than a couple of days at a time. Also, on average, do not take them for more than two days in any week for headaches. See a doctor if you need painkillers for headaches more often than this. If you take them more often, you may develop medication-overuse headache (see above). Do not take painkillers all the time to prevent headaches. Take each day as it comes. Painkillers that are used include the following:


    This often works well. It is best to take a full dose as soon as a headache starts. This may ward off the headache better than treating it after it has fully developed.

    Anti-inflammatory painkillers

    These are alternatives to paracetamol. On average, anti-inflammatory painkillers, rather than paracetamol, probably ease the pain in more people with headaches. However, some people develop side-effects such as stomach problems, and paracetamol does work in a lot of people.


    Research trials suggest that aspirin, at full dose, is probably the most effective drug for easing a tension-like headache.

    Other painkillers

    Opiate painkillers such as codeine, dihydrocodeine and morphine are not normally recommended for tension-type headaches. The reason is because opiate painkillers can make you drowsy. They are also the most likely type of painkiller to cause medication-overuse headache if used regularly.

How can I prevent frequent / chronic tension-type headaches?


It may help to keep a diary if you have frequent headaches. Note when, where, how bad each headache is, and how long each headache lasts. Also note anything that may have caused it. A pattern may emerge and you may find a trigger to avoid. For example, hunger, eye strain, bad posture, stress, anger, etc.


Stress is a trigger for some people who develop tension-type headaches. Avoid stressful situations whenever possible. Sometimes a stressful job or situation cannot be avoided. Learning to cope with stress and to relax may help. Breathing and relaxation exercises, or coping strategies, may ease anxiety in stressful situations and prevent a possible headache. There are books and tapes which can teach you how to relax. Sometimes a referral to a counsellor may be advised.

Regular exercise

Some people with frequent headaches say that they have fewer headaches if they exercise regularly. If you do not do much exercise, it may be worth trying some regular activities like brisk walking, jogging, cycling etc. (This will have other health benefits too apart from helping with headaches.) It is not clear how exercise may help. It may be that exercise helps to ease stress and tension, which can have a knock-on effect of reducing tension-type headaches.


Amitriptyline is the medicine most commonly used to prevent tension-type headaches. This is not a painkiller and so does not take away a headache if a headache develops. It is an antidepressant medicine and you have to take it every day with the aim of preventing headaches. A low dose is started at first and may need to be increased over time. Once the headaches have been reduced for 4-6 months, the amitriptyline can be stopped.

The time to consider taking medication to prevent headaches is not clear-cut. As a general rule, if you are regularly having tension-type headaches more than four times a month then it is best to discuss things with a doctor. It is thought that preventative treatment sooner rather than later is best before headaches become very frequent. This may prevent frequent episodic tension-type headaches from becoming chronic tension-type headaches.

It is often difficult in retrospect to say how well a preventative treatment has worked. Therefore, it is best to keep a headache diary for a couple of weeks or so before starting preventative medication. This is to record when and how severe each headache was, and also how well it was eased by a painkiller. Then, keep the diary going as you take the preventative medicine to see how well things improve. The headaches are unlikely to go completely, but the diary may show a marked improvement.