Tension-Type Headache


What Is It?

Tension-type headaches are the most common type of headache, affecting up to 40 percent of people at some time in their lives. These headaches are not caused by disease, and are often considered to be “normal” headaches. Tension-type headaches fall into two general categories:

  • Episodic — Occurring less than 15 times per month
  • Chronic — 15 or more headaches per month

Although people who have this type of headache often report a sense of muscular tension, there is no clear evidence that muscle strain or tension actually causes these headaches. Rather, these headaches probably are caused by changes in brain chemicals, which trigger pain from nerves and blood vessels that surround the brain. This mechanism is similar to that which causes migraine headaches.


Tension-type headaches often start in the afternoon or early evening, and their intensity typically comes and goes over time. The main symptom is usually a sense of tightness around the head — the “tight hatband” or “vise” sensation. Neck and shoulder muscles are often tense and sore to the touch. Other symptoms may include trouble concentrating and difficulty sleeping.

It is common for some people to have symptoms of both tension-type and migraine headaches. For example, headaches may be made worse by bright lights or loud noises, which is typical of migraine headaches, but will also have a constant, non-throbbing quality, which is more typical of tension-type headache.


There is no specific test to confirm the diagnosis of a tension headache. The diagnosis is determined by your symptoms, your medical history and a physical examination by your doctor. In some patients, a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the head may be ordered to investigate headache pain that is associated with unexpected or unusual symptoms.

Expected Duration

An episodic tension-type headache may last only a few hours or it may linger for a day or more. A chronic tension-type headache typically persists for part or all of the day for most days of the week, although the intensity of pain may fluctuate during that time.


Relaxation techniques and avoidance of stressful situation may help to prevent tension-type headaches from occurring. In some people, a medication taken daily may help to prevent headaches as well. Typically, one of the tricyclic antidepressants is used. Even for people without depression, this class of drug has been found to offer significant relief from tension headache pain.


For episodic tension headaches that occur less than three times per week, over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others) are convenient and effective. Combination products whose formulas combine pain medication with caffeine may help some people, but also may be habit-forming. Use of any type of over-the-counter pain reliever should be limited to no more than two or three days per week. If pain medications are used more frequently, “rebound” headaches may occur on the days that medications are not taken.

Chronic tension-type headaches are more difficult to treat, especially because rebound headaches are common when pain relievers are stopped. It is often more effective to prevent these headaches with a daily prescription medication such as a tricyclic drug.

Some people are able to treat their tension-type headaches without medications. An ice compress or a heating pad can be extremely helpful, or a massage to any tight areas in the neck and shoulders. Relaxation techniques, such as deep-breathing exercises, biofeedback or acupuncture, may help to decrease the frequency of headaches.

When To Call A Professional

Most headaches are harmless and only rarely signal the presence of a serious underlying medical problem. There is no reason to see a health-care provider if you are able to control your headaches without medications or with only occasional use of a pain reliever.

However, any of the following symptoms should prompt a phone call or visit to your doctor:

  • A headache that occurs after a Head injury
  • A headache accompanied by fever or vomiting
  • A headache associated with blurred vision, difficulty speaking, or numbness or weakness of the arms or legs
  • Headaches that seem to be increasing in intensity or frequency over time
  • A “thunderclap” headache or headache associated with loss of consciousness
  • Headaches that require daily use of pain-reliever medications


Given time, most tension-type headaches will go away on their own. Recovery may be speeded by pain-relieving medication and withdrawal from any tension-producing situations.

Johns Hopkins patient information

Last revised:

Diseases and Conditions Center

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.