Tension Headache – Symptoms, Causes, and Treatment

Tension headache is among the most common reasons for visiting a doctor for missing work or school. It is a mild to severe pain and sensation of building pressure, primarily due to muscle tension and fatigue. Pain in a tension headache begins at the back of the head, spreading forward in the form of a band around the head. The pain equally affects both sides of head and may also include muscles of the neck and shoulders. The most commonly reported cases are by people who work long hours at the office or people with stress and anxiety disorders.

Symptoms of tension headache

  • Dull pain or sensation of growing pressure around your head which may begin in the occiput
  • Pain behind the eyes
  • Pain in the temples
  • Tenderness over the skull vault
  • Tenderness at the occiput
  • Mood and sleep disturbances

The tension-type headache can cause pain that ranges from a sharp pain in the head to slight or building pressure around the head in the form of a band. While the severity of stress headaches can range from mild to severe. Tension headache is incompletely understood and some consider that it is simply a milder version of migraine.

Causes of tension headache

The exact cause is still not discovered. But some of the suspected causes can be:

  • Stress
  • Anxiety
  • Depression
  • Fatigue
  • Hunger
  • Poor posture while sleeping
  • Exertion
  • Cold 

Maybe just because of tiredness from long, demanding work hours and may last from a few hours to a few days depending on the cause. In some cases anxiety and stress about the headache itself may lead to continuation and prolonging of symptoms and by this time you may become convinced of a serious underlying condition.

What may trigger a tension headache?

As the name suggests, tension headache is mostly caused by stress and anxiety. Other triggers can be:

  • Lack of sleep
  • Poor diet
  • Fatigue
  • Poor posture
  • Depleting iron levels
  • Alcohol consumption
  • Smoking
  • Dehydration
  • Hectic work hours

Chronic tension headaches

Tension headache that lasts hours and may be continuous as the pain progresses throughout the day. If your headaches occur 15 or more days a month for at least three months, they’re considered chronic and need special medical attention.

Medication overuse headache

With the increasing availability of over-the-counter drugs, headache syndromes are becoming more common. Medication overuse headache (MOH) can complicate any headache syndrome but is more common with migraine and chronic tension-type headaches.

  • The most frequently consumed analgesics recorded are codeine, other opium-containing preparations, and triptans
  • Patients who consume analgesics on more than 10 to 15 days per month report with MOH

Management of MOH:

Patients should be warned of consequences due to the overuse of analgesics. Prophylactics for migraines may be helpful in reducing the rebound headaches which initially force the patient to take analgesic. Withdrawal of the culprit analgesic can be the only possible management for MOH.

How is a tension headache different from a migraine?

Tension headache occurs occasionally due to stress, anxiety, bad posture, or a poor sleeping position while migraines have a genetic predisposition. However, some environmental factors such as MSG containing foods, loud noises, sharp lights, and alcohol can trigger an episode. The location of pain also varies. Tension headache generally originates from the back of head and circles the head in the form of a band while migraine can occur at any point in the head mostly constituting one side of the head.

How to prevent a tension headache?

It can be prevented by taking a few precautions:

  • Limit alcohol use and smoking
  • Exercise regularly to relieve the stress
  • Drink plenty of water
  • Take your meals on time
  • If you manage to identify and avoid the triggering factors and keep track of your symptom patterns in a headache diary, you can figure out what’s causing them. You can successfully manage to decrease the number of episodes you have been having per month
  • Limit stress and your working hours
  • Take frequent breaks in between long durations of work hours
  • Maintain proper posture

What is the treatment of a tension headache?

  • Over-the-counter painkillers can relieve the pain:
    • Ibuprofen
    • Acetaminophen
    • Aspirin
    • Indomethacin
  • Muscle relaxants can also help with the neck tension
  • Stress and anxiety is treated by taking antidepressants
  • The treatment solely depends on the cause, such as:
    • Tension headaches caused by tiredness can be relieved simply by taking physiotherapy sessions, having a massage, or taking hot showers
    • People who experience pain or pressure in their head or pain in the head and eyes, more than 15 times a month should consult their doctor immediately
    • Symptoms for frequent tension headaches can be managed by taking a low dose of amitriptyline, which is a tricyclic antidepressant
    • In most cases, patients require psychological support and assurance that their condition is seriously taken care of and the treatment would give positive results


Some of the supplements that can help with a tension headache are:

  • Coenzyme q10
  • Vitamin B12
  • Vitamin B6
  • Magnesium
  • Vitamin D
  • Melatonin  

Life style changes and home remedies

  • Take complete rest after a long day at work
  • Hot oil massages can also provide relief
  • Hot showers are very relaxing after a tiring day
  • Use an ice pack or heating pad for headache
  • Cognitive-behavioral therapy can also be used for stress and anxiety
  • Stress can also be relieved by yoga, meditation, acupuncture, and other such technique
  • Hydrate yourself, inadequate hydration triggers a headache too
  • Avoid foods high in Histamine
  • Cold compresses are very soothing for the pain
  • Vitamin B complex contributes to Neurotransmitter synthesis
  • Co-enzyme Q 10 has anti-oxidant properties and helps the body get rid of toxins
  • Drink a warm cup of coffee
  • Meditation or yoga can help relax your mind


Where is a tension headache felt specifically?

A tension headache begins in the back of head and slowly circles around the head in the form of a band.

What is the best long term treatment of a tension headache?

Mind relaxing practices such as yoga and meditation calm your nerves and decrease the threshold as well as frequency of headaches.

I am completely relaxed but I still have a tension headache, why is it so?

Tension headache can also develop as a result of a bad posture, a bad sleeping position, or even working for long hours.

Are tension headaches serious?

No, tension headaches are not life threatening. You can cure a tension headache by doing some life style modifications and getting a pain killer.

Last medically reviewed on June 22, 2021.