Tension-Type Headache
The most common headache there is: a dull, pressing band around the head that doesn’t throb and rarely stops you functioning. Annoying, almost never dangerous, and tablets are only half the answer.
Typical signs: pain on both sides of the head, forehead or neck, like pressure or a tight band. The scalp and neck may feel tender. It doesn’t usually get worse with activity. Episodes last from half an hour to several days.
Why it happens: the exact cause isn’t known. Common triggers are stress, poor sleep, anxiety or low mood, posture, eye strain, dehydration and missed or erratic caffeine. Tight muscles can make the pain worse but aren’t thought to be the cause. Taking painkillers too often can cause headaches too.
Diagnosis: from your story and an examination. There’s no test for it, and a typical pattern with a normal examination doesn’t need a scan. A headache diary helps a lot.
The headache ladder
Painkillers help a bit; habits do the heavy lifting. If you need tablets on more than 2–3 days a week, change the plan, not the brand.
- Step 1 · Self-careSleep, fluids, caffeine and stressRegular sleep, enough to drink, steady (not yo-yo) caffeine, screen breaks, and a heat pack or massage for a tight neck.
- Works
- Not tested as a package, but these are the triggers guidelines list most often
- Cost
- Free
- How long
- A few weeks to see a pattern
- Watch for
- Missing your usual coffee can trigger a headache of its own.
Your head keeps receipts for last night’s four hours of sleep.
- Step 2 · PharmacyParacetamol, ibuprofen or aspirinOne standard dose when the headache starts.
- Works
- Paracetamol 1 g: about 24 in 100 pain-free at 2 hours vs 19 in 100 on placebo; 59 vs 49 in 100 have mild or no pain. Ibuprofen 400 mg is similar
- Cost
- About $3–10 a pack
- How long
- Works within 1–2 hours
- Watch for
- Use on no more than 2–3 days a week. Ibuprofen and aspirin: stomach and kidney cautions; no aspirin under 16.
Modest help, not magic. That’s the honest version of the box.
- Step 3 · Self-careHeadache diaryNote each headache: when, how bad, possible triggers and what you took.
- Works
- Recommended by guidelines to find triggers and catch painkiller overuse; no trial figures
- Cost
- Free
- How long
- 4–8 weeks
- Watch for
- If the diary shows tablets on most days, take it to your GP.
Data beats guessing, even for heads.
- Step 4 · Self-careRegular exercise and relaxationWalking, swimming, yoga, meditation or relaxation training, most days. CBT or biofeedback for stress-heavy headaches.
- Works
- Recommended for prevention; in trials, physio, massage and exercise did about as well as acupuncture
- Cost
- Free to low cost
- How long
- 6–12 weeks to judge
- Watch for
- A headache brought on by coughing or straining needs a doctor’s check.
Stress isn’t optional. How your shoulders store it partly is.
- Step 5 · Allied healthPhysio or acupunctureNeck and posture work with a physio, or a course of about 6–8 acupuncture sessions for frequent headaches.
- Works
- Acupuncture: about 5 in 10 halved their headache days vs 2 in 10 with usual care. Against fake acupuncture it was 51% vs 43%, so much of the effect is the ritual
- Cost
- Physio about $90–130 a session; acupuncture about $70–120; some health fund rebates
- How long
- About 6–12 weeks
- Watch for
- Courses add up; agree a set number of sessions, then review.
Fake needles nearly matching real ones tells you something.
- Step 6 · PrescriptionPreventive medicine (low-dose amitriptyline)A small nightly dose for frequent or near-daily headaches.
- Works
- An option for frequent headaches; it usually takes several months to work
- Cost
- Under the $25 PBS co-payment, about $22; $7.70 concession
- How long
- Months; reviewed regularly
- Watch for
- Drowsiness, dry mouth, constipation. See our amitriptyline guide.
A slow burner: judge it in months, not mornings.
- Step 7 · SpecialistNeurologistIf the pattern is unusual, the cause is unclear or nothing has helped.
- Works
- Helps when the diagnosis is uncertain or treatment isn’t working
- Cost
- Specialist fees vary; Medicare rebates with a GP referral
- How long
- Varies
- Watch for
- Most people never need one.
Most heads are sorted without a neurologist.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Routine brain scansFor a typical tension pattern with a normal examination, a scan doesn’t change treatment. A clear scan won’t cure a headache.
- Daily painkillers “just in case”Taking pain relief often is one of the commonest causes of daily headaches. The cure becomes the cause.
- Codeine and other opioidsNot a first-line headache treatment: more side effects, and a higher risk of painkiller-overuse headache.
What you can do
- Use the 2–3 day rule: painkillers on no more than 2–3 days a week.
- Keep a headache diary for a month before deciding anything.
- Move most days. Walking counts. So does yoga.
- Keep caffeine steady rather than all-or-nothing.
- For a stiff neck: a low, firm pillow, heat or cold packs, and our neck exercise plan.
See your GP if
- Headaches several times a week, or severe
- You need painkillers on more than 2 days a week
- The pattern changes, gets worse over weeks, is worse lying down, comes with morning sickness, or starts with coughing
- Throbbing, one-sided pain with nausea or light sensitivity (it may be migraine)
- You’re pregnant and get a sudden or different headache
- Headache with jaw pain when chewing, a sore scalp or vision changes (needs a same-day check)
Get emergency help (call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.) for a sudden, severe headache, or a headache with fever, stiff neck, vomiting, confusion, a seizure, blurred or double vision, weakness, trouble speaking, or after a head injury.
Common questions
Is a tension headache dangerous?
Almost never. Tension-type headaches are not a sign of an underlying illness. Warning signs such as a sudden severe headache, fever, confusion, weakness or a change in pattern need a doctor.
How often can I take painkillers for headaches?
Aim for no more than 2 to 3 days a week. Using pain relief more often than that can cause medication-overuse headaches and other side effects.
Does acupuncture work for tension headaches?
It helps some people. In trials about half of people halved their headache days with acupuncture, compared with about 2 in 10 with usual care. Fake acupuncture worked nearly as well, and physio or exercise did about as well.
Do I need a scan for my headache?
Usually not. There is no test for tension-type headache, and scans rarely help when the pattern is typical and your examination is normal.
Helpful resources
- Headache AustraliaPlain-English information on headache types and support groups. Free, Australia.
- NHS: Tension headachesClear guide to self-care, painkillers and warning signs. Free, UK.
- Neck pain exercise planPrintable neck exercises with sets and progressions. Free, from us.
Evidence and more information
- NHS: Tension headaches
- Healthdirect: Tension headache
- Cochrane 2016: Paracetamol for episodic tension-type headache
- Cochrane 2016: Acupuncture for tension-type headache
maladywise.com/tension-headache/