Tension-type headache

The most common headache type in the world

Symptoms

Tension-type headache (TTH) is usually described as a pain that feels like a tight band round your head or a weight on top of it. Your neck or shoulder muscles may also hurt along with the headache. The pain can last from 30 minutes to several days, or may be continuous.

Tension-type headache can develop into chronic tension-type headache when it becomes more disabling.

Differences between tension-type headache and migraine

If you have TTH, it will produce a mild to moderate pain whereas the pain of migraine can reach disabling severity. Normal movement during everyday activities shouldn’t make TTH worse, unlike a migraine, which can be aggravated by movement. Table 1 (see end) shows the symptoms commonly associated with TTH and migraine.

There is an overlap in the triggers of migraine and TTH, as both may be brought on by stress or tiredness. Head and neck movements are important triggers in patients with TTH whereas hunger and odour were significantly common triggers in migraine.

 

Mixed headaches

You may hear the term ‘mixed headaches’ if you have migraines and tension-type headache. Medical experts believe this term has no useful place in modern practice. Patients with migraine may experience headaches that are mild and thus are labelled tension-type headache. This does not change the underlying problem and most such patients have migraine attacks that just differ in severity.

Tension-type headache triggers

The most common causes of TTH reported are anxiety, emotional stress, depression, poor posture, and lack of sleep, although the evidence for each of these (except stress) is poor.

Physical exhaustion is also a common cause of TTH, so make sure you are getting enough sleep.

Treating tension-type headache

Obviously removing the cause of headaches would be the best treatment. Over-the-counter painkillers such as ibuprofen, aspirin, paracetamol and naproxen are commonly used to treat TTH and remain the mainstay of treatment for TTH. It shouldn’t be necessary to take stronger medications. Using painkillers more than twice a week, however, can increase the risk of TTH developing into chronic daily headache. This occurs when ‘rebound headaches’ form as each dose of medication wears off, and is especially common if the painkillers contain caffeine or codeine.

Psychological factors affecting your headaches are hard to tackle. You may find it helpful to learn relaxation techniques, and avoid stressful situations as much as possible. If you find you can’t reduce, or even identify the causes of stress in your life, that may be triggering your headaches, you may find it beneficial to seek help from a psychotherapist or counsellor.

Different treatments for TTH work for different people, so if one thing doesn’t help try another. Discovering what works for you is the key.

If you are pregnant you should discuss use of any drugs (both prescribed and over the counter) with your doctor. Not all drugs are safe to use in pregnancy.

Chronic tension-type headache

Overusing painkillers to treat TTH can cause chronic daily headaches to develop. These headaches usually occur early in the morning, and their symptoms include: poor appetite, nausea, restlessness, irritability, memory or concentration problems, and depression. Chronic daily headache is usually resistant to painkillers, and most sufferers experience migraines as well as an almost permanent TTH. The headache can vary in intensity, duration, and location, and the symptoms can be more severe than in people who have occasional TTH.

If you suffer chronic tension-type headache you are advised to see a neurologist or headache specialist.

Also, although it is hard to do, if painkiller overuse has caused you to develop chronic daily headache, you should try to withdraw from the painkillers slowly. The headaches will initially get worse, and can cause problems such as nausea, but the headache intensity and frequency will begin to reduce within two weeks after you finish the withdrawal.

Many people find when they realise that overuse is doing them more harm than good, that stopping painkillers is the best option. However, if you are at all concerned about your headaches, especially if they persist, you should seek medical advice.

Table 1 – Symptoms associated with tension-type headache and migraine

Tension-type headache Migraine
Occurs without warning Occurs after warning signs or aura
Pain more likely to be all over Pain more likely to be one-sided
No throbbing Throbbing
No nausea Nausea and/or vomiting
No light or noise sensitivity Light and/or noise sensitivity
No visual disturbances Visual disturbances
Rare to start during sleep Not uncommon to start during sleep

*These are typical symptoms, and may not apply to all people with TTH and migraine.