Tension Headache: Symptoms, Triggers and Relief

01Symptoms

What a tension-type headache feels like

According to Mayo Clinic and MedlinePlus, tension-type headache typically causes:

• dull, aching, pressure-like pain rather than throbbing pain
• a feeling of tightness or pressure across the forehead or on the sides and back of the head, like a band or vise
• pain all over the head rather than in one spot or on one side
• tenderness in the scalp, neck and shoulder muscles

MedlinePlus adds that the pain may be worse in the scalp, temples or back of the neck, may be triggered or worsened by stress, fatigue, noise or glare, and can make sleeping difficult. Many people try to ease it by massaging the scalp, temples or base of the neck.

02Patterns

Episodic and chronic patterns

Mayo Clinic divides tension-type headache into two main categories. Episodic headaches can last from 30 minutes to a week. They are considered infrequent when they occur less than one day a month and frequent when they occur on fewer than 15 days a month for at least three months. Episodic headaches can become chronic.

Chronic tension-type headaches occur on 15 or more days a month for at least three months, can last hours and may be constant. These categories are used by professionals after assessment; counting days on your own does not replace a diagnosis, but a record of how often headaches happen is very useful at an appointment.

03Migraine

How it differs from migraine and other headaches

Mayo Clinic explains that tension-type headaches can be hard to tell apart from migraines, especially mild migraines. Unlike some forms of migraine, tension-type headaches are usually not associated with visual disturbances such as bright spots or flashes, and do not usually cause nausea or vomiting. Physical activity tends to make migraine worse but does not affect tension-type headache pain. Sensitivity to light or sound can occur but is not common.

MedlinePlus notes that tension-type headaches can occur in people who also have migraine. Other causes of head pain, such as sinus problems, jaw problems or poor sleep, can overlap; see sinus headache, TMJ symptoms and morning headaches.

04Triggers

Triggers and the uncertain pain mechanism

Mayo Clinic states that the cause of tension-type headache is not known. Experts once thought it was caused by contraction of muscles in the face, neck and scalp, but research suggests muscle contraction is not the cause. The most common theory is that people with this headache have increased sensitivity to pain, and the muscle tenderness may result from that sensitized pain system.

Stress is the most commonly reported trigger. MedlinePlus lists other possible triggers:

• holding the head in one position for a long time, for example at a computer, doing fine work with the hands or using a microscope
• sleeping in a cold room or with the neck in an awkward position
• physical or emotional stress, fatigue or overexertion
• alcohol, too much caffeine or caffeine withdrawal, and smoking
• colds, flu or sinus infections
• jaw clenching or teeth grinding, and eye strain

06Assessment

What a clinical assessment involves

MedlinePlus explains that a mild to moderate headache without other symptoms that settles with home treatment within a few hours may not need medical attention or tests. In tension-type headache, the nervous system examination is usually normal, although tender points are often found in the neck and shoulder muscles.

Mayo Clinic advises seeing a healthcare professional if you need medicine for tension-type headaches more than twice a week or if headaches disrupt your life. The assessment usually focuses on the headache history, the pattern, triggers and medicine use, and on ruling out warning signs. A headache diary helps with this.

07Relief

Everyday relief and medicine precautions

MedlinePlus describes conservative measures that many people find helpful, such as relaxation or stress-management training, massage, biofeedback, cognitive behavioral approaches, acupuncture and ice or heat packs. When needed, over-the-counter pain relievers such as acetaminophen, ibuprofen, naproxen or aspirin may be used, following the label or professional advice.

Painkillers need care. MedlinePlus warns that taking them on more than 3 days a week may lead to rebound headaches, that too much acetaminophen can damage the liver and that too much ibuprofen, naproxen or aspirin can irritate the stomach or damage the kidneys. Mayo Clinic notes that using medicines together with stress management may be more effective than either alone. If you are using painkillers often, ask a professional to review your treatment rather than increasing doses yourself.

08Habits

Stress management, sleep and regular activity

Mayo Clinic notes that regular exercise can help prevent tension-type headaches, along with biofeedback, cognitive behavioral therapy and relaxation techniques such as deep breathing, yoga, meditation or progressive muscle relaxation. Its healthy lifestyle advice includes getting enough, but not too much, sleep, not smoking, staying active, eating regular balanced meals, drinking plenty of water and limiting alcohol, caffeine and sugar.

MedlinePlus suggests keeping warm if headaches are linked to cold, trying a different pillow or sleeping position, keeping good posture, frequently moving the neck and shoulders during computer or close work, and getting enough rest. For posture at work, see posture exercises and forward head posture.

If neck and shoulder tension, posture or reduced activity are part of the picture, our physiotherapy practice in Bilbao can help adults with an exercise and posture plan after the headache has been assessed by a doctor (consultations are in Spanish). Physiotherapy does not replace medical diagnosis and does not use forceful neck manipulation as a routine treatment.

09Sources

Where the sources differ

The sources disagree on the cause. MedlinePlus (October 2025) states that tension headaches occur when neck and scalp muscles become tense or contract, while Mayo Clinic (May 2026) says research suggests muscle contraction is not the cause and favors increased sensitivity to pain. The cause is therefore uncertain; stress is a well-recognized trigger, but a proven muscle “knot” mechanism should not be assumed.

They also give different thresholds for painkiller use: Mayo Clinic advises seeing a professional if you need medicine more than twice a week, while MedlinePlus warns that use on more than 3 days a week may cause rebound headaches. These figures are not safe limits; frequent use of any pain medicine is a reason for review. In a preventive plan, a clinician may also consider prescription medicines, which MedlinePlus mentions for preventing recurrences.

10Summary

In summary

Tension-type headache is the most common headache, with dull, pressing pain on both sides of the head and tenderness in the scalp, neck and shoulders. Episodes last from 30 minutes to a week, and when they occur on 15 or more days a month they are considered chronic. Its cause is uncertain, and stress is the most commonly reported trigger.

Regular exercise, sleep, stress management and attention to posture can help, and pain relievers should be used carefully to avoid rebound headaches. Seek emergency care for a sudden, very severe headache or one with neurological symptoms, fever or stiff neck. A record of headache days, how much they limit you and the days you take medicine is a practical tool to bring to an appointment.