Tension headache: symptoms, causes, treatment and how long it lasts

The NHS lists the common symptoms as pain on both sides of the head, face or neck, a feeling like something is pressing on your head or being tightened around it, and a tender affected area that may hurt more when touched. You should be able to continue doing daily activities without making the headache worse.

NICE Clinical Knowledge Summaries describes the classic pattern as recurrent episodes lasting from 30 minutes to 7 days that are not associated with nausea or vomiting, may have no more than one of sensitivity to light or sound, and have at least two of: both sides of the head, pressing or tightening and non-pulsating quality, mild or moderate intensity, and not made worse by routine physical activity such as walking or climbing stairs.

The NHS says common causes include stress, sleep problems and caffeine, and that taking painkillers for headaches too often or for a long time can also cause headaches. NICE Clinical Knowledge Summaries says the exact mechanism or cause of tension-type headache is unknown, and that peripheral pain mechanisms may play a role in episodic headaches, whereas central pain mechanisms and heightened sensitivity to pain may be more important in chronic ones.

The NHS general headache page lists other common causes of headaches: a cold or flu, drinking too much alcohol, bad posture, eyesight problems, not eating regular meals, not drinking enough fluids, taking too many painkillers, and hormone changes around periods or the menopause. It suggests a headache diary to help work out what triggers your headaches.

NICE says management includes assessing for triggers or other associated conditions such as stress, neck pain or sleep disorders.

The NHS says you can treat a tension headache yourself using painkillers such as paracetamol, aspirin and ibuprofen. Paracetamol is the first choice if you are pregnant and children under 16 should not take aspirin. A pharmacist can advise on the best painkiller, what to do if you are pregnant, and medicines for sleep problems.

The NHS also suggests doing activities to help you relax, such as exercise, yoga and massage, changing sleeping habits if insomnia may be causing your headaches, and using a low, firm pillow and heat or cold packs if you have neck pain and headaches. It advises cutting down on caffeine from tea, coffee or cola.

For frequent headaches, the NHS says an antidepressant medicine called amitriptyline is sometimes recommended to help prevent them, started at a low dose that may be increased, and usually taken for several months before it starts working. NICE Clinical Knowledge Summaries says that for frequent episodic or chronic tension-type headache a GP may advise that acupuncture may be helpful, consider physiotherapy, regular exercise, cognitive behavioural therapy or relaxation techniques, and offer a trial of amitriptyline.

The NHS says taking painkillers too often or for a long time can cause overuse or rebound headaches. NICE Clinical Knowledge Summaries defines medication overuse headache as headache on 15 or more days a month in someone with a pre-existing primary headache disorder, developing as a consequence of regular overuse of acute headache medicines for more than 3 months.

It says that simple analgesics such as paracetamol, NSAIDs or aspirin are taken on 15 days or more a month, and ergotamines, triptans, opioids or combination analgesics on 10 days or more a month. It advises that for episodic tension-type headache, opioid medication should be avoided.

NICE says most people with medication overuse headache improve after withdrawal of the overused medication, which is usually done under advice, and that headache may worsen initially. Speak to a GP or pharmacist rather than stopping suddenly on your own if you are using painkillers most days.

The NHS says tension headaches last at least 30 minutes but can last much longer, sometimes for several days. NICE Clinical Knowledge Summaries describes three patterns based on how often they happen.

For children, the NHS says children under 16 should not take aspirin. It gives specific advice for children under 12: get an urgent GP appointment or call 111 if the child has a headache that wakes them at night, a headache when they wake up in the morning, a headache that gets progressively worse, a headache triggered or made worse by coughing, sneezing or bending down, a headache with vomiting, or a headache with a squint or an inability to look upward. Call 999 or go to A&E if a child under 12 has a headache with vision problems or difficulty speaking, swallowing, balancing or walking, with drowsiness or persistent lack of energy, or starting within 5 days of a head injury.

In pregnancy, the NHS says paracetamol is the first choice of painkiller and that some medicines, such as ibuprofen, are not recommended in pregnancy. A pharmacist can advise what to do if you are pregnant, and the NHS has separate information on headaches in pregnancy.

NICE Clinical Knowledge Summaries says investigations are generally not needed to diagnose a primary headache. A GP asks about the onset, duration, frequency, pattern and characteristics of the pain, associated symptoms and triggers, and examines vital signs, neck, face and the nervous system. Red flags suggesting a serious secondary cause prompt urgent referral.

The NHS says that if you have regular tension headaches a GP may suggest a headache diary recording how often they happen, how long they last, how painful they are, other symptoms, possible causes and medicines you take. NICE says a headache diary for at least 8 weeks should be considered if the diagnosis is uncertain. You may be referred to a specialist if painkillers and relaxation do not help or it is unclear what is causing the headaches.

The NHS says to get an urgent GP appointment or call 111 if you have a severe headache with jaw pain when eating, blurred or double vision, a sore scalp, or numbness or weakness in the arms or legs.

Call 999 or go to A&E if you have a head injury, or a headache that came on suddenly and is extremely painful. Also call if you have an extremely painful headache with sudden problems speaking or remembering things, loss of vision, feeling drowsy or confused, a very high temperature with symptoms of meningitis, or the white part of the eye is red. The NHS general headache page adds a headache with a seizure, a rash that does not fade when a glass is rolled over it, or a stiff neck.

On the NHS, a pharmacist can help with the choice of painkiller and a GP can review headaches that are frequent or severe, arrange a headache diary and consider prevention, with referral to neurology if the diagnosis is uncertain or symptoms persist despite optimal management, as NICE describes.

Some people choose a private neurologist or headache clinic to rule out other causes or review medicines. It helps to bring a diary covering several weeks and a list of every painkiller you take and how many days a month you take them.