Health condition · Clinically reviewed
Tension-type headache, the most common headache pattern, plainly.
Bilateral, pressing, mild-to-moderate — the everyday headache most adults get. Distinguishing from migraine and managing chronic patterns are what matter.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, IHS or peer-reviewed sources you can see at the end.
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Updated for 2026
Reflects current UK guidance on episodic and chronic tension-type headache.
Key facts
Tension-type headache at a glance.
The essentials, in plain English — what it is, how it feels, how it differs from migraine, and what actually helps.
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What it is
Episodic or chronic tension-type headache — the everyday headache most adults experience at some point.
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How it feels
Bilateral, pressing or tightening quality — often described as a band around the head.
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What it isn’t
No nausea and no aura — the features that distinguish it from migraine.
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Chronic form
Headache on more than 15 days a month for at least 3 months deserves proper assessment.
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Medication overuse
Regular painkiller use can itself drive daily headache — a real and common trap.
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What helps chronic
Physiotherapy, posture work and stress management change chronic patterns more than another tablet.
Why this guide matters
The everyday headache, done properly.
Most tension-type headaches are simple. The ones that are not are usually chronic, driven by medication overuse, or hiding a red flag. Three points guide the rest of this page.
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Distinguish from migraine
Bilateral, pressing, no nausea, no aura — the clinical picture is what settles the diagnosis.
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Watch for medication overuse
Painkillers taken too often are the most common driver of a daily headache pattern.
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Chronic patterns need more
Physiotherapy, CBT and low-dose amitriptyline change chronic tension-type headache in ways another tablet cannot.
How the diagnosis is made
From first review to a clear plan.
The steps a UK GP will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Diary, pattern review and the SNOOP screen
Phase 2 · Confirming
Triggers identified and neurological examination
Phase 3 · Managing
Imaging only if flagged; neurology if refractory
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Recognising
A four-week headache diary
Daily notes on frequency, duration, triggers and any painkillers used — the single most useful diagnostic tool.
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Recognising
Symptom pattern review
Bilateral, pressing, mild-to-moderate pain without nausea or aura points to tension-type headache.
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Confirming
Red-flag screen (SNOOP)
Systemic, Neurological, Onset sudden, Older age, Progressive features are checked at every review.
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Confirming
Trigger identification
Poor sleep, dehydration, stress, screen posture and skipped meals emerge from the diary.
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Confirming
Neurological examination
A focused examination looking for any abnormal signs that would change the plan.
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Managing
MRI or CT only if red flags
Imaging is not routine for tension-type headache — reserved for red-flag features.
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Managing
Neurology if chronic
Referral if the pattern is chronic and refractory to first-line management.
Typical timeline: 4-8 weeks from first appointment to a settled plan.
Symptoms
What tension-type headache actually feels like.
A bilateral, pressing, mild-to-moderate ache — the everyday headache. Here are the features that place it, and the red flag that changes everything.
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Bilateral pressing
A band-like or tightening pressure across both sides of the head.
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Mild-to-moderate intensity
Uncomfortable but not disabling — you can usually keep working through it.
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No or minimal photophobia
Light sensitivity is a migraine feature — largely absent in tension-type headache.
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No nausea
Absence of nausea or vomiting is one of the clearest points against migraine.
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Cranial muscle tenderness
Tender pericranial muscles — scalp, neck and shoulders — are often palpable.
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Postural triggers
Long screen sessions, poor desk set-up and prolonged static posture bring it on.
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Medication overuse pattern
Painkillers used on more than 10-15 days a month can flip an episodic pattern into a daily one.
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Red flag: SNOOP features
Systemic, Neurological, Onset sudden, Older age, Progressive — any of these means urgent scan.
Treatment
How tension-type headache is treated in the UK.
Simple analgesia for episodes, the trigger and posture work that quiet chronic patterns, and preventive medication when they are truly frequent.
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Simple analgesia
Paracetamol or ibuprofen for occasional episodes — kept to a strict frequency limit to avoid overuse.
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Address triggers
Regular sleep, hydration, meals and stress management — the foundation for both episodic and chronic patterns.
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Physiotherapy & posture
Neck, shoulder and postural work — particularly helpful for headaches driven by desk-based work.
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CBT for stress
Cognitive behavioural therapy targets the stress and tension patterns that maintain chronic headache.
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Amitriptyline (chronic)
A low-dose tricyclic used as a preventive for chronic tension-type headache — not for occasional episodes.
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Botulinum toxin
Not first-line for tension-type headache — used more in chronic migraine.
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Address medication overuse
Stopping the overused painkiller is often the single most effective intervention in daily headache.
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Neurology referral
For chronic, refractory cases or diagnostic uncertainty — a specialist opinion is worthwhile.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or neurologist knows your history and can tell you which parts apply to you. If in doubt, seek assessment — especially with any red-flag features.
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NICE. Headaches in over 12s: diagnosis and management (CG150).
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British Association for the Study of Headache. National headache management guidelines.
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International Headache Society. ICHD-3 diagnostic criteria for tension-type headache.
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NHS. Headache information for patients.
Red flags
When a headache is more than tension-type.
Most headaches are benign. These are the patterns — captured by the SNOOP screen and beyond — that need urgent assessment.
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SNOOP features
Systemic, Neurological, Onset sudden, Older age or Progressive — any of these needs urgent assessment.
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Thunderclap headache
Worst-ever, sudden-onset pain reaching maximum within seconds — call 999.
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New headache after 50
A first-ever headache pattern in this age group deserves imaging.
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Progressive headache
A headache that steadily worsens over days or weeks — same-day review.
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Immunocompromised patient
Any new headache in an immunocompromised patient needs prompt assessment.
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Post-trauma headache
Headache after a head injury — especially if worsening — needs urgent review.
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Pregnancy with new headache
Particularly with high blood pressure or visual change — exclude pre-eclampsia urgently.
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Cancer history with headache
A new persistent headache in someone with a cancer history needs imaging.
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Meningism
Fever, neck stiffness or a rash with headache — possible meningitis. Call 999.
Living with it
A common pattern, and a very manageable one.
Four things that make the biggest difference day to day — the diary, the routines, the desk set-up and the trap of overuse.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes — kept up for months — do more than a heroic week that does not last.
- 01 Diary
Track before you treat
Four weeks of daily notes usually reveal a clear pattern — and any medication overuse.
- 02 Routines
Sleep, water, movement
The unglamorous basics change more chronic headaches than the next new tablet.
- 03 Posture
A desk that fits you
Screen height, chair support and regular breaks address the most common physical driver.
- 04 Overuse
The painkiller trap
Anything acute used more than 10-15 days a month can itself be causing the daily headache.
Frequently asked
Everything we get asked about tension-type headache.
Quick answers on distinguishing from migraine, chronic patterns, scans, medication overuse and when to see a neurologist.
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How is tension-type headache different from migraine?
Tension-type headache is bilateral, pressing and mild-to-moderate, with no nausea and no aura. Migraine is usually one-sided, throbbing, moderate-to-severe, and comes with nausea or light and sound sensitivity.
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What is a chronic tension-type headache?
Headache on more than 15 days a month for at least 3 months. It always deserves a proper review — including a check for medication overuse.
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Do I need a scan?
Usually not. Tension-type headache is a clinical diagnosis. MRI or CT is reserved for red-flag features — the SNOOP screen picks these up.
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What is medication overuse headache?
A headache pattern caused by regular use of painkillers, usually on more than 10-15 days a month. Stopping the overused drug is the treatment — and headaches often settle within a few weeks.
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Does amitriptyline work?
For chronic tension-type headache, low-dose amitriptyline is the best-studied preventive. It is taken at night and needs several weeks to show effect.
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When should I see a neurologist?
When the pattern is chronic and has not responded to first-line management, or if there is any diagnostic uncertainty. Any red flag warrants urgent assessment, not a routine referral.