What Is a Tension Headache?

Tension headaches are the most common type of headache, usually experienced as a mild-to-moderate band of pain around the head.

January 17, 2025 · 10 min · 2100 words · Amy Walls

Table of Contents

Table of ContentsView AllTable of ContentsWhat Is a Tension Headache?SymptomsCausesDiagnosisTreatmentCoping

Table of ContentsView All

View All

Table of Contents

What Is a Tension Headache?

Symptoms

Causes

Diagnosis

Treatment

Coping

Close

Tension headaches also referred to as tension-type headaches (TTH), are headaches that are mild to moderate in severity. Sufferers describe them as feeling like a band around their heads.

They are the most common type of headache, with up to 78%of the general population experiencing them at some point during their lives. The headaches may also be chronic in nature, for around three percentof the population.

There are two different types of tension headaches. Episodic ones happen on fewer than 15 days a month; chronic ones happen more than 15 days per month.

Tension Headache Symptoms

The symptomsyou experience during a tension headache may not be as severe as in amigraine, but they can still be debilitating:

How Are Headaches and Stress Connected?

What Causes Tension Headaches?

There are two schools of thought about the cause of tension-type headaches. One is that the headaches cause muscle tension. The other posits that muscle tension causes tension headaches. (Either way, muscle tension is present in 70%of those with tension headaches).

Earlier researchshowed that tensionheadacheswere a result of the muscles in the head and neck tensing up. In fact, they were even called a “muscle-contraction headache.”

A more recent studypoints to this muscle-contraction theory potentially not holding water. This study looked at patients who received Botox (botulinum toxin) injections to paralyze the temporal muscle (i.e., the temples.) Despite the freezing of the muscles, participants didn’t see any significant decreases in their headaches.

“We think the myofascial tissues send signals to the brain [that create] increased activity in those pain pathways. They become more sensitized and dysregulated,” saysDr. Jennifer Robblee, Assistant Professor of Neurology at Jan & Tom Lewis Migraine Treatment Program, Barrow Neurological Institute.

Some triggers may include:

Tension Headache Diagnosis

Two of the following featuresmust be present for a tension headache diagnosis:

Sometimes photophobia (light sensitivity) or phonophobia (discomfort from sound) may be present, but not both.

There is a high rate of overlap between people with mood disorders and people who deal with tension headaches. In one study,84% of the participants with tension headaches also had a psychiatric diagnosis, such as anxiety or depression. There is a theorythat some tension headaches may be thephysical manifestations of psychological distress.

How Are Tension Headaches Treated?

Tension headaches are treated in two main ways: pharmacologically (through medication) and non-pharmacologically, which may include things from cognitive-behavioral therapy toacupuncture.

Pharmacological Treatment for Tension Headaches

Many tension headaches can be managed with over-the-counter medications, but if the pain begins to become chronic, there are prescription medications you can try.

Over the Counter Medications

Some medications that people typically use are the usual non-steroidal anti-inflammatories (NSAIDs) such as Aleve (naproxen), Advil (ibuprofen) or Tylenol (acetaminophen).

Prescription Medications

Non-Pharmacological Treatments

Dr. Robblee notes that behavioral techniques and therapy can be used to treat these kinds of headaches. “They use the body’s innate response to turn down its response to being in pain," says Dr. Robblee.

Other ways to manage acute tension headaches without medicine that Dr. Robblee frequently recommends to patients are:

Coping with tension headaches may sometimes be harder to deal with than the actual headaches—the pain isn’t severe, but it’s just present enough to cause some level of impairment, whether that be once in a while or chronically.

There’s actually a condition calledcephalalgiaphobia,which is the fear of having a headache while in a pain-free state. The irony of this condition is that, given that stress is a headache trigger, this may actually cause more headaches.

“Pain is not just a physical sensation,” says Dr. Robblee. “There’s also an emotional component to it. Part of addressing that is knowing what’s causing the headaches so you can deal with that fear [that it might be something serious].”

She says that she will explain to patients why the symptoms of a headache are leading her to a certain diagnosis, and why she’s not worried.

“One of the most important things is to alleviate fear and make sure the person is being heard,” says Dr. Robblee.

A Word From Verywell

Headaches can be incredibly frustrating, especially when they become chronic or interfere with you doing the things you want to do, but most of the time, they are just a normal reaction within your body to stress or another trigger. Remind yourself that they have passed before and will pass again If you find that your headaches are painful or impacting your quality of life, reach out to your healthcare physician.

19 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.International Headache Society.Tension-type headache (TTH).World Health Organization.Headache Disorders.Medline Plus.Tension headache.Altura BM, Altura BT.Tension headaches and muscle tension: is there a role for magnesium?.Medical Hypotheses. 2001;57(6):705-713. doi:10.1054/mehy.2001.1439Budzynski T.Biofeedback in the treatment of muscle-contraction (Tension) headache.Biofeedback and Self-Regulation. 1978;3(4):409-434. doi:10.1007/BF00998945Zwart JA, Bovim G, Sand T, Sjaastad O.Tension headache: botulinum toxin paralysis of temporal muscles.Headache. 1994;34(8):458-462. doi:10.1111/j.1526-4610.1994.hed3408458.xBendtsen, L., and M. Ashina. “Sensitization of myofascial pain pathways in tension-type headache"The headaches3. 2000:637-641.Lake AE, Rains JC, Penzien DB, Lipchik GL.Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance.Headache: The Journal of Head and Face Pain. 2005;45(5):493-506. doi:10.1111/j.1526-4610.2005.05101.xPuca F, Genco S, Prudenzano M, et al.Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in italy.Cephalalgia. 1999;19(3):159-164. doi:10.1046/j.1468-2982.1999.1903159.xJackson JL, Damm TW.Barriers to the use of tricyclic antidepressants in the management of pain.Pain Management. 2011;1(2):99-101. doi:10.2217/pmt.11.1Kahriman, Azmin; Zhu, Shuhan (2018).Migraine and Tension-Type Headache. Seminars in Neurology, 38(6), 608–618.doi:10.1055/s-0038-1673683Mathew NT.The prophylactic treatment of chronic daily headache. : cme.Headache. 2006;46(10):1552-1564. doi:10.1111/j.1526-4610.2006.00621.xFogelholm R, Murros K.Tizanidine in Chronic Tension-Type Headache: A placebo controlled double-blind cross-over study.Headache. 1992;32(10):509-513. doi:10.1111/j.1526-4610.1992.hed3210509.xChristiansen S, Jürgens TP, Klinger R.Outpatient combined group and individual cognitive-behavioral treatment for patients with migraine and tension-type headache in a routine clinical setting.Headache. 2015;55(8):1072-1091. doi:10.1111/head.12626Nestoriuc Y, Rief W, Martin A.Meta-analysis of biofeedback for tension-type headache: Efficacy, specificity, and treatment moderators.Journal of Consulting and Clinical Psychology. 2008;76(3):379-396. doi:10.1037/0022-006X.76.3.379Wallbaum AB, Rzewnicki R, Steele H, Suedfeld P.Progressive muscle relaxation and restricted environmental stimulation therapy for chronic tension headache: a pilot study.Int J Psychosom. 1991;38(1-4):33-39.Gu Q, Hou JC, Fang XM.Mindfulness meditation for primary headache pain: a meta-analysis.Chinese Medical Journal. 2018;131(7):829-838. doi:10.4103/0366-6999.228242Linde K, Allais G, Brinkhaus B, et al.Acupuncture for the prevention of tension-type headache.Cochrane Database Syst Rev. 2016;4:CD007587. doi:10.1002/14651858.CD007587.pub2Peres MFP, Mercante JPP, Guendler VZ, et al.Cephalalgiaphobia: a possible specific phobia of illness.J Headache Pain. 2007;8(1):56-59. doi:10.1007/s10194-007-0361-3

19 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.International Headache Society.Tension-type headache (TTH).World Health Organization.Headache Disorders.Medline Plus.Tension headache.Altura BM, Altura BT.Tension headaches and muscle tension: is there a role for magnesium?.Medical Hypotheses. 2001;57(6):705-713. doi:10.1054/mehy.2001.1439Budzynski T.Biofeedback in the treatment of muscle-contraction (Tension) headache.Biofeedback and Self-Regulation. 1978;3(4):409-434. doi:10.1007/BF00998945Zwart JA, Bovim G, Sand T, Sjaastad O.Tension headache: botulinum toxin paralysis of temporal muscles.Headache. 1994;34(8):458-462. doi:10.1111/j.1526-4610.1994.hed3408458.xBendtsen, L., and M. Ashina. “Sensitization of myofascial pain pathways in tension-type headache"The headaches3. 2000:637-641.Lake AE, Rains JC, Penzien DB, Lipchik GL.Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance.Headache: The Journal of Head and Face Pain. 2005;45(5):493-506. doi:10.1111/j.1526-4610.2005.05101.xPuca F, Genco S, Prudenzano M, et al.Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in italy.Cephalalgia. 1999;19(3):159-164. doi:10.1046/j.1468-2982.1999.1903159.xJackson JL, Damm TW.Barriers to the use of tricyclic antidepressants in the management of pain.Pain Management. 2011;1(2):99-101. doi:10.2217/pmt.11.1Kahriman, Azmin; Zhu, Shuhan (2018).Migraine and Tension-Type Headache. Seminars in Neurology, 38(6), 608–618.doi:10.1055/s-0038-1673683Mathew NT.The prophylactic treatment of chronic daily headache. : cme.Headache. 2006;46(10):1552-1564. doi:10.1111/j.1526-4610.2006.00621.xFogelholm R, Murros K.Tizanidine in Chronic Tension-Type Headache: A placebo controlled double-blind cross-over study.Headache. 1992;32(10):509-513. doi:10.1111/j.1526-4610.1992.hed3210509.xChristiansen S, Jürgens TP, Klinger R.Outpatient combined group and individual cognitive-behavioral treatment for patients with migraine and tension-type headache in a routine clinical setting.Headache. 2015;55(8):1072-1091. doi:10.1111/head.12626Nestoriuc Y, Rief W, Martin A.Meta-analysis of biofeedback for tension-type headache: Efficacy, specificity, and treatment moderators.Journal of Consulting and Clinical Psychology. 2008;76(3):379-396. doi:10.1037/0022-006X.76.3.379Wallbaum AB, Rzewnicki R, Steele H, Suedfeld P.Progressive muscle relaxation and restricted environmental stimulation therapy for chronic tension headache: a pilot study.Int J Psychosom. 1991;38(1-4):33-39.Gu Q, Hou JC, Fang XM.Mindfulness meditation for primary headache pain: a meta-analysis.Chinese Medical Journal. 2018;131(7):829-838. doi:10.4103/0366-6999.228242Linde K, Allais G, Brinkhaus B, et al.Acupuncture for the prevention of tension-type headache.Cochrane Database Syst Rev. 2016;4:CD007587. doi:10.1002/14651858.CD007587.pub2Peres MFP, Mercante JPP, Guendler VZ, et al.Cephalalgiaphobia: a possible specific phobia of illness.J Headache Pain. 2007;8(1):56-59. doi:10.1007/s10194-007-0361-3

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

International Headache Society.Tension-type headache (TTH).World Health Organization.Headache Disorders.Medline Plus.Tension headache.Altura BM, Altura BT.Tension headaches and muscle tension: is there a role for magnesium?.Medical Hypotheses. 2001;57(6):705-713. doi:10.1054/mehy.2001.1439Budzynski T.Biofeedback in the treatment of muscle-contraction (Tension) headache.Biofeedback and Self-Regulation. 1978;3(4):409-434. doi:10.1007/BF00998945Zwart JA, Bovim G, Sand T, Sjaastad O.Tension headache: botulinum toxin paralysis of temporal muscles.Headache. 1994;34(8):458-462. doi:10.1111/j.1526-4610.1994.hed3408458.xBendtsen, L., and M. Ashina. “Sensitization of myofascial pain pathways in tension-type headache"The headaches3. 2000:637-641.Lake AE, Rains JC, Penzien DB, Lipchik GL.Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance.Headache: The Journal of Head and Face Pain. 2005;45(5):493-506. doi:10.1111/j.1526-4610.2005.05101.xPuca F, Genco S, Prudenzano M, et al.Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in italy.Cephalalgia. 1999;19(3):159-164. doi:10.1046/j.1468-2982.1999.1903159.xJackson JL, Damm TW.Barriers to the use of tricyclic antidepressants in the management of pain.Pain Management. 2011;1(2):99-101. doi:10.2217/pmt.11.1Kahriman, Azmin; Zhu, Shuhan (2018).Migraine and Tension-Type Headache. Seminars in Neurology, 38(6), 608–618.doi:10.1055/s-0038-1673683Mathew NT.The prophylactic treatment of chronic daily headache. : cme.Headache. 2006;46(10):1552-1564. doi:10.1111/j.1526-4610.2006.00621.xFogelholm R, Murros K.Tizanidine in Chronic Tension-Type Headache: A placebo controlled double-blind cross-over study.Headache. 1992;32(10):509-513. doi:10.1111/j.1526-4610.1992.hed3210509.xChristiansen S, Jürgens TP, Klinger R.Outpatient combined group and individual cognitive-behavioral treatment for patients with migraine and tension-type headache in a routine clinical setting.Headache. 2015;55(8):1072-1091. doi:10.1111/head.12626Nestoriuc Y, Rief W, Martin A.Meta-analysis of biofeedback for tension-type headache: Efficacy, specificity, and treatment moderators.Journal of Consulting and Clinical Psychology. 2008;76(3):379-396. doi:10.1037/0022-006X.76.3.379Wallbaum AB, Rzewnicki R, Steele H, Suedfeld P.Progressive muscle relaxation and restricted environmental stimulation therapy for chronic tension headache: a pilot study.Int J Psychosom. 1991;38(1-4):33-39.Gu Q, Hou JC, Fang XM.Mindfulness meditation for primary headache pain: a meta-analysis.Chinese Medical Journal. 2018;131(7):829-838. doi:10.4103/0366-6999.228242Linde K, Allais G, Brinkhaus B, et al.Acupuncture for the prevention of tension-type headache.Cochrane Database Syst Rev. 2016;4:CD007587. doi:10.1002/14651858.CD007587.pub2Peres MFP, Mercante JPP, Guendler VZ, et al.Cephalalgiaphobia: a possible specific phobia of illness.J Headache Pain. 2007;8(1):56-59. doi:10.1007/s10194-007-0361-3

International Headache Society.Tension-type headache (TTH).

World Health Organization.Headache Disorders.

Medline Plus.Tension headache.

Altura BM, Altura BT.Tension headaches and muscle tension: is there a role for magnesium?.Medical Hypotheses. 2001;57(6):705-713. doi:10.1054/mehy.2001.1439

Budzynski T.Biofeedback in the treatment of muscle-contraction (Tension) headache.Biofeedback and Self-Regulation. 1978;3(4):409-434. doi:10.1007/BF00998945

Zwart JA, Bovim G, Sand T, Sjaastad O.Tension headache: botulinum toxin paralysis of temporal muscles.Headache. 1994;34(8):458-462. doi:10.1111/j.1526-4610.1994.hed3408458.x

Bendtsen, L., and M. Ashina. “Sensitization of myofascial pain pathways in tension-type headache"The headaches3. 2000:637-641.

Lake AE, Rains JC, Penzien DB, Lipchik GL.Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance.Headache: The Journal of Head and Face Pain. 2005;45(5):493-506. doi:10.1111/j.1526-4610.2005.05101.x

Puca F, Genco S, Prudenzano M, et al.Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in italy.Cephalalgia. 1999;19(3):159-164. doi:10.1046/j.1468-2982.1999.1903159.x

Jackson JL, Damm TW.Barriers to the use of tricyclic antidepressants in the management of pain.Pain Management. 2011;1(2):99-101. doi:10.2217/pmt.11.1

Kahriman, Azmin; Zhu, Shuhan (2018).Migraine and Tension-Type Headache. Seminars in Neurology, 38(6), 608–618.doi:10.1055/s-0038-1673683

Mathew NT.The prophylactic treatment of chronic daily headache. : cme.Headache. 2006;46(10):1552-1564. doi:10.1111/j.1526-4610.2006.00621.x

Fogelholm R, Murros K.Tizanidine in Chronic Tension-Type Headache: A placebo controlled double-blind cross-over study.Headache. 1992;32(10):509-513. doi:10.1111/j.1526-4610.1992.hed3210509.x

Christiansen S, Jürgens TP, Klinger R.Outpatient combined group and individual cognitive-behavioral treatment for patients with migraine and tension-type headache in a routine clinical setting.Headache. 2015;55(8):1072-1091. doi:10.1111/head.12626

Nestoriuc Y, Rief W, Martin A.Meta-analysis of biofeedback for tension-type headache: Efficacy, specificity, and treatment moderators.Journal of Consulting and Clinical Psychology. 2008;76(3):379-396. doi:10.1037/0022-006X.76.3.379

Wallbaum AB, Rzewnicki R, Steele H, Suedfeld P.Progressive muscle relaxation and restricted environmental stimulation therapy for chronic tension headache: a pilot study.Int J Psychosom. 1991;38(1-4):33-39.

Gu Q, Hou JC, Fang XM.Mindfulness meditation for primary headache pain: a meta-analysis.Chinese Medical Journal. 2018;131(7):829-838. doi:10.4103/0366-6999.228242

Linde K, Allais G, Brinkhaus B, et al.Acupuncture for the prevention of tension-type headache.Cochrane Database Syst Rev. 2016;4:CD007587. doi:10.1002/14651858.CD007587.pub2

Peres MFP, Mercante JPP, Guendler VZ, et al.Cephalalgiaphobia: a possible specific phobia of illness.J Headache Pain. 2007;8(1):56-59. doi:10.1007/s10194-007-0361-3

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