Tension headache treatment: what helps and when to worry
Tension-type headache is the most common type of headache, yet it's often brushed off as 'just stress'. A review in the journal Headache described it as the most prevalent headache in the general population and, paradoxically, the least studied (Jensen, Headache, 2018). The good news is that there's a lot you can do about it.
| Tension-type headache | Migraine | |
|---|---|---|
| Location | Both sides, like a band or weight | Usually one side |
| Quality | Pressing or tightening, not throbbing | Throbbing |
| Severity | Mild to moderate | Moderate to severe |
| Effect of activity | Not worse with routine activity | Worse with activity |
| Other symptoms | Rarely nausea; often neck and scalp tenderness | Nausea, sensitivity to light and sound |
What does a tension headache feel like?
Typically a pressing or tightening pain on both sides of the head, often described as a band around the forehead or a weight on top of the head. It's usually mild to moderate, doesn't throb, and doesn't get worse with routine activity like walking up stairs. Unlike migraine, it rarely causes nausea or vomiting. Many people also notice tenderness in the neck, shoulders and scalp, and pain at the base of the skull.
What causes tension headaches?
There's rarely a single cause. Common contributors include long hours at a screen with the head held forward, stress, poor or short sleep, skipped meals and dehydration, jaw clenching or teeth grinding, and stiffness or sensitivity in the upper neck and shoulder muscles. Headaches that become very frequent also tend to make the nervous system more sensitive, which keeps the cycle going.
If your headaches start at the base of the skull, our post on suboccipital tension covers that pattern in more detail.
What is the best treatment for tension headaches?
For occasional headaches, simple pain relief, rest, water and a break from the screen are often enough. For frequent headaches, the focus shifts to prevention: regular sleep and meals, managing stress, regular exercise, workstation changes, and treatment for neck and shoulder involvement.
There's reasonable evidence for hands-on treatment. A systematic review found manual therapy improved pain intensity, frequency, disability and quality of life in adults with tension-type headache, with combining techniques appearing most effective (Cumplido-Trasmonte et al., Neurología, 2021). A meta-analysis comparing manual therapy with medication found manual therapy was more effective in the short term, with similar results at longer follow-up (Mesa-Jiménez et al., Cephalalgia, 2015).
How can an osteopath help tension headaches?
We take a detailed headache history to check it fits a tension-type pattern and screen for anything that needs a doctor. Treatment usually combines gentle soft tissue work and joint mobilisation for the upper neck and upper back, sometimes dry needling, and exercises to build endurance in the deep neck and shoulder blade muscles. We also look at your desk set-up, sleep position and jaw habits, as these often keep headaches coming back.
See our headache treatment page for more on how we assess headaches.
Can taking painkillers too often make headaches worse?
Yes. Taking simple painkillers on 15 or more days a month, or combination and codeine-containing painkillers on 10 or more days a month, can lead to medication overuse headache, where the medication itself keeps headaches going. If you're reaching for tablets most days, talk to your GP or pharmacist about a plan to cut back safely, and focus on prevention.
When do tension headaches become chronic?
Tension-type headache is classed as chronic when it occurs on 15 or more days a month for more than three months. At that point it's worth a GP review as well as a musculoskeletal assessment, as sleep problems, anxiety or low mood, jaw clenching and medication overuse often play a part and are all treatable.
How do I know if it's a tension headache or a migraine?
Migraine is usually one-sided, throbbing, moderate to severe, worse with activity, and comes with nausea or sensitivity to light and sound. Some people get both types of headache. If you're not sure which you have, keeping a headache diary for a few weeks, noting timing, triggers, symptoms and medication, is one of the most useful things you can bring to an appointment.
Does stress cause tension headaches?
Stress is a common trigger, but it's rarely the only factor. Stress tends to go hand in hand with poor sleep, long hours at a desk, skipped meals and clenching your jaw, and each of these can contribute. That's why tackling a couple of practical factors, such as sleep, regular breaks and neck and shoulder strength, often helps even when the stress itself can't be removed. If stress, anxiety or low mood are significant, your GP can help with that side of things too.
When is a headache an emergency?
Call 000 for a sudden, severe headache that peaks within a minute, often described as the worst headache of your life, or a headache with weakness, numbness, confusion, difficulty speaking, a drooping face, a seizure or loss of consciousness. Seek urgent medical care for a headache with fever and neck stiffness or a rash, a headache after a head injury, or a new headache if you're over 50, pregnant, or have a weakened immune system. See your GP if headaches change pattern, are getting steadily worse, wake you from sleep, or come with vision changes.
Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.
If you're in Berwick or nearby and this sounds like you, see our headache treatment in Berwick page for how we assess and treat it.
Sources
Jensen RH. Tension-type headache: the normal and most prevalent headache. Headache, 2018.
Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
Related articles
