Tension Headache: Causes, Relief and When to Worry

Tension Headache (Tension-Type Headache) — Causes, Relief and When to Worry

What a tension headache feels like, why it happens, how to ease it and prevent it, and the warning signs that need urgent care. Explained by a Sydney neurologist.

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When a Tight, Pressing Headache Needs Urgent Care

Most tight, pressing headaches are tension-type headaches, which are common and not dangerous. A few patterns need care straight away, so they come first.

Call 000 — or go to an emergency department — if

a headache comes on suddenly and severely and reaches its worst within a minute (the worst headache of your life), even if it then eases
a very high blood pressure reading (a top number of 180 or more, or a bottom number of 120 or more) comes with chest or back pain, shortness of breath, vomiting, problems with your eyesight, confusion or a seizure: call 000 straight away
your blood pressure is still very high when you measure it again after 5 minutes of sitting quietly, and you have a headache
the headache comes with fever and a stiff neck, a rash that does not fade when pressed, confusion or unusual drowsiness
you are over 50 with a new headache, or a change in your usual headaches, and you notice blurring, double vision, or sight that dims or goes dark in one eye, even if it lasts only a few minutes
the headache comes with sudden loss or dimming of vision (even if brief), double vision, a new drooping eyelid or one pupil larger than the other, slurred speech, sudden severe dizziness or unsteadiness, or numbness, weakness or drooping of the face, an arm or a leg
an eye becomes painful and red, with blurred vision, halos (coloured rings) around lights, or nausea and vomiting
the headache started after a head injury and is getting worse, comes with vomiting, drowsiness or confusion, or you take blood-thinning medicine
the headache comes with a seizure
you are more than 20 weeks pregnant or had a baby in the last 6 weeks and have a severe headache, a headache that does not get better with simple pain relief, blurred vision or flashing lights, sudden swelling of the face, hands or feet, pain under the ribs or in the upper tummy, vomiting with a headache, or a reading of 160/110 or more: go to your maternity unit or an emergency department now; call 000 for a seizure, trouble breathing or chest pain
you have a spinal cord injury at mid-chest level or higher and get a sudden, pounding headache, often with sweating or flushing above the injury: sit upright with your legs down, loosen anything tight, check your bladder, catheter and bowel, and follow your own dysreflexia plan if you have one; call 000 if it does not settle within a few minutes or you cannot find the cause

A sudden, explosive headache, wherever it is felt, can mean bleeding around or into the brain (a subarachnoid or intracerebral haemorrhage). A very high reading with chest or back pain or shortness of breath can mean the heart or the main artery from the heart is under strain; with vomiting, problems with eyesight, confusion or a seizure, it can mean the pressure is affecting the brain (hypertensive encephalopathy). A very high reading with a headache needs checking in an emergency department, because only tests can show whether the pressure is harming the brain, heart, eyes or kidneys. In someone over 50, a new headache with a change in vision can mean giant cell arteritis is cutting off the blood supply to the eye (see below): treated the same day, sight can usually be saved, but sight that is lost rarely comes back. Weakness, numbness or drooping of the face, trouble speaking, sudden unsteadiness or a sudden loss of vision can mean a stroke. Double vision, a new drooping eyelid or a change in the size of one pupil can mean pressure on a nerve from a bulging blood vessel (an aneurysm) or a tear in the wall of an artery in the neck (a dissection). A painful red eye with blurred vision and halos can mean a sudden rise in the pressure inside the eye (acute angle-closure glaucoma), which can permanently damage sight if it is not treated quickly. After a head injury, bleeding inside the skull can build up over hours, sometimes after a spell of feeling well. Fever with a stiff neck, or a rash that does not fade when pressed, can mean meningitis. A seizure with a headache needs urgent checks for a cause in the brain. In pregnancy or after a birth, a severe headache can be the first sign of pre-eclampsia, a condition of high blood pressure in pregnancy that can lead to seizures; after a spinal cord injury, a pounding headache can be autonomic dysreflexia, a sudden surge in blood pressure set off by something below the injury, such as a full bladder. In both, lower readings than 180/120 count: in pregnancy, 140/90 is high and 160/110 is severe; after a spinal cord injury, a rise in the top number of 20 to 40 or more above your usual reading matters, and 130/90 can already be high. All need urgent treatment. If you have migraine, your usual aura (shimmering or zigzag lines that spread slowly over several minutes and clear within an hour) does not need 000 on its own, and nor do the eye signs of attacks a doctor has already diagnosed as cluster headache (a red, watering eye, a drooping eyelid or a smaller pupil). A first cluster-like attack, a first aura after 50, or an attack or aura that is different from your usual ones needs an emergency department the same day; call 000 if it comes with a new drooping eyelid, one pupil larger than the other, or a very high reading. In the same way, vomiting in your usual migraine attack does not need 000 on its own; with a very high reading, it does. Remember FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 000.

See your GP the same day if

it is a new headache, or a change in your usual headaches, and you are over 50, especially with a new tender scalp that does not go away, pain in the jaw when you chew that eases when you stop, aching shoulders, or feeling generally unwell; with any change in your vision, see the list above
your blood pressure is still very high (a top number of 180 or more, or a bottom number of 120 or more) when you measure it again, even if the headache has gone and you feel well (in pregnancy and after a spinal cord injury, lower readings count: see above)
the headache is getting steadily worse over days or weeks
the headache is worse when you lie down, or is worst on waking and comes with vomiting or blurred vision
the headache is brought on by coughing, sneezing, laughing or straining, or comes with a whooshing sound in the ears in time with your heartbeat
you have a fever with the headache
it is a new headache, or a change in your usual headaches, and you have, or have had, cancer, or you have a weakened immune system
you are pregnant or have had a baby in the last 6 weeks, or a reading taken from 20 weeks of pregnancy to 6 weeks after the birth is 140/90 or more: contact your midwife, maternity unit or GP the same day; with blurred vision or sudden swelling of the face, hands or feet, contact your maternity unit or go to hospital now

Fever can mean an infection. Cancer, a weakened immune system, and pregnancy or a recent birth each make some serious causes more likely, so the bar for checking is lower. A very high reading without symptoms is rarely an emergency, but it needs a doctor that day to start or adjust treatment. The other items are explained further down this page. If you cannot see your GP that day, go to an emergency department. If something matches both lists, follow the 000 list.

Where most people sit

These patterns are uncommon. Tension-type headache is the most common headache of all, and for most people it is mild and comes only now and then. It does not damage the brain. If you are worried about a brain tumour: in a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have one, and tumours usually cause other symptoms too, such as weakness, seizures, confusion, or a headache that gets steadily worse over weeks. These figures do not apply if you have, or have had, cancer, or have a weakened immune system: see your GP the same day about a new headache.

If Tense Muscles Cause Tension Headaches, Why Do the Measurements Show So Little?

It is four o'clock. You have been at your desk since eight, your shoulders have crept up towards your ears, and a band of pressure has settled across your forehead. Rub your temples or the back of your neck and they ache. The name seems to explain it all: tense muscles, tension headache. So when Danish researchers measured the electrical activity of the head muscles in 547 people from the general population, you might expect them to have found muscles working overtime. They found muscles working only a little harder, and only in some people: those with headaches on most days, and the forehead muscle during a headache. How hard the muscles worked bore no relation to how often the headaches came, and the researchers concluded that measuring it was of little use in telling headaches apart. If tight muscles do not explain the headache, why do they hurt?

What sets these muscles apart is not how tight they are, but how tender. In another Danish study, doctors who did not know who had headaches pressed on the head and neck muscles of 735 people. People with tension-type headache were, on the whole, more tender than everyone else; the more tender they were, the more often their headaches came; and on a headache day, tenderness rose by about a third. The international classification of headache disorders, the rulebook neurologists use, calls this tenderness the most significant abnormal finding in tension-type headache. Tenderness is thought to come from oversensitive nerve endings in the muscles and coverings of the head, a little like a smoke alarm set so sensitive that it goes off when you make toast.

In people who have headaches on most days, the change goes deeper, into the parts of the brain and spinal cord that process pain. In a Danish study of 40 people with chronic tension-type headache, firm pressure on a finger, far from the head, hurt sooner than it did in 40 people without headaches. The whole pain system has turned its volume up, a process called central sensitisation. And when Danish researchers followed people for 12 years, the extra sensitivity came after the headaches became frequent, not before: frequent headaches turn the volume up, which is one reason it pays to stop them becoming frequent.

So where does tension come in? Stress and mental tension are the trigger people name most often: in a Danish population study they were the most conspicuous trigger of tension-type headache, and sleep habits mattered too. Doctors once thought tension-type headache was mainly psychological, but studies since have pointed strongly to a basis in the nervous system, at least for its more severe kinds. "Tension" is a fair word for what sets many of these headaches off, then, just not for what is happening in the muscles.

Where most people sit

Tension-type headache comes from how the pain system is working, not from damage to the muscles, the neck or the brain. When it becomes frequent, there are treatments that can help, set out further down this page.

What a Tension-Type Headache Feels Like

Doctors recognise it by its pattern: at least two of the first four features below, and the fifth and sixth.

Both sides of the head. Usually felt on both sides, often across the forehead, at the temples or at the back of the head, or all over, and sometimes spreading into the neck and shoulders. For a headache in one place, see headache at the back of the head, headache on top of the head or headache in the temples.
Pressing or tightening. Like a weight on the head, a tight band around it or a cap that is too small. It usually does not throb.
Mild to moderate. Unpleasant, but you can usually carry on with your day.
Not made worse by walking or climbing stairs. Ordinary activity, which makes a migraine worse, does not make a tension-type headache worse.
No nausea or vomiting. Light or noise may bother you a little, but not both. In the chronic form, mild nausea can occur.
Lasting 30 minutes to 7 days. In the chronic form, it can last hours to days at a time, or never fully go away.
Tender muscles. The scalp, temples, neck and shoulders are often sore to press, more so on a headache day.

Doctors divide it by how often it comes: infrequent (on fewer than 1 day a month), frequent (1 to 14 days a month) and chronic (15 or more days a month, for more than 3 months). The infrequent kind is a nuisance that rarely needs a doctor; the frequent and chronic kinds can disrupt work and family life, and they are the ones worth treating. In different studies, between 30% and 78% of people have had a tension-type headache; in a US survey of 13,345 adults, about 4 in 10 had had one in the past year and about 2 in 100 had the chronic form. Children and teenagers get them too: about 1 in 6, in a combined analysis of 48 studies. This page is written for adults; for a child or teenager with frequent headaches, see your GP.

Tension-Type Headache or Migraine?

Telling a tension-type headache from a mild migraine is, according to the classification itself, the most common difficulty in telling the common headaches apart, partly because people with frequent headaches often have both. These features help tell the two apart, along with three other causes of a headache that can feel similar.

Swipe the table sideways to compare all five →

Feature	Tension-type headache	Migraine	Medication overuse headache	The neck (cervicogenic headache)	The jaw (TMD)
Where it hurts	Both sides; across the forehead, the temples, the back of the head or all over	Often one side, but it can switch sides or affect both	Often where your usual headache is	One side, starting in the neck and spreading forward; always the same side	The temples, on one or both sides; often in front of the ear
Feels like	Pressing or tightening; mild to moderate	Throbbing; moderate to severe	Often like your usual headache, but on most days	An ache that neck movement, or pressing on the neck, can bring on	An ache that is worse when you use the jaw
How long	30 minutes to 7 days, or most of the time in the chronic form	4 to 72 hours	15 or more days a month, for more than 3 months	Comes and goes with neck movement and posture	Comes and goes with jaw use
Activity	Not made worse by walking or climbing stairs	Made worse by routine activity	No particular pattern	Neck movement or a held posture can bring it on	Chewing, talking, yawning, clenching or grinding the teeth
Other symptoms	No nausea; light or noise may bother you a little	Nausea or vomiting, or a dislike of light and noise; sometimes an aura	Pain relief taken on 15 or more days a month (10 or more for some others)	Reduced neck movement	Clicking or grating of the jaw, a stiff jaw

Many people have both. Migraine and tension-type headache often go together, and in people with migraine, a milder headache that looks like a tension-type headache can be a mild migraine. In a US study of 249 people with disabling migraine, their tension-type-like headaches responded to a migraine medicine at least as well as their migraines did. If you have migraine, ask your doctor how to treat the milder headaches too.

Headaches every day? A headache on 15 or more days a month is often called chronic daily headache. The usual causes are chronic tension-type headache, migraine that has become chronic, and taking pain relief on too many days, which can itself keep headaches going; often more than one is present. A daily headache that is new after 50, or that keeps getting worse, needs your GP the same day.

Where most people sit

The table is a guide, not a diagnosis. The features overlap, many people have more than one kind of headache, and sorting out which ones you have is the main job of a consultation. Tension-type headache, migraine and medication overuse headache are all common, and all treatable.

What Brings On a Tension-Type Headache?

There is rarely a single cause. These are the triggers people report most, and the things that keep headaches coming.

Stress and mental tension. The trigger named most often. In a Danish study that followed 549 people for 12 years, not being able to relax after work was one of the things that predicted who would develop tension-type headaches.
Short or poor sleep. In the same Danish study, sleeping few hours a night predicted new tension-type headaches, and in a Norwegian study of 15,268 people who had no headaches at the start, those with insomnia were about 40% more likely to have headaches 11 years later, with similar results for tension-type headache. Poor sleep and headaches feed each other.
Missing meals. In an Israeli study of 370 people, 39% of those who fasted for 25 hours developed a headache, against 7% of those who did not fast, and a fasting headache feels much like a tension-type headache.
Long hours in one position. Desk and screen work, and holding the head forward. People with chronic tension-type headache tend to hold their head further forward than other people, but in two small Spanish studies of 25 people each, how far forward was linked to how often headaches came in one and not in the other, so posture is probably one contributor among several.
Clenching or grinding the teeth. Strain in the jaw muscles often goes with tension-type headache: see headache in the temples.
Anxiety and low mood. Both are more common in people with frequent tension-type headaches: in a US clinic study, people with chronic tension-type headache were 3 to 15 times more likely than people without headaches to be diagnosed with an anxiety or mood disorder. They are worth treating in their own right. If you are thinking of harming yourself, call Lifeline on 13 11 14, day or night, or 000 if you are in danger now.
Your eyesight. Uncorrected long- or short-sightedness can bring on a headache after long spells of reading or screen work, which eases when you stop and settles once the vision is corrected, although this is a much less common cause of headache than is generally believed. An eye test is worthwhile if your sight has changed or you find yourself squinting.
Caffeine. If you have caffeine every day, stopping or delaying it can bring on a headache within a day that settles within a week.

When a Headache Like This Has Another Cause

A few conditions can feel like a tension-type headache. Each is less common, and each usually has a clue that gives it away.

Medication overuse headache. Pain relief taken on too many days a month (15 or more days for simple pain relievers, 10 or more for some others) can itself keep headaches going, and can turn occasional headaches into near-daily ones. About 1 to 2 in 100 people have it, usually people with migraine or tension-type headache. It usually improves once the pain relief is cut back: in a Norwegian trial, brief advice from a GP on cutting back ended the chronic headache in half of the people who received it, against 6% of those who did not. See medication overuse headache.
Sleep apnoea. Pauses in breathing during sleep, usually with loud snoring and daytime sleepiness, can cause a headache on waking. When sleep apnoea is the cause, the headache is usually on both sides, pressing and gone within 4 hours of waking, and settles once the sleep apnoea is treated. Waking headaches have many other causes; a sleep study shows whether sleep apnoea is one of them. See your GP if you snore loudly, stop breathing in your sleep or are sleepy through the day.
The neck (cervicogenic headache). A headache that starts in the neck and spreads forward over one side of the head, always the same side, brought on by neck movement or by pressing on the neck: see cervicogenic headache.
Raised pressure inside the head. A headache that is worse lying down or first thing in the morning, sometimes with vomiting or blurred vision, and that gets steadily worse, can mean pressure is building up inside the head, for example from a blockage of the fluid pathways or, rarely, a tumour. Raised pressure of the fluid around the brain without a tumour (idiopathic intracranial hypertension) can also cause a whooshing sound in the ears in time with the heartbeat, and is most common in women of child-bearing age, especially after weight gain. All need your GP the same day, because some can affect sight.
Low pressure of the fluid around the brain. A headache that comes on, or gets much worse, soon after you sit or stand up and eases when you lie down, often with a stiff neck or a change in hearing, can mean the fluid around the brain and spine is leaking. It can follow a lumbar puncture or an epidural, or happen with no clear reason. The pattern is clearest at the start and can fade over time, so tell your doctor how the headache began. See your GP within a day or two, or, if it began after a spinal procedure, contact the hospital or clinic that did it; if it is severe, or comes with vomiting, drowsiness or confusion, go to an emergency department.
A headache that starts one day and never stops. When a daily headache starts on a day you can remember and is there every day from then on, doctors call it new daily persistent headache. It can feel like a tension-type headache, but because a new headache that does not let up can have a cause, such as a change in the pressure of the fluid around the brain, it needs checking: see your GP, the same day if it is getting steadily worse.
Giant cell arteritis. After 50, a new headache with a tender scalp (the scalp is often tender in a tension-type headache or during a migraine attack; in giant cell arteritis the tenderness is new and does not go away), pain in the jaw muscles when you chew, aching shoulders or feeling generally unwell can be giant cell arteritis, an inflammation of the arteries of the head. It needs your GP the same day for blood tests, because it can affect the eyesight: if your sight blurs, doubles or dims, go to an emergency department now.
Cough headache. A headache set off within a second or two of coughing, sneezing, laughing or straining peaks almost at once and usually fades over seconds to minutes. About 4 in 10 cough headaches have an underlying cause, most often a Chiari malformation, where the lowest part of the brain sits lower than usual and crowds the top of the spinal canal, so a cough headache is always worth having checked, usually with an MRI scan.
Carbon monoxide. Headaches that affect several people in the same home at the same time, especially with a gas heater or another fuel-burning appliance running, can mean carbon monoxide poisoning: get everyone into fresh air, turn the appliance off if it is safe to, and call 000. Headaches that ease when you are away from home are another clue.
High blood pressure. Ordinary high blood pressure does not usually cause headaches; a sudden, very high rise can. If a reading taken with a headache is still very high (a top number of 180 or more, or a bottom number of 120 or more) after 5 minutes of sitting quietly, follow the 000 list at the top. In pregnancy, after a birth and after a spinal cord injury, lower readings count: see the lists at the top, and headache with high blood pressure.
A brain tumour. The worry many people have. Brain tumours are rare, and a tumour's headache can feel like a tension-type headache: in a New York study of 111 people with brain tumours, about half had headaches, and three in four of those headaches were like tension-type headaches. What gives a tumour away is usually something else: the headache is the only symptom in between 2 and 16 in 100 people with a brain tumour, and a headache that keeps getting worse is one of its key features. Weakness, numbness, trouble speaking, a loss of vision or a seizure needs 000; a headache that gets steadily worse over days or weeks needs your GP the same day (see the lists at the top). If you have, or have had, cancer, or have a weakened immune system, see your GP the same day about a new headache.

Where most people sit

These causes are uncommon, and most give themselves away: a headache that changes with lying down or standing up, one set off by coughing, one that started on a particular day and never stopped, one that worsens week by week, or other symptoms alongside it. A careful history and examination usually tell the doctor whether any of them is possible, and the right test, when one is needed (a scan, blood tests, a sleep study or an eye check), usually settles the question.

How Is Tension-Type Headache Diagnosed?

From your story and an examination. No scan or blood test shows a tension-type headache: the diagnosis rests on the pattern, and on finding nothing that points elsewhere.

Your story. Where the headaches are and what they feel like, how long they last, how many days a month you have them, what brings them on, how you sleep, how often you take pain relief and what kind, how much caffeine you have, and any other symptoms.
The examination. A full neurological examination, including the back of the eyes and your blood pressure, and a check of the muscles of the scalp, neck and shoulders, the movement of the neck, and the jaw.
A headache diary. A few weeks of a headache diary shows how many headache days and pain-relief days you really have, and what sets the headaches off.
A scan, only when it will change what happens next. When the pattern fits and the examination is normal, a scan is not needed. The Australian and New Zealand Association of Neurologists advises against brain scans for long-standing headaches like these: in people with recurring tension-type headaches or migraine and a normal examination, a CT or MRI scan finds a significant problem in fewer than 1 in 100, and in some studies as few as 2 in 1,000. UK guidance advises against scans done only for reassurance. A scan is arranged when something points away from a tension-type headache, such as a warning sign in the lists at the top or a headache that has changed.
Blood tests or a sleep study, when they fit. Blood tests for inflammation when a new headache starts after 50; a sleep study when snoring, pauses in breathing or daytime sleepiness suggest sleep apnoea.

How to Relieve a Tension Headache

For an occasional tension-type headache, simple steps usually work. The aim is to ease today's headache without making the next one more likely.

Simple pain relief, taken early. Simple pain relief from the pharmacy, taken early in the headache at the dose on the pack, eases many tension-type headaches. Ask your pharmacist which kind suits you, especially if you are pregnant, have other health conditions or take other medicines. In a UK trial of 542 people, about 7 in 10 had worthwhile relief within 2 hours of simple pain relief, but so did more than half of those given a dummy tablet, partly because many tension-type headaches ease on their own.
Keep pain relief to two or three days a week at most, and to fewer than 10 days a month for some kinds. Taking it on too many days (15 or more days a month for simple pain relievers, 10 or more for some others) can itself keep headaches going; ask your pharmacist which yours is, and see medication overuse headache.
Take a break and move. Step away from the screen, stretch your neck and shoulders, and go for a short walk: walking does not make a tension-type headache worse.
Heat and massage. A warm shower or bath, a heat pack, or a gentle massage of the neck: these are among the first steps Australian health services suggest.
Eat and drink. If you have missed a meal, eat something, and have a drink of water.
Loosen and relax. Loosen anything tight on your head, and try a few minutes of slow breathing or a relaxation exercise.

How to Prevent Tension-Type Headaches

When tension-type headaches come on several days a month, preventing them works better than chasing each one with pain relief. These are the main options, with what the trials show.

Know your pattern. A headache diary, ideally for 8 weeks, shows your headache days, your pain-relief days and your triggers, and shows whether a treatment is working.
Regular sleep, meals and exercise. Regular sleep and meals help, and treating insomnia is worthwhile in its own right. Regular exercise is good for sleep, mood and general health; for tension-type headache itself, the trials of exercise are small and their results uncertain. In a trial in people with recurrent headaches, drinking more water helped them feel better, though it did not reduce the number of headache days.
Psychological treatment. Learning to manage stress and pain, with cognitive behavioural therapy (CBT), relaxation training or a similar treatment, helps many people: in a 2025 combined analysis of 19 trials of 1,069 people with tension-type headache, the 5 trials that counted headache days found about 4 fewer a month than in the comparison groups. In a US trial of 203 adults with chronic tension-type headache, a short course of stress-management training and a preventive medicine each helped modestly, and the two together did better than either alone: about 2 in 3 people on both had their headache scores (a measure of how often and how badly the head hurt) at least halved, against about 1 in 3 with either alone and 3 in 10 with dummy tablets.
Biofeedback. A sensor on the forehead shows you how active your muscles are, so you can learn to relax them. A combined analysis of 53 studies found that it helped, with the benefit lasting through an average of 15 months of follow-up, although another review, which gave more weight to the better-designed trials, found no clear sign that biofeedback, relaxation or CBT worked better than no treatment or a dummy treatment.
Physiotherapy. Exercises for the neck and shoulders, posture work and hands-on treatment of tender muscles can help, although the trials are small: in a Dutch trial of 82 people with chronic tension-type headache, hands-on therapy (manual therapy) cut headache frequency by about 6 days more than usual GP care did, measured at 8 weeks. Quick, forceful manipulation of the neck was no better than no treatment in a combined analysis of trials.
Acupuncture. A review of 12 trials of 2,349 adults found that in the largest trial, about half of the people who had a course of acupuncture had their headaches at least halved in how often they came, against about 1 in 5 who had their usual care alone; effects beyond four months were not studied. Sham acupuncture, with needles placed away from the usual points or not pushed into the skin, did nearly as well (43% against 51%), so much of the benefit may not depend on where the needles go. UK guidance suggests a course of up to 10 sessions over 5 to 8 weeks for chronic tension-type headache.
A preventive medicine. When headaches come on many days a month, a preventive medicine, taken every day for some months, can reduce how often they come. Your doctor can advise whether one suits you.
Treat what feeds them. Cutting back pain relief that is being taken too often, treating sleep problems, anxiety or low mood, and easing jaw clenching.

Where most people sit

Frequent tension-type headaches often settle with time. In a Danish study that followed 161 people with frequent or chronic tension-type headache for 12 years, 45% had only occasional headaches or none by the end, 39% still had frequent ones and 16% had chronic tension-type headache; having migraine as well, and sleep problems, made improvement less likely.

When to See a Neurologist About Tension-Type Headaches

Headaches on many days a month, or pain relief needed on more than two or three days a week
Headaches that keep coming back despite the steps above
You are not sure whether it is tension-type headache, migraine or both
A daily headache, or one that never fully goes away
A headache that has changed, or a new kind of headache (see your GP first; a new headache after 50 needs your GP the same day)
You want help cutting back pain relief
You want a clear diagnosis and a plan

A consultation involves a detailed history, a neurological examination and a plan: working out which headache, or headaches, you have, arranging tests when the result will change what happens next, and coordinating with your GP and, when needed, a physiotherapist or a psychologist. Dr Ron Granot trained at Prince of Wales Hospital, Sydney, and sees patients in Bondi Junction. For the wider picture, read our migraine overview.

Frequently Asked Questions

How do you relieve a tension headache fast? +

Take simple pain relief early, at the dose on the pack (if you are pregnant, ask your pharmacist which kind is safe), and step away from what you were doing: a short walk, a stretch of the neck and shoulders, a warm shower or a heat pack, something to eat if you have missed a meal, and a drink of water. Many tension-type headaches also ease on their own. Keep pain relief to two or three days a week at most, and to fewer than 10 days a month for some kinds (your pharmacist can tell you which), because taking it more often can itself keep headaches going. A headache that comes on suddenly and severely and reaches its worst within a minute, or comes with fever and a stiff neck, confusion, weakness, numbness or drooping of the face, an arm or a leg, trouble speaking, a loss of vision or a seizure, is not a tension-type headache: call 000. If you are more than 20 weeks pregnant or had a baby in the last 6 weeks, a severe headache, or one that does not get better with simple pain relief, needs your maternity unit or an emergency department now; any other headache in pregnancy or in the 6 weeks after a birth needs your midwife, maternity unit or GP the same day.

What is the main cause of tension headaches? +

There is no single cause. Tension-type headache is thought to come from the nerves in the muscles and coverings of the head becoming oversensitive, and, when headaches are frequent, from the brain's pain system turning its volume up. The muscles are often tender, but their activity, when it is measured, is not much different from other people's. What sets the headaches off differs from person to person: stress and mental tension are the most common trigger, and others include short or poor sleep, missed meals, long hours in one position, clenching the teeth, and pain relief taken too often. A headache diary helps you find yours.

I've had a tension headache for 3 days. Is this normal? +

It can be: an episode of tension-type headache can last from 30 minutes to 7 days. Keep pain relief to two or three days a week at most, and to fewer than 10 days a month for some kinds (your pharmacist can tell you which). See your GP if it has not eased after a week or is a new kind of headache for you. See your GP the same day if it is getting steadily worse, is worse when you lie down, or is worst on waking with vomiting or blurred vision, comes with a fever, or is a new headache and you are over 50. If you are more than 20 weeks pregnant or had a baby in the last 6 weeks, a headache that has not got better with simple pain relief needs your maternity unit or an emergency department now; any other headache in pregnancy or in the 6 weeks after a birth needs your midwife, maternity unit or GP the same day. Call 000 if it came on suddenly and severely, reaching its worst within a minute, or comes with fever and a stiff neck, confusion, weakness, numbness or drooping of the face, an arm or a leg, trouble speaking, a loss of vision or a seizure, or, if you are over 50, with blurring, double vision, or sight that dims or goes dark in one eye.

What can be mistaken for a tension headache? +

Migraine most often: a mild migraine can feel like a tension-type headache, and many people have both. Others are medication overuse headache, from pain relief taken on too many days; a headache from the neck (cervicogenic headache) or the jaw; morning headaches from sleep apnoea; and, much less often, raised or low pressure of the fluid around the brain or, after 50, giant cell arteritis. A brain tumour is rare, and its headache rarely comes alone. See your GP the same day for a headache that is getting steadily worse, is worse when you lie down, or is worst on waking with vomiting or blurred vision, or is new after 50, especially with a new tender scalp that does not go away or pain in the jaw when you chew. A headache that comes on when you sit or stand up and eases when you lie down needs your GP within a day or two, or, after a lumbar puncture or an epidural, the hospital or clinic that did it; if it is severe, or comes with vomiting, drowsiness or confusion, go to an emergency department. Call 000 for a headache that comes on suddenly and severely, reaching its worst within a minute, or comes with fever and a stiff neck, weakness, numbness or drooping of the face, an arm or a leg, trouble speaking, a loss of vision or a seizure, or, if you are over 50, with blurring, double vision, or sight that dims or goes dark in one eye.

Can you get a tension headache every day? +

Yes. When tension-type headaches come on 15 or more days a month for more than 3 months, it is called chronic tension-type headache, and about 2 in 100 adults have it. But a headache every day has other common causes too, especially pain relief taken too often (medication overuse headache) and migraine that has become chronic, and often more than one is present: in many countries, more than half of people with a headache on 15 or more days a month turn out to have medication overuse headache. See your GP or a neurologist to sort out which: daily headaches often improve once the causes are treated. A daily headache that is new after 50, or one that keeps getting worse, needs your GP the same day, and a headache that started on one particular day and has not stopped since needs your GP soon, the same day if it is getting steadily worse.

Where is a tension headache felt? +

Usually on both sides of the head, often across the forehead, at the temples or at the back of the head, or all over, like a tight band or a weight, and it can spread into the neck and shoulders. A headache that is always on the same side is less likely to be a tension-type headache: it can come from the neck, or be another kind of headache, and a few need checking, so see your GP.

Is a tension headache a sign of a brain tumour? +

Very rarely. In a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have a brain tumour. A tumour's headache can feel like a tension-type headache, so the feel alone does not settle it, but tumours usually cause other problems too: the headache is the only symptom in between 2 and 16 in 100 people with a brain tumour. Call 000 for weakness, numbness or drooping of the face, an arm or a leg, trouble speaking, a loss of vision or a seizure. See your GP the same day for a headache that gets steadily worse over days or weeks, is worse when you lie down, or is worst on waking with vomiting or blurred vision. If your headaches have been the same for months or years and your examination is normal, a tumour is very unlikely. These figures do not apply if you have, or have had, cancer, or have a weakened immune system: see your GP the same day about a new headache.

Do tension headaches ever go away for good? +

Often they settle. In a Danish study that followed 161 people with frequent or chronic tension-type headache for 12 years, 45% had only occasional headaches or none by the end, 39% still had frequent ones and 16% had chronic tension-type headache; having migraine as well, and sleep problems, made improvement less likely. No single treatment stops them for good, but cutting back pain relief that is taken too often, better sleep, managing stress, psychological treatment, physiotherapy, acupuncture and, when needed, a preventive medicine can each help. A headache that changes needs your GP, and one that keeps getting worse needs your GP the same day.

Important: This page is general health information for adults living in Australia and is not a substitute for individual medical advice. If you have a sudden, severe headache that reaches its worst within a minute, a very high blood pressure reading (a top number of 180 or more, or a bottom number of 120 or more) with a headache, a headache with a stiff neck and fever, confusion, a headache with weakness, numbness or drooping of the face, an arm or a leg, sudden loss of vision, double vision, slurred speech or sudden unsteadiness, a painful red eye with blurred vision, a headache that is getting worse after a head injury, a seizure, or, if you are over 50, a new headache with blurring, double vision or dimming of sight, or any other warning sign listed at the top of this page, call 000 or go to an emergency department. If you are more than 20 weeks pregnant or had a baby in the last 6 weeks and have a severe headache, blurred vision or flashing lights, go to your maternity unit or an emergency department now. Diagnosis and treatment decisions are made on an individual basis with your treating doctor.

Sources: the studies and guidelines behind this page

The international classification of headache disorders (sections 1.1, 1.3, 2, 4.1, 4.10, 6.4.1, 7.1.1, 7.2.3, 7.4.1, 8.2, 8.3.1, 10.1.4, 11.2.1, 11.3.2 and 11.7): Headache Classification Committee of the International Headache Society. Cephalalgia 2018;38:1-211. PubMed 29368949
The most common headache: GBD 2016 Headache Collaborators. Lancet Neurol 2018;17:954-76. PubMed 30353868
The US survey of 13,345 adults: Schwartz BS, et al. JAMA 1998;279:381-3 (PubMed 9459472); children and teenagers, the combined analysis of 48 studies: Onofri A, et al. J Headache Pain 2023;24:8 (PubMed 36782182).
Muscle activity and tenderness: Jensen R, et al. Electroencephalogr Clin Neurophysiol 1994;93:335-44 (the Danish study of 547 people; PubMed 7525241); Jensen R, et al. Pain 1993;52:193-9 (the Danish study of 735 people; PubMed 8455967); Bendtsen L, et al. Arch Neurol 1996;53:373-6 (the 40 people with chronic tension-type headache; PubMed 8929161); Buchgreitz L, et al. Pain 2008;137:623-30 (the 12-year follow-up; PubMed 18061350).
Triggers: Rasmussen BK. Pain 1993;53:65-72 (the Danish population study; PubMed 8316392); Lyngberg AC, et al. Am J Epidemiol 2005;161:1066-73 (the 549 people followed for 12 years; PubMed 15901627); Ødegård SS, et al. Headache 2011;51:570-80 (the Norwegian study of 15,268 people; PubMed 21457241); Mosek A, Korczyn AD. Neurology 1995;45:1953-5 (the Israeli fasting study; PubMed 7501139); Torelli P, et al. Headache 2009;49:744-52 (fasting headache; PubMed 19472450); Fernández-de-las-Peñas C, et al. Cephalalgia 2006;26:314-9 and 2007;27:158-64 (head posture; PubMed 16472338, PubMed 17257237); Holroyd KA, et al. Headache 2000;40:3-16 (the US clinic study; PubMed 10759896).
Tension-type-like headaches in people with migraine (the US study of 249 people): Lipton RB, et al. Headache 2000;40:783-91. PubMed 11135021
Brain tumours: Hamilton W, Kernick D. Br J Gen Pract 2007;57:695-9 (the UK study of family-doctor records; PubMed 17761056); Forsyth PA, Posner JB. Neurology 1993;43:1678-83 (the New York study of 111 people; PubMed 8414011).
Pain relief and dummy tablets (the UK trial of 542 people): Steiner TJ, et al. Cephalalgia 2003;23:59-66. PubMed 12534583
Medication overuse headache: Ashina S, et al. Nat Rev Dis Primers 2023;9:5 (PubMed 36732518); Diener HC, et al. Lancet Neurol 2019;18:891-902 (PubMed 31174999); Kristoffersen ES, et al. J Neurol Neurosurg Psychiatry 2015;86:505-12 (the Norwegian trial; PubMed 25112307).
Prevention: Yuan L, et al. J Headache Pain 2025;27:1 (psychological treatments, 19 trials; PubMed 41315905); Holroyd KA, et al. JAMA 2001;285:2208-15 (the US trial of 203 adults; PubMed 11325322); Nestoriuc Y, et al. J Consult Clin Psychol 2008;76:379-96 (biofeedback, 53 studies; PubMed 18540732); Verhagen AP, et al. CNS Neurosci Ther 2009;15:183-205 (PubMed 19499626); Castien RF, et al. Cephalalgia 2011;31:133-43 (the Dutch trial of 82 people; PubMed 20647241); Kamonseki DH, et al. Disabil Rehabil 2022;44:1780-9 (neck manipulation; PubMed 32924640); Tao QF, et al. Postgrad Med J 2025;101:1147-55 (exercise; PubMed 40257956); Linde K, et al. Cochrane Database Syst Rev 2016;4:CD007587 (acupuncture, 12 trials; PubMed 27092807); Spigt M, et al. Fam Pract 2012;29:370-5 (drinking more water; PubMed 22113647).
The 12-year Danish follow-up of 161 people: Lyngberg AC, et al. Neurology 2005;65:580-5. PubMed 16116119
Guidance: Australian and New Zealand Association of Neurologists, Choosing Wisely Australia recommendation on brain imaging for non-acute primary headache; National Institute for Health and Care Excellence (UK), Headaches in over 12s: diagnosis and management (CG150); healthdirect, Tension headaches; Headache Australia, Tension-type headache.

Tension Headaches?

Book a consultation with Dr Ron Granot — neurologist with a special interest in headache, Bondi Junction. Ask your GP for a referral, then get in touch.

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Emailreception@eastneurology.com.au

Last reviewed: 17 October 2026 by Dr Ron Granot, FRACP — Consultant Neurologist, East Neurology, Bondi Junction.