Tension-type headache is the most common type of headache. It usually feels like a dull, pressing or tight band around both sides of the head, and it does not normally come with sickness or worsen with routine activity. Most people can manage it well with simple painkillers used sparingly, regular exercise and attention to triggers such as stress and poor sleep.
Also known as tension headache, stress headache
Symptoms
- A dull, pressing or tightening ache, often on both sides of the head
- A feeling of a tight band around the forehead or back of the head
- Mild to moderate pain that lets you carry on with daily life
- Tender muscles in the neck, shoulders or scalp
- Usually no nausea or vomiting, and it is not made worse by walking or climbing stairs
- Episodes lasting from 30 minutes to several days
Causes and risk factors
- Stress, anxiety and feeling under pressure
- Poor or irregular sleep
- Long periods in one position, such as at a desk or driving
- Missed meals or not drinking enough fluids
- Low levels of physical activity
- Taking painkillers too often, which can cause medication overuse headache
What the evidence says helps
- NICE guidance recommends considering aspirin, paracetamol or an anti-inflammatory such as ibuprofen for an episode, and advises against opioid painkillers such as codeine. Using painkillers on many days a month can itself cause headaches, so it is worth talking to a pharmacist or GP if you need them often.1
- For chronic tension-type headache, NICE guidance suggests a course of up to 10 acupuncture sessions over 5 to 8 weeks may be considered.1
- A network meta-analysis of physiotherapy trials found that combining hands-on techniques, such as joint mobilisation, with exercise was among the most effective approaches for reducing how often headaches happen in the short term. Confidence in these findings was low to moderate, and longer-term effects are less clear.3
- A systematic review of trials in people with chronic tension-type headache found that exercise programmes generally reduced pain more than usual care, although the number of good-quality studies is still limited.4
- Keeping a headache diary can help you and your clinician spot patterns, triggers and how often you are using painkillers.1
Things you can try at home
- Keep a simple diary of headaches, sleep, stress, meals and painkiller use for a few weeks
- Build regular movement into your day and take short breaks from screens and desk work
- Aim for a regular sleep routine and try not to skip meals
- Try relaxation, breathing exercises or a walk when you feel tension building
- Limit painkillers to fewer than 10 to 15 days a month unless your GP advises otherwise
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Call 999 for a sudden, severe headache that peaks within about 5 minutes (a 'thunderclap' headache)
- Call 999 if a headache comes with weakness, numbness, slurred speech, confusion or loss of vision
- Get urgent help (NHS 111 or A&E) for headache with fever, a stiff neck or a non-blanching rash
- See a GP urgently if a headache follows a head injury, or is triggered by coughing, sneezing or straining
- See a GP urgently if you are over 50 and have a new headache with scalp tenderness, jaw pain when chewing or changes in vision
- See your GP if your headaches change pattern, are getting steadily worse or wake you from sleep
How Apollo can help
Our osteopaths take a detailed history to check your symptoms fit a tension-type pattern and to look for anything that needs referral to your GP. We assess your neck, shoulders and daily routines, explain what may be contributing, and may use hands-on care alongside a tailored exercise programme. We can also support you with activity, desk set-up and stress-related tension, working with your GP where medication or other care is needed.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How do I know if my headache is a tension headache or a migraine?
Tension-type headache is usually a pressing ache on both sides of the head that lets you carry on with daily life. Migraine is often throbbing, may be on one side, and commonly comes with feeling sick or sensitivity to light and noise. If you are unsure, your GP can help make the diagnosis.
Can neck and shoulder tension cause headaches?
Many people with tension-type headache have tender neck, shoulder and scalp muscles, and stress and long periods sitting can make things worse. Research suggests that combining hands-on care with exercise may reduce how often headaches happen for some people, although the evidence is still developing.
Can taking painkillers too often make headaches worse?
Yes. Using painkillers on many days each month can lead to medication overuse headache. NICE guidance advises that this is managed by stopping the overused medicines with support from a GP.
References
- National Institute for Health and Care Excellence (2012, last updated 2025). Headaches in over 12s: diagnosis and management (CG150). NICE. View source
- Stovner LJ, Hagen K, Linde M, Steiner TJ (2022). The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. The Journal of Headache and Pain. View source
- Jung A, Eschke RC, Struss J, Taucher W, Luedtke K (2022). Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache: a systematic review and network meta-analysis. Cephalalgia, 42(9), 944–965. View source
- Río CJP, Monti-Ballano S, Lucha-López MO, Hidalgo-García C, Tricás-Moreno JM (2025). Effect of exercise on chronic tension-type headache and chronic migraine: a systematic review. Healthcare (Basel). View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
