Tension headaches are characterised by pain in the head, scalp, or neck, commonly associated with tightness or spasm of the neck muscles. Tension headaches are common, it is thought that all adults have experienced these at some time. Tension headache is by far the most common type to headache.

The central feature of a tension headache is usually the contraction of the neck and scalp muscles, often as a response to stress, depression or anxiety and it is this neck muscle tension that leads to the pain of the headache. [This may be a slight over-simplification but is largely correct and accurate.] Causes include:

  • Anxiety and worry
  • Muscle spasm due to poor posture: prolonged sitting, prolonged use of computers, sleeping with the neck in an abnormal position etc.
  • Fatigue
  • Insomnia/difficulty sleeping
  • Eye-strain
  • Excessive alcohol or caffeine use

A tension headache is often described as a dull, pressure-like pain in any area of the head, but is often worse in the scalp, temples or back of the neck. It is often described as a “tight band” or “vice grip” across the head and it may last for several hours, or even days. The experience of tension headache can be quite variable – different people experience this in different ways.

The description of the headache is often all that is needed to make the diagnosis, but doctors may do tests (e.g. brain scans) if they suspect other causes of headache. This can be quite helpful and reassuring (the negative brain scan relives some anxiety in itself) although there is room for a balanced approach given the cost of these tests. Given that most headaches are tension headaches and that few headaches have a sinister cause, some common sense is advisable. Not every headache requires a brain scan. By all means see your doctor if you have worrying headaches, but try to take a sensible approach here.

Treatments include:

  • Rest
  • Heat applications
  • Massage
  • Dealing with sources of stress
  • Simple analgesics like paracetamol (Panado) and anti-inflammatories like ibuprofen (Brufen), which often prove sufficient
  • Prescription muscle relaxants or sedatives like diazepam (Valium), which are not routinely used, but are worthwhile when used in short courses only (which avoids potential dependency problems)
  • Counselling and psychotherapy for some people with more significant underlying mental health or emotional issues

Tension headaches are not dangerous but can cause significant distress. Many people find that these headaches recur frequently, perhaps because they are unable to make the necessary lifestyle changes.

Written by Dr Colin Burns