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Tension headache

Written by Caidr's team of doctors and pharmacists based in UK | Updated: 04.01.2023 | 12 min read
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A tension headache is the most common type of headache and feels like a tight band has been wrapped around your forehead, causing a constant ache to the sides of the head. Your neck or shoulders might feel tight and tender and a dull ache or pressure can build up behind the eyes.

It’s commonly referred to as a stress headache for good reason – it comes at the busiest or most stressful times. While frustrating, for most people it’s mild enough for them to be able to continue with everyday activities.

In medical terms, it’s known as a primary headache which – put simply – means that there is no underlying medical condition causing it. It may last between 30 minutes and a few hours. More rarely, some people get a chronic tension-type headache that can last for much longer, or come and go for days within a flare-up period.

Most describe tension headaches as mild and short-lived. Many feel better after a sleep or a warm bath, and tension headaches usually respond well to simple painkillers like paracetamol or ibuprofen. Let's talk you through how to shake off a tension headache and how to avoid triggers in future.

Causes and triggers

The exact mechanism that creates a tension headache is unknown, but certain triggers may play a role.

Stress and anxiety

Tension headaches often occur at the end of a hectic day, or at just the time when you feel yourself pulled in several directions at once. As stress and anxiety mounts up, our neck and scalp muscles tighten, which brings with it a tension affecting the head: a tension headache.

Inactivity and working from home

Poor posture or a sedentary lifestyle can certainly contribute to a tension headache, as pain builds up in the muscles in the back of the neck while you’re stooping at your desk all day and straining to look at your laptop.

Poor eyesight

Squinting not only tires your eye muscles as they try to focus, and your brain as it tries to make sense of images or text, but if you’re working at a computer or reading, you will be leaning forward to try to decipher what you’re seeing, and this poor posture adds further to neck strain and tension headache.

If it’s been more than a year since you saw an optician, it’s worth booking an eye test.

Sense of smell

Certain smells can contribute to a tension headache, such as a particularly pungent perfume from your work colleague.

Noisy environments

Any bothersome constant noise can bring on a headache – at the extreme end of the spectrum is that pneumatic drill outside your office, but even the low persistent buzzing from a fluorescent light can do the same.

Tiredness

This can often go hand-in-hand with the wakeful nights related to stress. Getting a good night’s sleep will help you better process any stressful or hectic times, and will rest your brain to be prepared for the next day.

Dehydration

If exercise or a hot climate has you sweating, you will have lost water, and this can cause headaches, as the brain has a large water component, and this can deplete even with mild dehydration. Sweating can also cause loss of important salts like sodium, which, when low, can add further to a headache.

External compression

It sounds trivial, but if you’re getting regular tension headaches, especially at the end of the day, just check that your ponytail isn’t pulled too tight, causing the scalp to stretch and bringing on a tension headache. Any tight restrictive device can cause a headache, such as tight swimming goggles, a headband or a hat, especially if elasticated or too small.

Caffeine withdrawal

While most of us don’t feel right without our first coffee or tea in the morning, some people fall into the excessive use category, and their bodies can become reliant on caffeine. If they have to go without, their body goes into withdrawal, causing symptoms like tension headache, nausea and tiredness.

How can I tell it apart from other headaches?

Migraine

This causes a severe throbbing or pulsating headache, usually around one temple. Many self-diagnose migraine thinking it describes a severe headache, but certain criteria need to be present to make the clinical diagnosis.

A migraine causes sensitivity to movement, noise, light or smells, and prevents you from carrying out normal activities. It’s common to feel or be sick, and symptoms are eased by laying down in a dark quiet room. Some sufferers experience an aura – a warning that a migraine is about to happen – which can be flashing lights, numbness, tingling, dizziness or muscle weakness.

Medication overuse headache

This is an over-reliance on headache medication, and you get a withdrawal headache on the days you don’t take painkillers. Unfortunately the treatment for medication overuse headache is to avoid all painkillers, including over-the-counter ones, for a few weeks or months, and then restrict use – it's usually best to plan this out with your doctor.

Cluster headache

This is relatively rare, where you get an excruciating pain over one eye and often extending to the temple and cheek, with many describing it as a piercing or burning pain. The eye often becomes red and watery and the eyelid might droop or swell. It can last minutes to hours, but a cluster headache can keep recurring over the day, and continue for several days or weeks in a row. Men are more often affected, and these usually start in the 30s to 40s. You should see your doctor the first time you get one of these, and you may be referred to a neurologist for treatment options.

Sinus headache

This is one of the symptoms of sinusitis, an infection that causes a deep throbbing pain and a feeling of pressure radiating from the bridge of the nose to the cheeks and the middle of the forehead. It goes alongside a blocked or runny nose and possibly fevers. For most, this infection clears in 2 to 3 weeks, but some with chronic sinusitis find this headache persists for several months.

Hormone changes

Women are more likely to suffer from tension headaches and migraines in general, and many experience this with hormone changes, such as before or during menstruation and during the menopause. Pregnancy may bring on worse or more frequent headaches and migraines.

Infection

Certain viral infections including the flu and COVID-19 can affect multiple body systems, and a headache is one symptom along with body or joint aches and pains, a cough, a runny or blocked nose, a sore throat, fever and feeling run-down or exhausted. The headache will improve once your body has fought off the virus.

Is it something serious?

Brain tumour

Brain tumours always seem at the forefront of most people’s minds with new headaches, and while a scary prospect, it's actually fairly rare in adults. Signs to look out for alongside headaches include having a seizure or fit, persistent nausea or vomiting, progressive weakness or numbness on one side of the body, or persistent unsteadiness or lack of balance, problems with your speech, problems with cognition like memory or word-finding ability, a personality change or behavioural problems. These are all reasons to see your doctor urgently.

Metastatic cancer

Unfortunately cancers can spread to other parts of the body, and the brain is one of these target organs. The most likely of these cancers originate in the lung, breast, kidney, skin (as melanoma) or bowel, so if you have new headaches and have been diagnosed with any of these, see your treatment team or doctor with urgency.

Brain bleeds

The head is well protected by the hard bone of the skull, but it’s still vulnerable to damage from knocks and injuries. You should consult a doctor for any significant knocks, in case of fracture or intracranial bleeding.

The lining of the brain can bleed over days to weeks, so you should see a doctor even if a mild injury, if your new headaches persist for up to 3 months afterwards, especially if they are getting worse, as this could indicate a subdural haemorrhage.

A headache that starts suddenly, and builds up to the worst headache you’ve ever experienced within 5 minutes, could indicate a subarachnoid haemorrhage and needs immediate medical attention.

Some people are born with a Budd-Chiari malformation, where blood vessels in the brain form in an irregular way. This may only become apparent in adulthood, when you notice that any brief pressure build-up in the head causes a headache, such as straining for a poo, coughing, sneezing, exercising or bending over. You should see your doctor in this case.

Intracranial hypertension

This is a build-up of pressure around the brain, which may be the result of a severe head injury or a stroke, in which case it will come on suddenly. Rarely it can come on gradually and persist, making you feel sleepy, confused or irritable, and nauseous. It will worsen if you change your head position, like getting up in the morning or looking at something on the bottom shelf, or if you’re coughing or straining. The same movements might cause a temporary change to vision, like you’re blacking out.

Brain infections

Rarely you can get infections in the brain itself or the brain lining, such as meningitis or encephalitis, in which case you will feel feverish, have neck stiffness and pain and you may have a rash. Those who are immunocompromised with HIV or other conditions occasionally suffer a brain abscess. These conditions require immediate medical attention.

Treatment: home or drug-free

Once we’ve understood the causes of a tension headache, we can build up an artillery of treatments to either stop them once they’ve arrived, or prevent them from happening in the first place. If your tension headache is mild, you may prefer to stick to natural remedies and avoid medication. Similarly, these suggestions can be used alongside medication to maximise benefits, with no added risk to you.

Hydration

Dehydration can cause or worsen a tension headache, so it’s important to keep fluid levels topped up, especially if exercising or in hot weather. If you think conditions are causing you to lose lots of fluid, it may help to top up with oral rehydration salts to replace the lost electrolytes, like sodium, alongside sweat.

Cold pack

A cold pack, such as a bag of frozen peas wrapped in a tea towel, can help relieve a headache if applied to the point of pain in the head, such as the temple. Don’t exceed 20 minutes with this technique, or you might start to compromise circulation to the skin.

Warm compress

It’s trial and error, but some prefer a warm compress or heat pad to a cold pack. This is especially effective during a tension headache if applied to the neck or back of the head, and can be a hot water bottle (only leave it on for 20 minutes at a time or you risk getting a rash) or a wheat bag that you can heat in the microwave.

If you don’t have a compress to hand, some find that an ointment that generates a feeling of heat, such as Tiger Balm, helps to alleviate pain when applied to the temples, and some become primed to the distinctive smell as a healing aid even before it’s applied, which magnifies the healing power by using positive aromatic memories.

Magnesium

Some studies have suggested magnesium supplements can help prevent or end a tension headache. An article in the Nutrients journal in 2020 looked at published evidence in magnesium studies, and found it may be beneficial for some with moderate tension headaches, if the sufferers are deficient for any reason, but they concluded that more research is needed. So it may not work for everyone, but given that standard supplements are relatively safe and well-tolerated, it might be worth trying this.

Exercise

Here at Caidr, we are big activity fans, helping mind and body perform at their best. With tension headaches, any exercise – walking, running, swimming, cycling – will help blood flow to the muscles and brain to help overall. Any exercise session – defined as where you get out of breath and your heart rate goes up for at least 30 minutes – will release a wave of feel-good endorphins, which help to counteract stress. Core strengthening and conditioning can also help to improve posture and make the spine more healthy, hopefully at the same time releasing neck muscles and reducing tension build-up.

Stress

Yoga or pilates falls into our exercise category, building up the core muscles that include the paraspinal muscles, alongside the spine, and stretching out muscles so they feel more free. Stress is one of the biggest underlying factors in tension headaches, and it’s important to build in stress reduction techniques to your every day – you will know what’s best for you, but some ideas include meditation or mindfulness, listening to music, having a dance to disco around your kitchen or a good laugh with friends or family.

Sleep

Sleep is hugely important to regulating energy, emotions and stress levels, as well as physical rest. Routine is key, maintaining similar hours of bedtime and waking, regardless of weekday or weekend, and if you need to catch up, your body much prefers an earlier bedtime to a lie-in in the morning.

Mouth guard

It’s really common for people to grind their teeth in their sleep, especially if restless or stressed, and your dentist may see signs of this. This can add to a tension headache and jaw or neck muscle tension. If you think this applies to you, you can buy a simple mouth guard to wear at night, or your dentist can tailor-make one, protecting your teeth, aiding sleep and hopefully preventing headaches.

Caffeine

There’s evidence that caffeine – found in tea, coffee, cola and caffeinated energy drinks – may help chase a tension headache away. As doctors, we even advise it after a certain procedure on the spine that can bring on headaches (a lumbar puncture). But it’s a little of what you fancy – if you are a regular caffeine user, your body becomes reliant on it, and you can get a caffeine withdrawal headache if you cut out your daily dose.

Peppermint

Some find a peppermint tea can help to relax and unwind, but a team of German researchers in 2016 found that peppermint oil rubbed into neck muscles may also help them to relax and alleviate pain. Some enjoy the cooling sensation of menthol when rubbed into the temples, and it’s possible that the aroma of peppermint tea has a similar effect.

Anti-glare computer screen and lighting

If you’re spending hours at your computer, the flickering light of the screen may be contributing to headaches, along with the poor posture we’re all guilty of. So address your work station to make sure you’re at maximum comfort while maintaining a good and supported posture, and consider adding an anti-glare device to reduce flicker from the screen. Swap out any flickering fluorescent strip lighting, while you’re at it, and consider exchanging harsh white-blue spectrum lights with soft, warm white lights, which are more restful to the eye.

Pharmacist recommended products

Tension headache Health Kit
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Herbal pain relief
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Locally acting massage balm
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Warming pain relief
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Relax tense neck & shoulder muscles
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Replenish electrolytes
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Restore fluid balance
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Prevents dehydration
More info
£23.26
Recommended by Caidr pharmacist
Why this Health Kit

Tension headaches are usually described as mild and last from 30 minutes to a few hours. However, it can feel different when you experience one for yourself, bringing on pain and tenderness in the head, neck and shoulders, and it feels difficult to concentrate on ordinary tasks. While it’s comforting to think it will go away eventually, it's useful to find certain medications that can help.

This Health Kit aims to:

  • Reduce headache and neck and shoulder pain

  • Provide soothing relief of forehead, temples, and neck muscles with either heat or cold.

  • Restore electrolyte and fluid balance to help you recover.

Nuromol contains two active ingredients: ibuprofen and paracetamol. Ibuprofen is an anti-inflammatory pain reliever from a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs). Paracetamol is another type of pain reliever that works differently from ibuprofen to relieve pain. This is a powerful combination of two active ingredients in the same tablet is very effective for many kinds of pain, including tension headaches, and gets to work from the inside out.

When you are stressed, tired, overworked or have poor posture, your neck and shoulders carry the strain, and this can bring on tension headaches. Inspired by centuries of Chinese wisdom and containing a unique blend of herbal ingredients, Tiger Balm White Ointment is a proven, safe and effective herbal ointment for treating tension headaches. It targets aching and painful areas to soothe muscles and ease away any headache. Each little jar is a powerful drug-free treatment, and with use over time, the distinctive smell can prompt aromatic memories that help to heal before you’ve even put it on.

Deep Heat Pain Relief Patches uses penetrating heat to relax stiff and aching neck and shoulder muscles that have got knotted up with tension. Healthcare professionals recognise and recommend heat therapy for muscular pain and stiffness. Therapeutic heat from the patch delivers target pain relief right where you need it, working from the outside in, while pain relief medications deliver relief from the inside.

O.R.S. Hydration tablets can help replenish fluid and electrolytes, reversing any dehydration or electrolyte imbalance that may have caused your tension headache. The lemon flavour also contains vitamin B2 (riboflavin), which can help boost energy levels.

Using the products in this Health Kit together, with different modes of action, can help alleviate the pain and discomfort of tension headaches and rebalance electrolyte and fluid balance, helping you to get on with your day.

Note: Always read the information leaflets and specific product information before purchasing, as some products may not be suitable for all patients. This may be especially true if you take any other medicines or suffer from other medical conditions. If you are unsure about anything, please speak to your local pharmacist, doctor, or another qualified health practitioner.

What medications should I use to relieve a tension headache?

You don’t usually need to see your doctor for the management of a tension headache. Instead, you can buy medications from your pharmacy. Paracetamol or ibuprofen can be very effective either on their own or in combination. Codeine or other opioid painkillers are not usually recommended.

For the treatment of headaches, painkillers should only be used for a short period of time.

This is because taking painkillers over a long period (usually 10 days or more) may conversely lead to medication-overuse headaches developing. This happens when your body gets used to the painkiller and when you stop, the headache returns or gets worse.

When should I see a doctor?

Most people experience headaches from time to time, and they are rarely a sign of something serious. However, there are certain symptoms and signs that can alert us to underlying causes that may need further examination and investigation. You should see a doctor urgently if you have any of the following:

  • a new headache that feels different in location or intensity to your usual headache, especially for those over 50
  • a new headache that came on suddenly and feels like the worst pain you’ve ever experienced
  • a headache with sudden loss of vision or you have persistent visual changes despite a recent eyesight test
  • a headache with any persistent weakness or numbness in your arms or legs or lack of balance
  • a headache with fever, vomiting, neck stiffness, drowsiness or rash
  • a headache with a new seizure or collapse
  • a headache with any drowsiness or altered consciousness, especially if household members have the same
  • a headache with any change to thinking or behaviour, or any change in personality
  • a headache following any type of head injury, even if days later (or up to 3 months), but persistent and worsening
  • a headache in your final trimester of pregnancy or up to 6 weeks after birth, especially with known high blood pressure or ankle swelling
  • a headache triggered by coughing, sneezing, bending or exertion

Other reasons to visit your doctor are if you're suffering headaches on a regular basis and they are having a significant impact on work, studies or family life, if you are requiring pain relief for headaches at least 5 times a week, most weeks, if you experience visual symptoms such as aura for the first time, or you have a painful red and watery eye without diagnosis.

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