Tension-type headache

What it is

Tension-type headache is a pressing or tightening pain, usually on both sides, mild to moderate, and not made much worse by ordinary activity. That last part is what separates it from migraine, which typically has you looking for a dark room.

The muscles involved are the upper trapezius, the suboccipitals at the base of the skull, sternocleidomastoid and temporalis at the temple. Held at a low-level contraction for hours, they develop tender points that refer pain in predictable patterns - and over time the pain system itself becomes more sensitive, so the same muscle tension produces more headache.

What it feels like

• A band or vice around the head, or pressure at the temples and the back of the skull
• Both sides rather than one
• Dull and pressing, not throbbing
• Builds through the day, particularly on desk days and stressful days
• Tender to press at the base of the skull, the temples and the top of the shoulders

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Sustained low-level muscle contraction

Muscles holding a light contraction for hours never fully relax. Blood flow falls, metabolites build up and the muscle becomes tender - and these particular muscles refer their pain into the head.

Trigger points in the neck and shoulders

Tender bands in upper trapezius and the suboccipitals produce a well-mapped referred pattern - up the back of the head, behind the eye, around the temple - that is felt as a headache rather than as neck pain.

Forward-head posture at a screen

The further forward the head sits, the harder the muscles at the back of the neck work to hold it. That work is continuous, which is exactly the input this headache is made of.

Jaw clenching and teeth grinding

Temporalis and masseter are powerful muscles, and clenching through a stressful day or a night of grinding loads them for hours. Temporalis refers directly into the temple.

Stress and sustained sympathetic tone

Stress raises resting muscle tone across all of these muscles at once, and lowers the threshold at which the resulting signal is felt as pain. This is why the headache and the stressful fortnight arrive together.

Poor or short sleep

Sleep loss both raises muscle tension and lowers pain thresholds. It is one of the most consistently reported triggers, and it is a two-way street with the headache itself.

Dehydration, missed meals and caffeine swings

All three are common, all three are easily corrected, and caffeine in particular cuts both ways - a regular intake missed by a few hours is a reliable trigger.

Eye strain and an uncorrected prescription

Squinting, an out-of-date prescription or a screen that is too bright or too dim recruits the muscles around the eyes and forehead all day.

Medication-overuse rebound

Taking painkillers for headache on more than about ten to fifteen days a month can itself produce a daily headache. This is common, it is under-recognised, and it will not respond to anything else until the pattern is broken.

A sensitised pain system

In people with frequent headaches the muscles are often no more tense than anyone else's - the difference is in how strongly the signal is amplified. This is why treatments aimed only at the muscle sometimes disappoint.

Who tends to get it

• Desk and screen workers, particularly through a stressful stretch
• People who clench or grind their teeth
• Anyone sleeping badly or irregularly
• Regular users of over-the-counter painkillers for headache, who are at risk of the rebound pattern
• People with existing neck pain, which very often carries the headache with it

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineTension Headache Relief

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Thunderclap onset; first severe headache after 50; fever with stiff neck; neurological deficit; worse when lying flat; wakes from sleep

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Individual headaches settle in hours; the useful question is frequency, and that usually improves over six to twelve weeks of neck strengthening, better screen habits and better sleep. If headaches are happening on more days than not, or painkillers are being used most days, the rebound pattern is likely and needs breaking before anything else will work - that is worth a conversation with a clinician rather than another treatment.

Prevalence basis: Meta-analysis of population-based data from 41,614 adults across 17 countries

Others the same routine covers

These share the Tension Headache Relief routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.