Tension-Type Headache (Stress Headache)

Overview

Tension-type headache is a very common type of headache. It usually feels like a dull, pressing or tightening ache — often described as a tight band or a heavy weight — across the forehead, the temples or the back of the head, on both sides. It is typically mild to moderate: most people can carry on with work or study, and it is not usually made worse by walking or climbing stairs. An episode may last from half an hour to several days. When headaches happen on 15 or more days a month for several months, doctors call it chronic tension-type headache.

It is different from the other headaches on our site. Migraine is usually throbbing, often one-sided, and comes with nausea or sensitivity to light and sound. Cervicogenic headache starts in the neck, is mostly one-sided, and is brought on or changed by neck movement. Tension-type headache is the steady, both-sided "band" headache without those features — although many people have a mix, which is why a careful history matters.

The exact cause is not fully understood. The muscles of the scalp, neck and shoulders are often tender, and the nervous system becomes more sensitive during periods of stress, poor sleep and long hours at a screen. Many people find that easing muscle tension, improving their desk set-up and sleep, and managing stress may help reduce how often headaches come. Outcomes vary from person to person.

Causes and risk factors

• Stress, anxiety and busy periods such as exams, deadlines or a new job
• Poor, short or irregular sleep
• Long hours at a desk, laptop or phone with the head held forward
• Tight, tender neck, shoulder and scalp muscles
• Jaw clenching or teeth grinding, often linked to stress
• Skipped meals, not drinking enough water and changes in caffeine intake
• Taking painkillers on many days each month, which can itself lead to medication-overuse headache

How we may be able to help

Assessment comes first. We take a careful headache history — how often the headaches come, where they are felt, what sets them off and how much pain relief you use — to check that the pattern fits tension-type headache rather than migraine, cervicogenic headache or something that needs medical attention. We examine neck and upper back movement, feel for tender areas in the neck, shoulder and jaw muscles, and look at your posture and desk habits. If your headaches are frequent, have changed, or you are taking pain relief on many days, we ask you to see your GP and can arrange an online private GP consultation if that is quicker.

Our physiotherapists combine soft-tissue work and gentle mobilisation of the neck and upper back with a programme of deep neck and shoulder blade strengthening, desk set-up advice and simple relaxation and breathing techniques. Evidence suggests that exercise and manual therapy may help some people reduce how often and how strongly tension-type headaches occur. Dry needling or acupuncture can be used for tender trigger points in the neck and shoulder muscles, and cupping and IASTM may help ease broader muscle tension across the shoulders and upper back.

Where neck or upper back stiffness is contributing, our chiropractor can mobilise or manipulate those segments if assessment shows it is suitable. A 3D posture scan can show how far forward your head sits relative to your shoulders, which helps target your exercises and workstation changes.

What you can do at home

• Keep a headache diary noting sleep, stress, screen time, meals, caffeine and any pain relief taken
• Aim for regular sleep and meal times, and drink water through the day
• Set your screen at eye level and take a short movement break every 30 to 45 minutes
• Do gentle shoulder rolls, chin tucks and neck stretches a few times a day
• Use a warm pack on the neck and shoulders, and try slow breathing or a short walk when tension builds
• Talk to your GP if you find yourself needing pain relief on more than a few days a week