Tension headaches

Most people are acquainted with tension headaches: nagging, pressing pain in the head that occurs now and then. They are not a reason to worry and can be relieved with non-prescription painkillers. To prevent them, endurance sports or relaxation exercises may be useful.

At a glance

  • Headaches are often so-called tension headaches: more than 40% of people have these repeatedly.
  • They are nagging, pressing headaches that can be mild to moderate.
  • Tension headaches are less severe than migraines or cluster headaches.
  • It is not known what causes them. But triggers for the pain such as stress are often identified.
  • Anyone who feels severely affected can relieve the pain with non-prescription painkillers.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Tension headaches: older woman leaning on a rail clutching her forehead with one hand. The woman looks exhausted.

What are tension headaches?

Tension headaches are very common. Many people are acquainted with the nagging, pressing headaches and experience them sometimes. 

Contrary to what the name suggests, they are not normally caused by muscle tension. Their cause is still unexplained. Because they are not the result of another illness, tension headaches like migraines and cluster headaches are known as primary headaches. 

Compared to migraines or cluster headaches, they are less severe but can still be debilitating – especially if they last for an extended time. 

Anyone feeling severe adverse effects can take non-prescription painkillers. However, this should not become a habit. Specifically, if these are taken too often or regularly, the headaches may become more frequent. 

What are the most common types of headache?

The video below outlines the most common types of headache and how they are expressed.

This and other videos can also be found on YouTube

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What are the symptoms of tension headaches?

Most people experience tension headaches as nagging and pressing. For many, their entire head hurts, while for some their forehead in particular is painful. However, the pain can also feel like an oppressive ring around the skull – rather like wearing a hat that is too small.

Tension headaches can just be mild, but also moderate. The duration varies from a few minutes up to a week in some cases. They do not get worse with physical activity such as exercising or climbing stairs. Unlike migraines for instance, there are no accompanying symptoms such as sensitivity to light or nausea.

What are the causes of tension headaches?

The cause of tension headaches is still unknown. However, certain triggers for pain can sometimes be observed, like stress for example.

Tension headaches are common in some families. Many illnesses like depression also appear to increase the risk of headaches.

How common are tension headaches?

Tension headaches are very common. Nearly everyone probably experiences them during their life. More than 40% of people have them repeatedly. For about one out of 100, the symptoms are very common over an extended period of time or even remain in the long term.

More than 40% of people have recurrent tension headaches.

People of any age can have tension headaches. But they usually occur for the first time in young adults. They are somewhat more common in women than men.

How do tension headaches develop?

Most people affected by headaches have them sporadically. Experts refer to this as episodic. 

If the symptoms occur very frequently over a longer period of time, doctors call these chronic tension headaches. They are diagnosed if the pain:

  • occurs for 3 months in succession on 15 or more days per month
  • is present on more than 180 days per year
  • lasts for hours or remains constant each time

How are tension headaches diagnosed?

It is sensible to make a doctor’s appointment for headaches that occur repeatedly. With questions and a physical examination, the doctor can determine whether they are tension headaches. Among other things, muscle power and sensory perception are checked as part of a neurological examination. This should rule out the possibility that another illness is causing the pain. If this cannot be done beyond doubt, other examinations may follow.

How are tension headaches treated?

Those who only have mild headaches usually do not need any drugs. Some people find it helpful to dab peppermint oil on their forehead, temples or neck, or go for a walk in the fresh air.

Tension headaches can be treated with peppermint oil on the forehead or temples, over-the-counter painkillers, going for a walk in the fresh air.

Anyone who wants to relieve pain with drugs can take non-prescription painkillers (analgesics) from a drugstore. But these can also have side effects and cause stomach problems for instance. Moreover, if painkillers are taken too often, the headaches may become more common.  

To prevent tension headaches in the long term, endurance sports or relaxation exercises may be useful. 

More detailed information, for example on which drugs are helpful for tension headaches, is available at gesundheitsinformation.de.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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