Tension Type Headaches: What Are They and What Can You Do About Them?

by Carien Boshoff

Tension-type headaches are one of the most common forms of headache and can affect

people of all ages. They often develop gradually and may make it difficult to concentrate,

work, exercise or enjoy everyday activities.

Many people describe them as a "tight band" around the head or a feeling of pressure

through the forehead, temples or back of the head. Although they can be uncomfortable,

tension-type headaches are generally not associated with serious underlying conditions.

The good news is that, for many people, understanding the factors contributing to their

headaches and adopting appropriate management strategies may help reduce the

frequency and impact of symptoms.

Understanding tension type headaches

Tension type headaches (TTH) are classified as a primary headache disorder, meaning

they are not caused by another medical condition. They are thought to involve increased

sensitivity of the nervous system along with muscle tenderness around the head, neck and

shoulders.

Tension type headaches can occur occasionally or more frequently. Unlike migraines,

tension type headaches are usually not associated with significant nausea or sensitivity to

light and sound, although mild sensitivity may sometimes occur.

Common symptoms may include:

• A dull, aching or pressure like headache

• A feeling of tightness or a band around the head

• Tenderness through the scalp, neck or shoulder muscles

• Mild to moderate pain on both sides of the head

• Symptoms that gradually build throughout the day

Symptoms vary from person to person and may be influenced by factors such as stress,

sleep, physical activity, posture and overall health.

Why do tension type headaches happen?

There is rarely a single cause. Instead, tension type headaches usually develop due to a

combination of contributing factors.

Muscle tension

Many people experience increased tension or tenderness through the neck, upper back,

jaw and shoulder muscles. While muscle tightness alone does not fully explain headaches,

these muscles may contribute to symptoms in some individuals.

Stress

Periods of increased stress, anxiety or emotional demands are commonly associated with

tension type headaches. Stress may influence muscle tension, sleep quality and how

sensitive the nervous system becomes to pain.

Prolonged postures

Spending long periods sitting at a desk, driving or using computers and mobile devices

may increase strain through the neck and upper back in some people, particularly if

regular movement breaks are limited.

Sleep and fatigue

Poor sleep quality, insufficient sleep and ongoing fatigue may increase the likelihood of

developing headaches or make existing headaches more noticeable.

Changes in activity levels

Sudden increases in workload, prolonged concentration or changes to physical activity

levels may contribute to headaches in some individuals.

Does movement make headaches worse?

Not necessarily. For many people, regular physical activity can be an important part of

managing tension type headaches.

Research suggests that exercise may help improve overall wellbeing, reduce stress and

improve the body's ability to tolerate everyday physical and emotional demands.

Helpful forms of exercise may include:

• Walking

• Strength training

• Swimming

• Cycling

• Pilates

• Yoga

• Other enjoyable physical activities

The goal is to gradually build consistent movement that suits your current abilities and

lifestyle.

How are tension type headaches managed?

Management varies from person to person. The aim is usually to reduce the impact of

headaches, improve function and help identify factors that may be contributing to

symptoms.

1. Exercise and movement

Regular physical activity may help improve muscle endurance, reduce stress and support

overall health.

An exercise program may include:

• Neck and upper back strengthening

• Shoulder strengthening

• General aerobic exercise

• Mobility exercises

• Gradual return to regular physical activity

2. Managing contributing factors

Looking at daily habits may help identify patterns associated with headaches.

Helpful strategies may include:

• Taking regular movement breaks during prolonged sitting

• Improving workstation setup where appropriate

• Managing workload when possible

• Developing healthy sleep habits

• Staying hydrated

• Eating regular meals

Small, consistent changes are often more sustainable than trying to change everything at

once.

3. Managing stress

Stress management looks different for everyone. Strategies that some people find helpful

include:

• Regular exercise

• Mindfulness or relaxation techniques

• Breathing exercises

• Spending time outdoors

• Talking with supportive friends, family or healthcare professionals

4. Hands-on osteopathic treatment

Osteopaths assess how the body moves and whether different areas may be contributing

to symptoms.

Treatment may include:

• Joint mobilisation

• Soft tissue techniques

• Advice regarding posture and movement

• Exercise recommendations

• Education to support self-management

Hands on treatment is generally used alongside active strategies such as exercise and self

management rather than replacing them.

5. Lifestyle factors

Overall health can influence how headaches are experienced.

Helpful lifestyle habits include:

• Regular physical activity

• Prioritising good quality sleep

• Managing stress

• Staying hydrated

• Eating a balanced diet

• Maintaining regular daily routines where possible

Do you need a scan?

Most people with tension type headaches do not require imaging.

A healthcare professional will consider:

• Your symptoms

• Your medical history

• Your physical assessment

• Whether any features suggest another cause for the headache

Scans are usually only recommended when there are features suggesting a more serious

underlying condition or when further investigation is clinically appropriate.

Conclusion

Tension type headaches are common and can have many contributing factors. Although

they can be frustrating, they are often manageable with a combination of education,

regular movement, exercise, healthy lifestyle habits and appropriate healthcare guidance.

Understanding your individual triggers and building sustainable self-management

strategies can help you stay active and reduce the impact headaches have on your daily

life.

References

Ashina, S., Bendtsen, L., Lyngberg, A. C., Lipton, R. B., Hajiyeva, N., & Jensen, R. (2021).

Prevalence of tension-type headache and its associated burden. The Journal of Headache

and Pain, 22(1), 24.

Bendtsen, L., Sacco, S., Ashina, M., Terwindt, G. M., Mitsikostas, D. D., Ahmed, F., Pozo-

Rosich, P., Martelletti, P., & European Headache Federation. (2020). Guideline on the treatment of tension-type headache. The Journal of Headache and Pain, 21(1), 1–15.

International Headache Society. (2018). The International Classification of Headache

Disorders (3rd ed.). Cephalalgia, 38(1), 1–211.

National Institute for Health and Care Excellence. (2021). Headaches in over 12s:

Diagnosis and management (Clinical guideline CG150). https://www.nice.org.uk/guidance/cg150

World Health Organization. (2024). Headache disorders. https://www.who.int/news-room/fact-sheets/detail/headache-disorders