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Tension headache

Tension-type headache, also known as tension headache, is the most common form of primary headache, with a prevalence estimated globally at around 46–80% over a lifetime. So, it's quite likely that you have experienced or are experiencing tension-type headaches. You may have also heard of idiopathic headache (unknown cause) or stress headache. Both terms essentially refer to the same thing as tension-type headache.

What does tension-type headache feel like? The most typical symptom of tension-type headache is a band-like/pressing headache on both sides of the head, such as around the temples, which can last from 30 minutes to 7 days. The headache usually begins during the day and may worsen towards the evening. The location of the pain is significant because typically, headaches caused by migraines are unilateral. In migraines, the headache is also usually much more intense than in tension-type headaches. Often, there is also tenderness in the muscles of the head when palpated, such as in the neck or temples. In addition to the headache, you may experience mild nausea, sensitivity to light or sound if tension-type headache persists (lasting over 3 months). Tension-type headache usually doesn't worsen during normal physical activities, unlike migraines. The frequency of headache episodes varies greatly among individuals, which is why tension-type headaches are classified into four different categories based on the duration and frequency of headaches:

  1. Infrequent episodic tension-type headache

  2. Frequent episodic tension-type headache

  3. Chronic tension-type headache

  4. Probable tension-type headache

What causes tension-type headache? Currently, the exact causes of tension-type headaches are unfortunately not known, but it is believed that factors such as stress, unfavorable nervous system function, and different tension states in the muscles surrounding the head and neck may be involved. In chronic tension-type headache, the sensitization of the central nervous system's "pain pathways" also plays a role. However, in this text, I won't delve further into chronic headaches. Additionally, studies have found that individuals with tension-type headaches have more sleep problems compared to those without headaches.

How is tension-type headache treated? Acute tension-type headaches should ideally be treated without medication, and typical treatment measures at the osteopath's office include therapeutic exercise and various manual therapy techniques, some of which patients may find helpful (massage, acupuncture, joint mobilizations, etc.). The patient is thoroughly examined because, in addition to tension-type headache, other types of headaches may also be present. Healthy lifestyle habits such as exercise, good nutrition, and adequate sleep are also always important. Various relaxation techniques may also be worth trying. Tension-type headaches often come and go quickly and may not necessarily require any specific treatment. Traditional over-the-counter medications such as ibuprofen are usually used for medication treatment. However, caution should be exercised with self-medication, as excessive use of painkillers can lead to so-called medication-overuse headaches. If you feel that you can't control your headaches, it's advisable to seek help from a healthcare professional.

Ilari Keckman

Osteopath, sports massage therapist, educator

Flexus Terveyspalvelut Oy


1. Scripter C. Headache: Tension-Type Headache. FP Essent. 2018 Oct; 473:17-20. PMID: 30346680.

2. Kahriman, A., & Zhu, S. (2018). Migraine and Tension-Type Headache. Seminars in Neurology, 38(06), 608–618. doi:10.1055/s-0038–1673683

4. Cho, S.-J., Song, T.-J., & Chu, M. K. (2019). Sleep and Tension-Type Headache. Current Neurology and Neuroscience Reports, 19(7). doi:10.1007/s11910-019-0953–8

5. Jensen, R. H. (2017). Tension-Type Headache - The Normal and Most Prevalent Headache. Headache: The Journal of Head and Face Pain, 58(2), 339–345. doi:10.1111/head.13067


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