Tension-type headache
Why do I get a tight, band-like headache?
The most common type of headache: a pressing ache on both sides of the head. Non-drug treatments, including physiotherapy, can help.
What it feels like
A pressing or tightening ache, like a band around the head, usually on both sides, mild to moderate, and not made worse by routine activity. It does not usually come with nausea. Some people have it occasionally; others on many days each month.
What is actually happening
Tension-type headache is the most common type of headache. Its causes are not fully understood, but increased sensitivity of the pain system, muscle tenderness around the head and neck, stress, poor sleep and long periods in one position are all linked to it. It can occur alongside migraine or headaches from the neck, which is why the headache pattern is assessed carefully.
When to see a doctor urgently
Seek urgent medical care for a sudden, severe headache that peaks within seconds or minutes, a headache after a head injury, a new headache with fever and a stiff neck, or a headache with weakness, numbness, confusion, or changes in vision, speech or balance. See your doctor promptly for a new headache pattern after the age of 50, headaches that are steadily getting worse, or if you are taking pain medication for headaches on many days each month.
How it is assessed
Assessment includes a detailed headache history and diary, screening for the warning signs above, and examination of the neck, jaw and the muscles around the head and shoulders, which are often tender in tension-type headache.
How it is treated
The European (EFNS) guideline on tension-type headache recommends non-drug management, including relaxation and biofeedback, and notes that physiotherapy and acupuncture may be useful options for frequent tension-type headache, although the evidence is limited. A 2022 systematic review found that physiotherapy interventions such as exercise and manual therapy can reduce headache frequency and intensity, and a Cochrane review found that acupuncture can reduce how often tension-type headaches occur. Treatment combines neck and shoulder exercise, hands-on treatment, acupuncture where suitable, and practical work on posture breaks, sleep and stress.
What to do first
Keep a headache diary for two to four weeks, take regular movement breaks from screens, and look at sleep and stress. If headaches are frequent, have them assessed, and speak to your doctor about medication use.
Where this is assessed
- Athlete's Care Sports Medicine Centres Yonge & Eglinton · Mon/Wed/Fri · 8:00 AM – 2:00 PM Book at Athlete's Care
- Push Pounds Sports Medicine Downtown Toronto · Tue/Thu · 8:30 AM – 6:30 PM Call Push Pounds to book
- Country Lane Physio Home office & virtual · Sat · By appointment only Message me to book
References
This page is based on the following clinical practice guidelines and research.
- Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010;17(11):1318-25.
- Jung A, Eschke RC, Struss J, et al. Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache. A systematic review and network meta-analysis. Cephalalgia. 2022;42(9):944-965.
- Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016;4(4):CD007587.