Tension headache

Tension headaches usually feel like a dull pain with pressure. Many people find that their whole head hurts, while some mostly feel the pain across their forehead. Others describe the pain as feeling like a tight band around their head – as if they were wearing a hat that is too tight.

The pain of tension headaches is mild to moderate in intensity. It sometimes goes away after only a few minutes, but it can last up to a week in some cases. The headache doesn't get worse with physical activity – for example, when climbing stairs or doing sports. It is not associated with other symptoms, like nausea or sensitivity to light.

The cause of tension headaches is unknown. But they are sometimes triggered by certain things – like stress, for example.

Tension headaches run in some families. Certain illnesses are considered to be risk factors, too – such as depression.

Tension headaches are very common: Most people will probably have one at some point in their life.

More than 40 out of 100 people keep getting tension headaches. About 1 out of 100 people have them very often (or even constantly) over a long time period.

Tension headaches can happen at any age, but they usually first start in early adulthood. They are slightly more common in women than in men.

Most people who have tension headaches get them at irregular intervals. The headaches are then said to be "episodic."

If the headaches occur very often over a long time period, they are considered to be chronic. This is the case if the headaches occur

• on 15 or more days per month for three months in a row or
• on more than 180 days per year and
• last for hours or don’t go away at all.

If you often have headaches, it's best to talk to your doctor about them. Simply talking about current and past symptoms (your medical history) and having a physical exam is often enough to find out whether your headaches are tension headaches. The physical exam includes neurological testing, where the doctor will test things like your muscle strength and sensory perception.

If it’s still not clear whether the pain is being caused by another illness, further examinations may be recommended.

There are various things that people with tension headaches can try out to help reduce the number of headaches they get. For example, they can regularly do low-intensity endurance sports, manual therapy, relaxation techniques, yoga and biofeedback exercises following instructions.

If the tension headaches are chronic, they can also be treated with behavioral therapy or multimodal pain management, which involves a combination of various treatment approaches. Some medications can prevent frequent attacks – especially amitriptyline. But in rare cases, this medication can also cause side effects like an irregular heartbeat, dry mouth and weight gain.

Many people who have mild tension headaches cope well without medication. Some relieve the pain by applying peppermint oil to their forehead, temples or neck – or by taking a walk in the fresh air.

The medication options include over-the-counter painkillers (analgesics) from the pharmacy. These medications can relieve the pain, but they can also have side effects like stomach problems. If taken too often, they can lead to more frequent headaches. So it’s important to keep an eye on how often you take the painkillers – for example, by using a headache diary. If you notice that you regularly take medication on more than ten days a month, it's a good idea to talk to your doctor about it.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.