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Tension Headaches


Tension-type headache is a term used to describe a headache causing mild to moderate pain that often feels like a tight band across your forehead or pressure around the head and neck. These headaches may be provoked by the stress of everyday life, eyestrain or poor posture. They are not worsened by routine activity, and therefore usually don't prevent people from going about their daily activities.

Typically, the pain is not troublesome enough to cause sufferers to see a doctor. People who get tension-type headache do not experience sensitivity to light, sound, or movement, and they do not experience nausea or vomiting.

The underlying cause of tension-type headache is unknown.

Our Approach to Tension Headaches

Our headache specialists – neurologists who focus on treating headaches – provide comprehensive assessments and care. We offer a range of medication options for tension headaches, including drugs that help prevent them and others that treat the headache pain. We see patients from around the world who have difficult-to-treat headache disorders, and are committed to delivering effective care with the utmost compassion and respect. When needed, our specialists work closely with other experts at UCSF, such as alternative medicine providers, to better manage tension headaches.

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Signs & symptoms

Symptoms of a tension headache include:

  • Mild to moderately intense pain, lasting from 30 minutes to as long as an entire week
  • Tightness or pressure across your forehead or on the sides and back of your head
  • Tenderness on your scalp, neck and shoulders
  • Sometimes, loss of appetite

Tension headaches are considered chronic if they occur 15 or more days a month for at least three months. They're considered episodic if they occur fewer than 15 times a month.

Tension headaches differ from migraines in that they're not associated with abdominal pain, nausea and vomiting, slurred speech, visual disturbances such as blind spots or flashing lights, and weakness or numbness on one side of the body. Physical activity typically doesn't aggravate the pain like it does migraines. Increased sensitivity to light or sound can occur, although it's not common.


Tension-type headaches usually are diagnosed based on symptoms. Your doctor will ask about the severity, frequency and duration of your headaches as well as other symptoms that occur and medications you are taking. Keeping a headache journal is a good way to track the location and severity of pain, duration of pain, medications taken and possible headache triggers.

If your doctor suspects a tumor or aneurysm, you may undergo one or more of the following tests:

  • Computerized Tomography (CT) Scan A CT scan uses a thin X-ray beam that rotates around the area being examined. A computer processes data to create a 3-D, cross-sectional image.
  • Magnetic Resonance Imaging (MRI) An MRI uses magnetism, radio waves and computer technology, rather than X-rays, to produce images of your brain. Under the right circumstances, MRI and other imaging procedures allow doctors to see how larger structures in the brain are involved during migraine and headache.


Your doctor may prescribe drugs to prevent and treat tension headaches. Drugs that may help prevent tension headaches include:

  • Tricyclic Antidepressants Antidepressant drugs have analgesic or pain-relief qualities. Although you may not be depressed, your doctor may prescribe drugs such as amitriptyline or doxepin to help reduce the frequency and severity of your headaches.
  • Beta-blockers A drug such as propranolol may be combined with an antidepressant, such as amitriptyline, to prevent chronic daily headaches.
  • Divalproex Sodium This drug is used to treat chronic daily headache, including chronic tension-type headaches.

Drugs prescribed to treat the pain of tension headaches include:

  • Nonprescription Pain Relievers These are usually adequate to relieve mild to moderate pain. They include aspirin, acetaminophen, ibuprofen and naproxen.
  • Combination Pain Relievers The use of these drugs is limited, because overuse can worsen the headache pattern and over time can become habit forming. These drugs often contain butalbital, a barbiturate or narcotics combined with aspirin or acetaminophen.

If your doctor prescribes you medication, be sure to ask:

  • How often the medication should be taken
  • If the medication should be taken with meals or on an empty stomach
  • What to do if pain or other symptoms persist

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

Recommended reading

Keeping a Headache Journal

Keeping a headache journal is a great way to track the location, severity, duration, and any medications that may trigger headaches. Learn more.

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