Tension headache

Also called Tension-type headache, Ordinary headache

The commonest headache there is. The main risk is treating it so often that the painkillers start causing the headaches.

What it is

The everyday headache: a dull, pressing, band-like ache across both sides of the head, without the nausea, vomiting and light sensitivity of migraine.

Almost everybody gets them. They become a medical problem when they are frequent, when they are chronic, meaning 15 or more days a month, or when the treatment has become the cause.

**Medication overuse headache is the part worth knowing about.** Taking painkillers for headache on more than about 10 to 15 days a month, depending on the drug, causes a daily headache that will not respond to more of the same. It is common, it is frequently unrecognised, and the only treatment is stopping the painkillers, which makes things worse for two to six weeks before it gets better. Codeine and combination painkillers are the worst offenders.

Common triggers are stress, poor sleep, dehydration, missed meals, eye strain, neck posture, and jaw clenching. See temporomandibular disorder.

Most headaches are benign. The pattern that needs urgent assessment is a headache that is new, different, or accompanied by other symptoms.

Signs you might notice

Dull, pressing or tightening pain on both sides, like a band around the head.

Mild to moderate, not throbbing, and not usually made worse by ordinary activity.

Tightness in the neck, shoulders and scalp.

No vomiting, and usually no significant light or sound sensitivity.

Lasting 30 minutes to several days.

999 or A and E: a headache reaching maximum severity within a minute; headache with fever, neck stiffness and a rash; headache with weakness, numbness, confusion, seizure or visual loss; headache after a head injury. See subarachnoid haemorrhage and meningitis.

Urgent GP: headache that is worse in the morning or on lying flat, or with vomiting; a new headache over 50, especially with scalp tenderness or jaw pain, which may be giant cell arteritis; a changing pattern; or headache with a history of cancer or immunosuppression.

How it can affect day-to-day life

The commonest reason a headache becomes daily is not a sinister cause; it is medication overuse, and the person is usually appalled to be told the tablets are the problem.

Keeping a headache diary for a month, including every painkiller taken, is the single most useful thing anybody can do before an appointment. Most people substantially underestimate how many days they medicate.

Screen work, poor posture and jaw clenching are genuine contributors and are cheap to address.

For someone with a learning disability or dementia, a headache may present as agitation, head-holding or withdrawal. Untreated headache is a recognised cause of distress that gets labelled behaviour.

Preventive treatment, usually amitriptyline, exists for chronic tension headache and is under-used, while acute painkillers are over-used.

Supporting someone well

Count the days. Painkillers for headache on more than 10 to 15 days a month is the threshold, and crossing it causes the problem.

Keep a diary for a month: headaches, painkillers, sleep, meals, stress.

If medication overuse is the cause, stop the painkillers under advice and expect two to six bad weeks. It works.

Avoid codeine and combination painkillers for headache.

Regular meals, fluids, sleep, and getting up from the desk. Boring and effective.

Get eyes tested, and check screen and desk height.

Ask about preventive treatment for chronic headache rather than more acute relief.

Learn the red flags above, and act on the sudden ones immediately.

Where to get help

A pharmacist for simple pain relief and advice on overuse.

A GP practice for frequent or changing headaches, and for preventive treatment.

999 for thunderclap headache, or headache with fever, rash, confusion or weakness.

Migraine Trust have good material on headache diaries and medication overuse, which applies to tension headache too.