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Tension headaches

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  • Content

  • At a glance
  • Definition
  • Symptoms
  • Causes
  • Prevalence
  • Outlook
  • Diagnosis
  • Treatment
  • Sources

ICD codes: G44.2 What are ICD codes?

Most people are acquainted with tension headaches: nagging, pressing pain in the head that occurs now and then. They are not a cause for concern and can be relieved with non-prescription painkillers if necessary. To prevent them, endurance sports or relaxation exercises may be useful.

At a glance

  • Headaches are often so-called tension headaches: more than 40% of people have these repeatedly.
  • They are nagging, pressing headaches that can be mild to moderate.
  • Tension headaches are less severe than migraines or cluster headaches.
  • It is not known what causes them but triggers for the pain (such as stress) can often be identified.
  • Anyone who feels severely affected can relieve the pain with non-prescription painkillers.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Eine ältere Frau fasst sich mit einer Hand an die Stirn. Eine ältere Frau fasst sich mit einer Hand an die Stirn.

What are tension headaches?

Tension headaches are very common. Many people are acquainted with the nagging, pressing headaches and experience them occasionally.

Contrary to what the name may suggest, they are not normally caused by muscle tension. Their cause is still unexplained. Tension headaches, just like migraines and cluster headaches, are known as primary headaches because they are not the result of any other health condition.

Tension headaches are less severe than migraines or cluster headaches. However, they can still be debilitating – especially if they last for an extended time.

Anyone feeling severe adverse effects can take non-prescription painkillers. However, this should not become a habit. Specifically, if these are taken too often or regularly, the headaches may become more frequent.

Video What are the most common types of headache?

The video below outlines the most common types of headache and how they are expressed.

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What are the symptoms of tension headaches?

Most people experience tension headaches as nagging and pressing. For many, their entire head hurts, while for some their forehead in particular is painful. However, the pain can also feel like a ring or band that runs around the skull and presses on it – rather like wearing a hat that is too small.

Most people experience tension headaches as nagging and pressing.

Tension headaches range from mild to moderately severe. The duration varies from a few minutes up to a week in some cases. They do not get worse with physical activity such as exercising or climbing stairs. Unlike migraines for instance, there are no accompanying symptoms such as sensitivity to light or nausea.

What are the causes of tension headaches?

The cause of tension headaches remains unknown. However, certain triggers for pain can sometimes be observed, such as stress, for example.

Tension headaches are common in some families. Many illnesses like depression also appear to increase the risk of headaches.

How common are tension headaches?

Tension headaches are very common. Nearly everyone experiences them at some point in their lives. Over 40 percent of people suffer them on a recurring basis. For about 1 percent of people, the symptoms occur very frequently for an extended period of time or even permanently.

Over 40 percent of people suffer tension headaches on a recurring basis.

People of any age can have tension headaches. But they usually occur for the first time in young adults. They are somewhat more common in women than men.

How do tension headaches develop?

Most people affected by these headaches have them sporadically. Experts refer to this as episodic.

If the symptoms occur very frequently over a longer period of time, doctors call these chronic tension headaches. They are diagnosed if the pain:

  • occurs on 15 or more days per month for 3 months in succession
  • is present on more than 180 days per year
  • lasts for hours or is constant each time

How are tension headaches diagnosed?

It is sensible to make a doctor’s appointment for headaches that occur repeatedly. With questions and a physical examination, the doctor can determine whether the headaches are tension headaches.

Among other things, muscle power and sensory perception are checked as part of a neurological examination. This should rule out the possibility that another illness is causing the pain. If any doubts remain, other examinations may follow.

How are tension headaches treated?

Those who only have mild headaches usually do not need any drugs. Some people find it helpful to dab peppermint oil on their forehead, temples or neck, or go for a walk in the fresh air.

Anyone who wants to relieve pain with drugs can take non-prescription painkillers (analgesics) from a drugstore. But these can also have side effects and cause stomach problems for instance.

Important: If painkillers are taken too often, the headaches may begin to occur more frequently.

To prevent tension headaches in the long term, sufferers may benefit from doing light endurance sport on a regular basis, having manual treatment, doing relaxation exercises or yoga, or attending biofeedback therapy.

More detailed information about which drugs are helpful for tension headaches is available at gesundheitsinformation.de.

  • Anheyer D, Klose P, Lauche R et al. Yoga for Treating Headaches: a Systematic Review and Meta-analysis. J Gen Intern Med 2020; 35(3): 846-854. doi: 10.1007/s11606-019-05413-9. Epub 2019 Oct 30.
  • Berlit P. Klinische Neurologie. Springer: Berlin 2013.
  • Derry S, Wiffen PJ, Moore RA. Aspirin for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev 2017; (1): CD011888. doi: 10.1002/14651858.CD011888.pub2.
  • Derry S, Wiffen PJ, Moore RA et al. Ibuprofen for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev 2015; (7): CD011474. doi: 10.1002/14651858.CD011474.pub2.
  • Göbel H, Heinze A, Heinze-Kuhn K et al. Oleum menthae piperitae (Pfefferminzöl) in der Akuttherapie des Kopfschmerzes vom Spannungstyp. Schmerz 2016; 30(3): 295-310. German. doi: 10.1007/s00482-016-0109-6.
  • Haag G, Diener HC, May A et al. Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migräne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft für Neurologie (DGN), the Österreichische Kopfschmerzgesellschaft (ÖKSG) and the Schweizerische Kopfwehgesellschaft (SKG). J Headache Pain 2011; 12(2): 201-217. doi: 10.1007/s10194-010-0266-4.
  • Hacke W. Neurologie. Springer: Berlin 2016.
  • International Headache Society (IHS). Die Internationale Klassifikation von Kopfschmerzerkrankungen. 3. Auflage – ICHD-3. Aufgerufen am 21.10.2022.
  • Kamonseki DH, Lopes EP, van der Meer HA et al. Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis. Disabil Rehabil 2022; 44(10): 1-10. doi: 10.1080/09638288.2020.1813817.
  • Law S, Derry S, Moore RA. Triptans for acute cluster headache. Cochrane Database Syst Rev 2013; (7): CD008042. doi: 10.1002/14651858.CD008042.pub3.
  • Stephens G, Derry S, Moore RA. Paracetamol (acetaminophen) for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev 2016; (6): CD011889. doi: 10.1002/14651858.CD011889.pub2.
  • Straube A. Therapie des episodischen und chronischen Kopfschmerzes vom Spannungstyp und anderer chronischer täglicher Kopfschmerzen. S1-Leitlinie. AWMF-Registernummer 030-077.
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In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

As at: 21.10.2022
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