Family doctor

What is it?

Tension headache is the name given to a headache which usually begins slowly and gradually and causes a constant, dull aching feeling around the head. Occasionally it can hurt as much as a migraine headache. Some people with a tension headache also have a tight feeling in the head or neck muscles.

It is also sometimes called a stress headache or muscle-contraction headache. This latter term attempts to indicate that the headache is not a psychological headache, but a physical headache arising possibly from prolonged contraction of the thin scalp muscles and the upper neck muscles. The exact cause of tension headache is not known. It is helpful to think of it as the neck and scalp muscles being under tension rather than the brain being under tension.

What are the symptoms?

The usual features of this headache include:

• It is often associated with the sufferer being under stress of some kind.
• It does not stop the sufferer in his or her tracks; he or she can continue to work.
• Simple painkillers such as aspirin or paracetamol often do not seem to help much.
• It can sometimes be present from waking in the morning until bedtime.
• It is diagnosed from the description of the headache. Blood tests, x-rays or scans - such as computed tomography (CT) or magnetic resonance imaging (MRI) - are usually not needed.

What can be done?

The painkillers of the NSAID group (e.g. dicofenac, naprosyn etc) are sometimes more effective than aspirin or paracetamol but have to be used with some caution as they can cause indigestion and even gastric bleeding in elderly people.

Other things that may help include:

• A heat pack or an ice pack on your head or neck to ease the pain.
• Finding another person to do gentle scalp and neck muscle massage.
• Take a hot shower to ease the pain.
• Get enough rest or sleep.
• Take time away from things that are stressful. This could mean anything from taking a brief walk to going on a long vacation.
• Get regular exercise of all types.

Getting help

If your headaches don't get better or if they get worse, contact your doctor for further advice.