Tension-type headache is a pressing, band-like pain on both sides. It is mild to moderate, with no nausea and no worsening on stairs. Treating it means finding out whether it is really migraine, rebound from overused painkillers, or a neck problem. An occipital nerve block both treats and tests the neck.
It is the most common headache there is. It is also the one most likely to be something else wearing its clothes.
What does a tension headache feel like?
Pressing or tightening rather than throbbing. On both sides. Mild to moderate. And, importantly, not made worse by walking up stairs. There is no nausea. There may be sensitivity to light or to sound, but not both. People describe a band around the head or a weight on top of it. Most keep working through it.
What can be mistaken for a tension headache?
A great many headaches called tension-type are actually mild migraine. The tell is whether routine activity makes it worse, whether there is any nausea, and whether it ever builds to the point of stopping you. If a “tension headache” occasionally forces you into a dark room, it was never a tension headache.
The difference is not academic. Migraine responds to migraine-specific treatment. Tension-type headache largely does not. So the wrong label leads to years of the wrong drug.
The other frequent impostor is cervicogenic headache, where the pain is referred from the neck. Does your headache track with neck position, desk posture or a past neck injury? Then that is the thread to pull.
Can painkillers make tension headaches worse?
Tension-type headache is mild enough to treat with whatever is in the cupboard. Because of that, it is the headache most likely to end in medication-overuse. Simple analgesics (painkillers) taken on more than about fifteen days a month, or combination products on more than ten, can drive a daily headache. It looks like worsening tension-type headache. In fact it is the treatment. If you are taking something most days, that is the first thing to address. And it is addressable.
How is chronic tension headache treated?
Frequent or chronic tension-type headache is not usually an infusion problem. It is a diagnosis problem, a rebound problem, or a neck problem. It is treated by working out which. Where the occipital or cervical (neck) area is truly involved, an occipital nerve block is both a treatment and a diagnostic test.
Sources
- Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headache – report of an EFNS task force. European journal of neurology, 2010. PMID 20482606. pubmed.ncbi.nlm.nih.gov
- Ashina S, Mitsikostas DD, Lee MJ, et al. Tension-type headache. Nature reviews. Disease primers, 2021. PMID 33767185. pubmed.ncbi.nlm.nih.gov
Booking online shows our scheduled openings; call or text for hours that are not listed. Please contact us before coming in rather than arriving unannounced — we need to know what is happening to have the right treatment ready.
A note on coverage, and on timing. Same-day treatment and prior authorization do not run on the same clock. Many insurers take days to weeks to decide, and some acute headache treatments are not covered at all. Your headache will not wait for that process.
We will verify your benefits and, where a treatment needs prior authorization, we will attempt to obtain it. An authorization confirms that a service meets criteria for review — it is not a guarantee of payment, and no clinic can make that promise on your insurer’s behalf. Where something is unlikely to be covered, or cannot be certified in time to treat you today, we will tell you before we treat rather than after, so the decision is yours. Payment is due at the time of service.
Frequently asked questions
How are tension headaches diagnosed?
By the pattern of the pain. A tension-type headache presses or tightens rather than throbs. It sits on both sides, stays mild to moderate and does not get worse when you climb stairs. There is no nausea. There may be sensitivity to light or to sound, but not both. If a headache ever forces you into a dark room, it is more likely migraine.
Why won’t my tension headache go away?
A headache that has become daily usually has one of three explanations. It may be rebound from painkillers. Simple analgesics (painkillers) on more than about fifteen days a month, or combination products on more than ten, can drive a daily headache. It may be mild migraine under the wrong label. Or it may come from the neck. That is the thread to pull if it tracks with posture.
Can a nerve block help a tension headache?
When the neck is truly involved, yes. Where there is real occipital or cervical involvement, an occipital nerve block is both a treatment and a diagnostic test. If it relieves the pain, the neck was part of the source. Frequent tension-type headache is not usually an infusion problem. So the block is used where the history points to the neck. One example is a headache that tracks with neck position, desk posture or a past neck injury.