Horrible tension headache: what to know

Tension headache commonly presents with pressing or tightening pain on both sides of the head, forehead, temples or the back of the head. Neck and shoulder muscle tenderness, stress, poor sleep, prolonged screen use or jaw clenching can accompany it. Nausea, repeated vomiting, marked light sensitivity, fever or neurological changes suggest that another headache pattern may need consideration. Headache is the symptom associated with tension headache; it is not evidence that every headache has this cause.

Note the onset, location, intensity, duration, triggers and associated symptoms. A headache diary can reveal links with skipped meals, dehydration, posture, sleep or frequent pain-medicine use.

Move away from the screen, relax your jaw and shoulders, drink water and eat if you have missed a meal. Gentle neck movement, a warm shower or a cool cloth may ease muscle tension. Aim for regular sleep and brief posture breaks during desk work. Use pain medicine only as directed and avoid repeatedly treating headaches without review, because frequent use can itself sustain headaches.

Arrange a GP Consultation if attacks are becoming more severe, frequent or difficult to control, or if the pattern has changed. Bring your medicine list and headache notes.

Seek emergency help for a sudden thunderclap headache, new weakness or numbness, trouble speaking, confusion, seizure, fainting, severe vision loss, fever with a stiff neck, or repeated vomiting. Get prompt advice after a head injury or when headache occurs with a painful red eye. Do not wait for self-care to work when the pain is dramatically different from previous headaches or you feel seriously unwell.

Does my pattern fit tension headache, and what other causes should be considered? How can I manage neck strain, sleep or jaw clenching? Which treatment is suitable for me, how often can I use it, and what change should trigger an urgent review?