Headache Hub guide
Tension-type headache: symptoms, criteria, and tracking
Tension-type headache (TTH) is the most common headache disorder: bilateral pressing or tightening pain of mild to moderate intensity. This guide covers what it feels like, the ICHD-3 criteria specialists use, and how tracking your own pattern changes the conversation with your doctor.
- ICHD-3 category 2
- Most common headache type
The basics
What is tension-type headache?
Tension-type headache is the most common primary headache disorder. According to ICHD-3 criteria, these headaches are not aggravated by routine physical activity and typically lack the associated symptoms seen in migraine.
Key characteristics
- Bilateral (both sides) pressing or tightening pain
- Mild to moderate pain intensity
- Not worsened by routine physical activity
- Usually no nausea or light/sound sensitivity
Prevalence and demographics
- How common
- The most common headache type
- Who it affects
- More common in women
- Typical duration
- 30 minutes to 7 days
ICHD-3 category 2
Diagnostic criteria for tension-type headache
The International Classification of Headache Disorders, 3rd edition, defines tension-type headache with five criteria, labelled A through E. These are the questions a specialist works through.
Criterion A
At least 10 episodes
Occurring on fewer than 1 day per month on average for the infrequent episodic form.
Criterion B
Duration
Headaches last 30 minutes to 7 days.
Criterion C
Pain characteristics (at least 2)
Bilateral location, pressing or tightening quality, mild to moderate intensity, not aggravated by routine physical activity.
Criterion D
Both of the following
No nausea or vomiting, and no more than one of photophobia or phonophobia.
Criterion E
Not attributed
Not better accounted for by another ICHD-3 diagnosis.
How tracking with Ember helps
Clarity on classification
A structured diary captures the exact features ICHD-3 asks about: where the pain sits, how it feels, and whether activity makes it worse. That helps your clinician distinguish tension-type headache from migraine and other types.
Trigger identification
Logging headaches as they happen surfaces patterns in stress, posture, sleep, and the other common triggers, instead of reconstructing them from memory.
A history your doctor can use
Your entries become a structured, ICHD-3-aware summary that supports decisions about lifestyle changes and prevention strategies.
Tension-type headache is often the most treatable headache type, and simple interventions go a long way. Ember helps you track and organize your history; it does not diagnose, and it never replaces evaluation by a clinician.
Subtypes
Episodic and chronic tension-type headache
ICHD-3 separates tension-type headache by frequency. The distinction matters because it changes both the outlook and the treatment approach.
Episodic tension-type headache
- Frequency
- Fewer than 15 days per month
- Duration
- 30 minutes to 7 days
- Impact
- Minimal disability
- Treatment
- Usually responds to OTC medications
The most common form of tension headache. Often triggered by stress, fatigue, or poor posture, and generally manageable with lifestyle modifications.
Chronic tension-type headache
- Frequency
- 15 or more days per month for 3 or more months
- Duration
- Hours to days, may be continuous
- Impact
- Can cause significant disability
- Treatment
- May require preventive medications
Less common but more disabling. Often develops from the episodic form and benefits from a broad management approach with your clinician.
Triggers and management
Common tension headache triggers
Log headaches alongside changes in sleep, meals, and stress.
Stress and emotional
- Work or family stress
- Anxiety and depression
- Emotional tension
- Life changes
- Conflict situations
Physical factors
- Poor posture
- Neck and shoulder tension
- Eye strain
- Jaw clenching (TMJ)
- Muscle fatigue
Lifestyle factors
- Sleep disturbances
- Irregular meals
- Dehydration
- Caffeine changes
- Weather changes
Management strategies
Immediate relief
- Over-the-counter pain relievers
- Cold or warm compress
- Gentle neck stretches
- Relaxation techniques
- Adequate hydration
Prevention
- Stress management
- Regular sleep schedule
- Good posture habits
- Regular exercise
- Trigger avoidance
Discuss persistent or worsening headaches with your clinician before starting or changing any treatment.
Frequently asked questions
Next step
Understand your tension headache pattern
Keep a headache history to review with your doctor.