What is it?
Tension-type headache is a dull, pressing pain that wraps around both sides of your head like a band. It does not beat like a pulse. Ordinary movements such as climbing stairs or bending over do not make it noticeably worse. It is most often mild to moderate: it makes the day harder, but it does not stop you altogether.
The pain does not come from brain tissue. Tightness in the scalp, temple, back of the neck and chewing muscles, together with how sensitively the centres that process these signals respond, both play a part. That is why you may find tenderness when you press on your temple, the back of your neck or your chewing muscle while the pain is there.
Here is the part that concerns dentistry: in someone with a clenching habit the chewing muscles work through the day and at night, adding their own pain to the same area. The two problems can feed each other. If the muscle share is missed, a painkiller on its own may not give the relief you expect.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Muscle tension and a clenching habit
When the temple, neck and chewing muscles stay contracted for long stretches, tender points build up in them. In someone who clamps their teeth together during the day without noticing, this load repeats every single day.
- 02
Broken sleep and tiredness
Short, broken sleep lowers your pain threshold. The same muscle tension can stay quiet on a rested day and be felt as pain on a sleepless one. This cycle is common in people who work shifts.
- 03
Posture and screen time
When your head is held forward, the neck muscles work constantly to carry it. In people who stay in the same position at a screen for hours, the pain often starts around midday and builds towards the evening.
- 04
Frequent use of painkillers
Taking painkillers on most days of the week can, over time, contribute to headaches becoming more frequent. Telling your doctor how often you take them allows that possibility to be assessed.
How does it progress?
- 1
Infrequent episodic
You have fewer than one painful day a month. It usually appears after a tiring or demanding day and eases with rest.
- 2
Frequent episodic
There are between one and fourteen painful days a month. At this stage it becomes worthwhile to note your triggers and to weigh up how much the muscle load contributes.
- 3
Chronic
The pain is there on more than fifteen days a month and has lasted longer than three months. At this stage a neurology assessment should not be put off, and your use of painkillers should be reviewed as well.
How is it treated?
Making the diagnosis and deciding on medication belongs to neurology. The pattern of the headache, how often it comes and any findings that go with it are assessed, and other causes are ruled out if needed. The medicines used during an attack and the preventive treatment considered when the pain is frequent are separate decisions, and a doctor makes them.
The dentist's contribution is on the muscle and bite side. Feeling the chewing muscles by hand, measuring how far your mouth opens and looking at wear marks on the teeth and fillings shows how much the clenching contributes. A night guard may be used in suitable people to reduce the load on the muscles; it does not take the place of headache medication and it does not count as a treatment plan on its own.
To reduce the share coming from the muscles, you will talk through daytime awareness work, neck and shoulder exercises, a review of how you work and keeping your sleeping hours steady. If physiotherapy is needed, you are referred to the relevant department. These steps complete the neurology plan; they do not replace it.
- A headache that reaches its worst within seconds and is unlike anything you have had before
- A headache with fever and a stiff neck
- Headache together with loss of vision, difficulty speaking or weakness in an arm
How is it prevented?
- Check regularly through the day whether your teeth are touching: lips closed, teeth apart.
- Keep the times you wake and go to bed steady, weekends included, and do not cut your sleep short.
- Bring your screen up to eye level and take a short break before the hour is out to loosen your neck and shoulders.
- Mark on a calendar the days you take a painkiller and show that list to your doctor.
Frequently asked questions
- Will a night guard cure my headache?
- A night guard aims to reduce the load that clenching puts on the muscles. If a large share of your pain comes from the muscles, some relief may be seen, but this is not a guarantee of a cure and it does not take the place of medical treatment for tension-type headache.
- How do I tell tension-type headache from migraine?
- Tension-type pain is most often on both sides, dull, and does not stop you moving about. Migraine is usually one-sided and throbbing, comes with nausea and sensitivity to light and sound, and gets worse with movement. A doctor makes the final distinction through examination.
- Is it a problem if I take painkillers regularly?
- Taking painkillers steadily on more than a couple of days a week can, over time, contribute to the pain becoming more frequent. Rather than increasing how often you take them on your own, tell your doctor; the decision to cut down is also made together with your doctor.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.