Tension-type headache (TTH) is the most common primary headache disorder — lifetime prevalence around 40 percent vs 14 percent for migraine. It’s typically described as a tight band around the head, pressing rather than pulsing, mild to moderate in intensity, and lasting from 30 minutes to several days.
The older name “muscle contraction headache” has fallen out of use as evidence accumulated that the mechanism is more central than peripheral — though muscle tension association remains.
The ICHD-3 criteria
For infrequent episodic tension-type headache (ICHD-3 2.1):
- A. At least 10 episodes occurring on fewer than 1 day per month on average (under 12 days/year).
- B. Lasting 30 minutes to 7 days.
- C. At least 2 of:
- Bilateral location.
- Pressing or tightening (non-pulsating) quality.
- Mild or moderate intensity.
- Not aggravated by routine physical activity (walking, stairs).
- D. Both of:
- No nausea or vomiting (anorexia may occur).
- No more than one of photophobia or phonophobia.
Higher-frequency variants (2.2 frequent episodic, 2.3 chronic tension-type) use the same criteria with different frequency requirements.
How TTH differs from migraine
The disambiguator is the collection of accompanying symptoms:
| Feature | Tension-type | Migraine |
|---|---|---|
| Pain quality | Pressing, band-like | Pulsing |
| Location | Bilateral | Often unilateral |
| Intensity | Mild–moderate | Moderate–severe |
| Worsened by activity | No | Yes |
| Nausea | No | Common |
| Photophobia | At most one | Both, usually |
| Phonophobia | At most one | Both, usually |
| Duration | 30 min – 7 days | 4–72 hours |
| Disability | Usually mild | Often substantial |
Note the explicit exclusion: tension-type can have at most one of photophobia or phonophobia. Both = migraine territory. This is one of the cleaner disambiguators when the pain pattern alone is ambiguous.
The coexistence pattern
Many people with migraine also experience tension-type headaches between migraine attacks. This is so common that distinguishing day-to-day can be hard — patients may classify all their headaches as “migraine” or all as “tension” when both types are present.
For treatment purposes, the distinction matters:
- Tension headaches typically respond well to simple analgesics (acetaminophen, NSAIDs) and don’t usually need migraine-specific medication.
- Migraine often needs migraine-specific acute treatment (triptans, gepants) — simple analgesics are often insufficient.
Mistreating one as the other tends to underwhelm. If you have both, knowing which is which on a given day informs the treatment choice.
Common triggers
Tension-type triggers overlap significantly with migraine triggers but with different relative weights:
- Stress — most commonly identified.
- Sleep deprivation or disruption.
- Eye strain — extended screen work, poor lighting.
- Postural — sustained neck/shoulder positions.
- Dehydration.
- Skipped meals — though more commonly cited for migraine.
Note the absence of weather and hormonal triggers, which are much more characteristic of migraine than tension.
Treatment
For most tension-type headaches:
- Acute: acetaminophen, ibuprofen, or naproxen — usually effective and inexpensive.
- Behavioural: stress management, ergonomic adjustments, regular exercise, sleep hygiene.
- Preventive (for chronic TTH): amitriptyline (the most evidence base), mirtazapine, or behavioural therapy.
The same MOH thresholds apply — frequent simple analgesic use (>15 days/month) can transform episodic TTH into chronic TTH, just as it can transform episodic migraine into chronic.
What Hermly does with tension headaches
Hermly’s prediction model is trained for migraine. Tension-type headaches can be logged in the same way — Apple Health doesn’t distinguish the headache types — but the predicted risk number applies to migraine specifically.
For users whose headaches are primarily tension-type, the prediction may feel imprecise — the model’s signal isn’t calibrated to your headache pattern. The attack tracking, medication logging, and doctor report features still work fine; the forecast is the part most attuned to migraine physiology.