What Africans Need to Know About Tension Headache


By: Elizabeth Obigwe. Freelance Writer, with medical review and editorial support by the DLHA Team


Black woman probably suffering from tension headache

Black woman probably suffering from tension type headache. Image by DC studio on Freepik




  • Tension headache is identified as a tightening pain around the head
  • Tension-type headache is the most common type of primary headache
  • The prevalence of tension headache varies across Africa, between 20.6% to 22.9% for most regions
  • Stress, hunger and sleep disturbances are the most common triggers of tension headache





Almost everyone has had a headache at one point or another. These headaches often manifest differently. Sometimes, it is a sharp pain, other times, the pain may be throbbing or tightening, etc. The pain may also occur at different locations around your head and neck region. 


If you ever had a headache that felt like you had a tight band on your head, you probably had a tension headache. However, beyond the tightening feel, there are other characteristics a headache needs to have to qualify as a tension headache. We will discuss them in detail in this article.



What Is a Tension Headache?


A tension headache or tension type headache (TTH) is a primary headache that causes a pressing or tightening pain of mild to moderate intensity on both sides of the head. 


In the past, different terms were used to describe TTH including psychogenic headache, stress headache, muscle contraction headache, etc. However, the International Classification Headache Diagnosis I (ICHD I) chose the name tension-type headache to indicate that some kind of mental or muscular tension may contribute to it.



What Causes Tension Type Headache?


The underlying cause of tension headaches is still uncertain. Although studies are pointing out different possible contributors, there is no conclusive result yet.


One study showed that patients with tension-type headaches (TTH) have relatively weak neck extension muscles compared to those without the condition. However, it did not establish a valid cause-effect relation. 


In the absence of a known underlying cause, other factors that are known to trigger this condition include:

  • Physical and emotional stress
  • Anxiety
  • Depression
  • Fatigue
  • Alcohol use
  • Excessive smoking
  • Too much caffeine or caffeine withdrawal
  • Dental problems
  • Eye strain
  • Colds, flu, sinus infection 
  • Poor posture
  • Hunger
  • Lack of sleep



Types of Tension Headaches


Tension-type headaches are divided into two based on their frequency of occurrence. Otherwise, the clinical features of these headache types are similar.


  • Episodic tension-type headache (ETTH)


Episodic tension-type headache is further divided into; Infrequent ETTH and Frequent ETTH

Infrequent ETTH happens less than 12 days per year.

Frequent ETTH happens more than 12 days but less than 180 days a year. It may also be at least 10 episodes occurring more than 1 day and less than 15 days a month for at least 3 months.


  • Chronic tension type headache (CTTH)  


CTTH occurs more than 180 days a year or more than 15 days a month for at least 3 months.



How Common Are Tension Headaches in Africa?         


Tension headache is the most common headache disorder globally and in Africa. Yet, there is no proper study that captures its overall prevalence in Africa. However, there are studies from different parts of the continent. 


One of the few studies available was carried out in Tanzania. It revealed that the 1-year prevalence of TTH was 7% with 5% reported episodic TTH and 0.4% chronic TTH.


Another study from Ethiopia revealed a 20.6% 1-year prevalence of tension-type headache. The study also showed that tension headaches were more common among women than men and in rural than in urban areas. 


A few more studies in other parts of Africa showed results similar to the Ethiopian study. One study from Nigeria showed an overall prevalence of 22.9%, with a prevalence of 28.4% in females and 15.1% in males. Another study from Zambia showed a 22.8% prevalence.


Overall, the prevalence of tension-type headaches and other primary headaches appears to be lower in Africa than in Western countries.



Tension Type Headache vs Migraine 


Tension headaches and migraine are the two most common types of primary headaches. However, TTH is more common. These two headache types share certain similarities such as; they can both be triggered by stress and sleep disturbances. However, they also have several differences that allow healthcare providers to distinguish them. Some of these differences include:

Prevalence: TTH is more prevalent than migraine both in Africa and on the global level. However, migraine is said to have a higher difference in female-to-male prevalence (3:1) than tension type headache (1.2:1).

Duration of Attack: While TTH lasts between 30 minutes to 24 hours, migraine lasts between 4 to 72 hours.

Quality/Severity of Headache: Tension type headaches usually feel like a tightening pain on both sides of the head. The severity of this pain ranges from mild to moderate. On the other hand, migraine feels like a throbbing pain on one (sometimes both) side(s) of the head. The pain may be moderate or severe.

Additional Symptoms: Migraine is usually accompanied by symptoms like photophobia (sensitivity to light), phonophobia (sensitivity to sound), aura and vomiting.  TTH may also be associated with photophobia or phonophobia, but not aura and vomiting. It also does not worsen with activity as migraine does.



Symptoms of Tension-Type Headache


According to the criteria laid down for diagnosing TTH by the International Headache Society (IHS), at least two of the following characteristics should be present:

  • Pressing or tightening (non-pulsating) pain
  • Pain should be located on both sides of the head, starting at the front of the head or the area around the eyes, and spreading to the whole head
  • The intensity of the pain should range from mild to moderate
  • Symptoms do not get worse with physical activities
  • Presence of either photophobia or phonophobia (not more than one of the two)



Treatment of Tension Type Headache 


Headache tablets, behavioural modalities and home care are all effective for the prevention and treatment of tension type headache and they should be used in combination to achieve optimum results.




  • Over-the-counter analgesics and NSAIDs


Most patients do not report TTH at first and would rather rely on OTC drugs and NSAIDs such as aspirin, acetaminophen and ibuprofen. The downside to this is that prolonged use may lead to drug overuse or rebound headaches. If you are experiencing recurrent headaches, do well to see your healthcare provider.


  • Prescription medicines


Amitriptyline: This is the best-known antidepressant for treating recurrent ETTH and CTTH. Nortriptyline which is similar to amitriptyline is also effective for treating CTTH.


Mirtazapine: This is a noradrenergic and serotonergic antidepressant that can be given in situations where amitriptyline is either ineffective or contraindicated.


Triptans: Triptans may be used to treat patients with ETTH who also have migraine. However, the patient should be taught how to differentiate between the two headache types so that they can take the right drug for any attack. 


New findings show that estrogen may trigger ETTH just like with migraine. If you notice this, consider stopping the use of any estrogen-based medications.


Non-drug Treatment Options

  • EMG biofeedback 
  • Cognitive-behavioral therapy (CBT)
  • Relaxation training/therapy which involves activities like breathing exercises and meditation
  • Acupuncture


Home Remedies For Tension Headaches

  • Avoid triggers
  • Rest well and get enough sleep
  • Do not skip meals, especially breakfast
  • Improve your posture
  • Apply hot or cold packs on your head
  • Engage in home-based exercises
  • Massage and yoga may help



Can Tension Headaches Be Prevented?


Tension headache is caused by triggers as discussed earlier. So, to prevent it, you need to avoid the triggers. Some of the most common triggers are stress, hunger and lack of sleep. Try to make lifestyle changes where necessary to reduce the frequency of occurrence.


Journaling may also be helpful. Taking note of when a headache occurs, what you ate at that time and the activities you engaged in may help you track your triggers and adjust accordingly.



What You Need to Know if You Are Living With Tension Headache


Tension type headache is not a life-threatening condition and it often responds to treatment. However, attacks may prevent you from going about your normal life, sometimes causing you to miss school, work or other important functions. If this happens often, you should see a doctor. 


If you notice any of these additional severe symptoms, treat the condition as an emergency and report to the hospital immediately:

  • Worst headache of your life ever
  • Headache feeling like you were struck by thunder
  • Stiff neck
  • Confusion
  • Slurred speech 
  • Shortness of breath
  • Change in vision
  • Loss of balance





Tension headache is an often overlooked health concern that many Africans deal with. And because most people resort to self-medication at the first sign of a headache, there is no sufficient clinical report on the condition. This knowledge of the triggers, symptoms, and potential preventive measures will help you better manage and alleviate the impact of tension-type headaches on your daily life.




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Published: January 16, 2024

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