How long can tension-type headaches last?

Duration of Tension-Type Headaches

Tension-type headaches typically last from 30 minutes to 7 days per episode, with episodic forms lasting hours to days and chronic forms occurring ≥15 days per month for more than 3 months. 1, 2

Episodic Tension-Type Headache Duration

• Individual episodes last from 30 minutes up to 7 days, with most attacks resolving within hours to a few days 3, 2
• The pain is typically bilateral, pressing or tightening in quality, and of mild-to-moderate intensity 1, 2
• Unlike migraine (which has a defined 4-72 hour duration), tension-type headache duration is more variable and can be quite brief 4, 1

Chronic Tension-Type Headache Pattern

• Chronic tension-type headache is defined as headache occurring ≥15 days per month for more than 3 months, representing a transformation from episodic to chronic form 1, 5
• This chronic pattern affects 1-3% of the population and causes considerably more disability than episodic forms 3, 2
• Individual episodes within the chronic pattern still follow the same duration characteristics (30 minutes to days), but the frequency distinguishes it from episodic forms 2

Clinical Differentiation from Other Headache Types

• Migraine attacks last 4-72 hours when untreated, providing a key distinguishing feature from tension-type headache 4, 1
• Cluster headaches last only 15-180 minutes and are strictly unilateral with autonomic features, making them easily distinguishable 1, 6
• If a headache persists beyond 72 hours without resolution, consider status migrainosus or chronic daily headache rather than simple tension-type headache 1

Important Clinical Caveats

• Medication-overuse headache can develop when patients use acute analgesics ≥15 days/month for ≥3 months, perpetuating a chronic headache pattern that may be mistaken for chronic tension-type headache 4, 1
• The transformation from episodic to chronic tension-type headache likely involves central sensitization mechanisms, not just increased frequency of the same peripheral process 2
• Despite the typically benign nature of tension-type headache, chronic forms can cause substantial disability comparable to migraine and require preventive therapy with amitriptyline as first-line treatment 4, 2