Can a tension-type headache in an adult last for several days?

Can Tension Headaches Last Days?

Yes, tension-type headaches can absolutely last for several days—in fact, individual episodes can persist for 30 minutes to 7 days in episodic forms, and in chronic tension-type headache, the pain can be continuous or nearly continuous for months. 1

Duration Patterns of Tension-Type Headache

Tension-type headache presents in three distinct temporal patterns that determine duration:

Episodic Tension-Type Headache

• Individual episodes last from 30 minutes up to 7 days when untreated or unsuccessfully treated 1
• Infrequent episodic form: fewer than 12 headache days per year 2
• Frequent episodic form: 1-14 headache days per month 2

Chronic Tension-Type Headache

• Headaches occur ≥15 days per month for more than 3 months, and individual episodes may last hours or be continuous 1, 3
• This affects up to 4% of the general population, with women comprising up to 65% of cases 3
• The pain can essentially be present most days without significant relief 1

Clinical Characteristics to Confirm Diagnosis

The headache quality helps distinguish tension-type from other headache disorders:

• Bilateral location with pressing or tightening quality (not pulsating) 1
• Mild to moderate intensity that does not prevent daily activities 1
• No aggravation by routine physical activity (unlike migraine, which worsens with movement) 1
• Absence of significant associated symptoms such as nausea, vomiting, or combined photophobia and phonophobia 1

Important Diagnostic Pitfalls

Rule Out Secondary Causes First

Before attributing multi-day headaches to primary tension-type headache, exclude red flags requiring urgent evaluation 4:

• Thunderclap or sudden-onset headache 4
• Worsening when lying down or with Valsalva maneuver 4
• Focal neurological deficits 4
• Headache awakening patient from sleep or progressively worsening pattern 4
• New-onset headache in patients over 50 years (migraine typically remits with age while secondary headaches increase) 4

Distinguish from Chronic Migraine

Chronic migraine also presents with ≥15 headache days per month, but differs in that it must fulfill migraine criteria on ≥8 days per month, with features like unilateral pulsating pain, moderate-to-severe intensity, aggravation by activity, and associated nausea or photophobia/phonophobia 5

When Multi-Day Headaches Warrant Treatment Escalation

Consider Preventive Therapy When:

• Headaches occur ≥15 days per month (chronic tension-type headache) 4
• Very frequent episodic pattern interferes with quality of life 2
• Patient is at risk of medication overuse headache from excessive acute medication use 2
• Simple analgesics are ineffective, poorly tolerated, or contraindicated 1

First-Line Preventive Treatment

Amitriptyline is the drug of first choice for chronic tension-type headache prophylaxis, with the strongest evidence base from multiple double-blind, placebo-controlled studies 5, 4, 2, 6

Monitoring Multi-Day Headache Patterns

• Use a headache diary to track frequency, severity, duration, and medication use 4
• Evaluate treatment response at 2-3 months after initiating or changing preventive therapy 4
• Monitor for medication overuse headache development (≥15 days/month of simple analgesics or ≥10 days/month of combination analgesics for >3 months) 5, 4

The key clinical takeaway: tension-type headaches lasting multiple consecutive days are well-documented and diagnostically consistent with both episodic (up to 7 days per episode) and chronic forms (continuous or near-continuous). The duration alone does not indicate a more serious condition, but the pattern should prompt consideration of preventive treatment to improve quality of life.