Welcome to question of the day #243

Eyetools question of the day #243

Many of my patients complain of headaches. I’m never quite sure how to tell the difference between headaches associated with serious brain or eye disease and those associated with stress or migraine. One recent male patient aged 23 had moderate pressure over each temple, lasting around two hours, two to three times per week, and is sometimes light sensitive. He can carry on with his daily activities but would like to get rid of them. Is it serious?

This sounds very much like a tension headache. This is caused by the person being tense which is also known as stress.

People may also feel the neck muscles tighten and a feeling of pressure behind the eyes. They can develop at any age, but are more common in teenagers and adults. Women tend to suffer from them more commonly than men. Some adults experience tension-type headaches more than 15 times a month for at least 3 months in a row. This is known as having chronic tension-type headaches.

Tension headache can last anywhere between 30 minutes and seven days. It typically has two or more of the following:

Bilateral location.

Pressing or tightening (not-pulsating).

Mild or moderate severity.

Not made worse by routine physical activity.

And both of:

No nausea or vomiting.

Some people will have light or sound sensitivity.

The cause of tension headaches is not clear, but certain things are known to trigger them:

Stress and anxiety


Poor posture



Missing meals

Lack of physical activity

Bright sunlight


Certain smells

Avoiding these triggers will help reduce the frequency and severity of cluster headaches. Some people use paracetamol or ibuprofen to deal with the pain.

Relaxation techniques may help:




Applying a cool flannel to the forehead or a warm flannel to the back of the neck often helps.