X
More than 60,000 patients use Brite
4.6 stars
Your health finally understandable with Brite
Enter email and you're done. No subscription, no credit card.
Search, tap and you're done. Over 3,400 medicines.
Check, remind, get an overview.
Sarah K., 34
I finally understand my therapy. The app reminds me, answers my questions — and I don't feel alone with it anymore.
This article is about the dull, pressing head that many people describe as "pressure" or "tightness" rather than pain. An overview of all types of headache is given in the article on headaches, throbbing attacks with nausea are described in the article on migraine, and pressure straight after waking up in the article on morning headaches.
The most common form of headache is the one least often recognised as such: a band around the forehead, a helmet that is too tight, a vice at the temples. According to the international headache classification, it is typically felt on both sides, pressing rather than pulsating, of mild to moderate intensity, not made worse by walking or climbing stairs, and without nausea. An episode lasts from half an hour to several days; if it occurs on 15 or more days a month for more than three months, it is considered chronic. Tense, tender muscles of the head and neck play a part, as does altered pain processing. Common triggers are stress, lack of sleep, lack of exercise, long hours at a screen and not drinking enough.
The first step does not involve medication: regular endurance exercise and a relaxation technique such as progressive muscle relaxation. For 10 per cent peppermint oil applied to the forehead and temples, studies show relief during an acute episode. If the headache becomes chronic, your practice may consider preventive treatment; the best evidence is for low-dose amitriptyline, which in this case works on pain processing.
In acute sinusitis (rhinosinusitis), secretions build up behind swollen mucous membranes. They press over the forehead, the cheeks or between the eyes, noticeably more when you bend forward. On top of that come a blocked nose, a runny nose and often a reduced sense of smell. It usually follows a cold, is viral and clears up within one to two weeks. According to the guideline, antibiotics are needed only in certain situations, such as severe pain with a high fever or renewed worsening after initial improvement. If it lasts longer than twelve weeks, it is called chronic — more on this in the article on sinusitis.
An honest assessment: many people who put recurring head pressure down to a sinus problem turn out, on closer examination, to have migraine or tension-type headache. Without a blocked or runny nose, the sinuses are an unlikely cause — and then neither antibiotics nor decongestant sprays will help.
The cervical spine can give rise to a headache that pulls from the back of the head towards the front and depends on posture and head movement (cervicogenic headache), usually together with neck pain. If you clench your teeth under stress or grind them at night, you overload your chewing muscles: the temples and cheeks feel hard, the jaw is tired in the morning and the teeth show signs of wear. Here the dental practice is the first port of call; a bite splint often helps.
Out-of-date glasses or uncorrected poor eyesight can cause pressure over the eyes and forehead after long hours of screen work, more often in the evening; an eye test will clarify this. The raised eye pressure in chronic glaucoma, on the other hand, is not something you can feel. The exception is an acute glaucoma attack with a red, hard, very painful eye, deteriorating vision and often nausea — an emergency for an eye hospital.
"I can tell when my blood pressure is high" — as a rule, that is not true. Mildly to moderately raised readings usually cause no symptoms, which is why high blood pressure often goes unnoticed for years. Conversely, pain and agitation push blood pressure up in the short term: a high reading during an episode of head pressure can be a consequence rather than the cause. Only very high readings, from around 180 mmHg systolic or 120 mmHg diastolic, can cause headaches, typically at the back of the head. Together with chest pain, shortness of breath, vision problems, confusion or paralysis, this is a hypertensive emergency — call 112. Without such symptoms, measure again after a few minutes' rest and, if the readings are still very high, call your practice or the out-of-hours medical service on 116 117 the same day. The guide Measuring blood pressure correctly explains how to measure reliably. Blood pressure that is too low tends to feel empty and weak — this is described in the article on lightheadedness.
In many people, ongoing strain shows itself physically — as pressure in the head or as a feeling of being "wrapped in cotton wool". That is not imagined: chronic stress increases muscle tension, worsens sleep and changes how pain is perceived. In anxiety disorders and depression, dull head pressure is one of the common accompanying symptoms. Everyday factors add up, too: little sleep, too little to drink, long stretches without food. If you drink a lot of coffee every day, going without it will often give you a withdrawal headache around 12 to 24 hours after your last cup — typically at the weekend.
A brain tumour is very rarely the explanation for persistent head pressure. The clues are not the pressure alone but accompanying signs: a steady increase over weeks, vomiting in the morning, worsening when coughing or straining, new neurological deficits, a first seizure or a change in personality. Idiopathic intracranial hypertension (raised pressure inside the skull without a tumour) mainly affects young women who are overweight: a pressing headache that is worse when lying down, a whooshing noise in the ears in time with the heartbeat, and vision that blacks out for seconds at a time. Left untreated, it threatens eyesight; medicines can also trigger it.
From the age of 50, a new headache at the temples with pain when chewing or vision problems can point to giant cell arteritis (inflammation of the arteries of the head). A new, persistent headache while taking the pill, during pregnancy or in the weeks after giving birth can, rarely, be caused by cerebral venous thrombosis. And if several people in a household have head pressure, dizziness and nausea at the same time, think of carbon monoxide from a faulty heating system.
These observations do not replace a diagnosis. But they help you describe the pattern — and that is exactly what matters at the practice, because most types of headache are recognised from the medical history.
Without warning signs, what is usually needed is not equipment but a good conversation and a targeted examination.
If head pressure is new or has changed, it is always worth looking at your medication plan.
Nitrates for angina, such as glyceryl trinitrate spray or isosorbide mononitrate, very commonly cause a dull headache, especially in the first few days. Calcium channel blockers such as amlodipine or nifedipine can cause head pressure, facial flushing and ankle swelling, and with erectile dysfunction medicines such as sildenafil or tadalafil, headaches are among the most common side effects. PDE-5 inhibitors and nitrates must never be combined — blood pressure can drop dangerously.
Taking painkillers very often can keep a dull, pressing, often daily headache going, one that is frequently already there when you wake up. Overuse means simple painkillers such as ibuprofen, acetylsalicylic acid or paracetamol on 15 or more days a month, or triptans, combination products or opioids on ten or more days, in each case for more than three months. According to the guideline, what helps is education, a medically supervised break from the medication or a reduction, and prevention of the underlying headache disorder. At first the headache can get worse; after that, it improves markedly for many people. Never stop opioids or sedatives abruptly.
Contraceptives containing oestrogen can trigger an oestrogen-withdrawal headache during the pill-free interval; the practice can adjust the regimen or the product. Rarely, tetracycline antibiotics such as doxycycline, acne medicines such as isotretinoin or very high amounts of vitamin A trigger raised intracranial pressure; isotretinoin and tetracyclines must therefore not be combined. New head pressure with vision problems during acne treatment should be assessed without delay.
Using decongestant nasal sprays for longer than a few days makes the mucous membranes swell up again and again — the nose stays blocked and the pressure stays; more in the guide on nasal spray dependence. SSRI antidepressants often cause headaches in the first few weeks, which usually settle. Long-acting sleeping pills and sedatives can leave you with a "woolly" head in the morning.
For acute tension-type headache, acetylsalicylic acid, ibuprofen and naproxen have been well studied, while paracetamol is somewhat less effective; combinations with caffeine work but carry a higher risk of overuse. Without medical advice, the package leaflet usually says: no longer than three to four days in a row. The German Migraine and Headache Society (DMKG) recommends the 10-20 rule: painkillers on no more than ten days a month, and none on at least 20 days. Anti-inflammatory painkillers put a strain on the stomach and kidneys and interact with blood thinners and blood pressure medicines — there is an overview in the painkiller comparison. Which medicine is right for you is decided by the practice treating you.
The number that decides whether it counts as overuse — counted as you go rather than estimated.
Readings, symptoms and medicines as one history that you can simply show at your appointment.
This article is for general information and does not replace medical advice, diagnosis or treatment. The self-tests described are a guide and not a diagnosis. If you have a sudden, extremely severe headache, paralysis, difficulty speaking or seeing, fever with a stiff neck, symptoms after a head injury, or if several people in your household have symptoms at the same time, please contact a doctor or the emergency services without delay.
