Many tension headache sufferers describe their pain as producing a sensation of pressure or tightness around the head, as though a band were pulled tightly around it; others compare the feeling to having their head clamped in an ever-tightening vise. The pain usually begins gradually and increases steadily over a period of hours, but while severe and distracting, it rarely becomes overwhelming and physically debilitating, as in a migraine.

In mild to moderate tension headaches, there is a constant, band-like pain or pressure that lasts from 30 minutes to all day. Tension headaches tend to be moderate or mild and are rarely severe. Unlike migraines they are not usually unilateral, throbbing or associated with light and sound sensitivity or nausea and vomiting. Other features of tension headaches may include:

Headache upon awakening
General muscle aches
Difficulty falling asleep and staying asleep
Chronic fatigue
Irritability
Disturbed concentration
Mild sensitivity to light or noise
Occasional dizziness

The typical tension headache is one that produces a dull, steady, achy pain on both sides of the head. This contrasts which the classic symptom of migraine, which is severe, throbbing or pulsating pain, usually on one side of the head.

However, a small proportion of tension-headache patients report that their pain, when at its worst, does at times develop a pulsating quality, a phenomena which physicians sometimes call a tension-vascular headache. This represents one more area where the distinction between tension headaches and migraines becomes somewhat blurred, and tends to support the theory that the two headache types are not actually separate conditions, but opposite ends of common spectrum of primary headache activity.