OBJECTIVES: To quantify the impact of tension headache on work productivity loss and activity impairment of adults aged 18 to 64 in 5 European countries.METHODS: We analyzed data from the 2007 European National Health and Wellness Survey (NHWS), an annual, cross-sectional study of adults (aged 18+) in France, Germany, Italy, Spain, and the UK.  NHWS data were collected via self-administered, Internet-based questionnaires.  The analysis sample consisted of respondents aged 18 to 64, who reported three or more tension headaches in the past month..  The control group included respondents who did not experience any types of headache in the past year.  Work productivity loss and activity impairment were assessed using the general health version of the Work Productivity and Activity Impairment (WPAI) questionnaire.  Linear regression models were developed to adjust for gender, age, country of residence, number of physical comorbid conditions, and presence of a psychiatric condition.RESULTS: Across the five countries, there were a total of 5,144 (20.1%) adults with tension headaches and 20,453 (79.9%) controls.  Adults with tension headaches were significantly more likely to be female, younger, reside in Germany or the UK, have a greater number of physical comorbid conditions, and have a psychiatric condition than adults without headaches (p<0.001 for all).  Adjusting for demographics and comorbidity, adults with tension headaches who worked full-time experienced 4.93% greater impairment while working (presenteeism), and 4.86% greater overall work impairment than controls (p<0.001 for both).  Missed work time (absenteeism) was not significantly affected by tension headache.  Overall, adults with tension headaches experienced 6.21% greater activity impairment than controls (p<0.001).CONCLUSIONS:. The study results showed significant reduction in productivity in patients with tension headaches. Because patients often self-medicate patient reported outcomes may help employers and payers to better understand and manage the disease.