Tension-Type Headaches: What are they and what can I do about them?

By Dr. Meghan Faulkner, MS, DC, DACBSP

Have you ever felt pressure behind your eyes or band-like tension around your skull? Or felt pain radiating from your neck up to your head? Or even the really weird sensation of a headache wrapping from the back of your head to your eyes/forehead? These are all common symptoms and locations of the tension-type headache. This pain can be excruciating and persist anywhere from a few hours to over 15 days! Often these types of headache are misdiagnosed as migraines and are treated with over-the-counter medications with no lasting relief. While chiropractic care is not a cure-all for every type of headache, it is incredibly effective for tension-type headaches. Let’s dive into this particular headache type and how it can be treated.

Common causes of this headache include stress, muscle tension, spasm and trigger points, joint dysfunction of the cervical and upper thoracic spine, and poor posture.  

Increased stress levels can lead to an influx of cortisol into our system. Cortisol is a potent anti-inflammatory hormone, and its dysfunction is likely to result in widespread inflammation. Studies have shown associations of cortisol and stress-related chronic pain*. Essentially, if you are prone to stress and muscle tension, stress hormones will increase your perception of pain and trigger headaches.  You can help reduce your stress levels by trying the following techniques:

  • Get at least 6-8 hours sleep per night
  • Breathing techniques
  • Exercise for at least 30 minutes most days
  • Yoga
  • Massage
  • Acupuncture
  • Journaling
  • Talk therapy
  • Reduce screen time

Common areas that people carry stress are the neck and shoulder muscles. Muscle tension pulling on the connective tissue throughout the neck and shoulders can also transfer or refer pain into the cranium causing what we think of as a headache. Prolonged muscle tension can cause trigger points. Trigger points are focal muscle spasms that cause tension along the muscle they inhabit and can also cause radiating pain in several different directions. Common trigger point locations that cause headaches include the suboccipital, upper trapezius fibers, and the sternocleidomastoid muscles.

Quick reminder to check your water intake people!! Dehydration is a common cause of headaches and can easily be prevented. Decreased water or hydration to the muscles also causes tension and can therefore increase tension on the muscles that are known aggravators of tension headaches. The daily water intake recommendation is one half your body weight in ounces per day. This amount will increase if you drink coffee or alcohol, or sweat profusely throughout the day. 

As mentioned in the beginning of this blog, chiropractic can help you reduce, manage and even prevent your tension-type headaches.  In addition to using a hands-on approach to your treatment plan, your chiropractor should also guide you through behavior modifications, as well as rehabilitative exercises, to address all causes of these types of headaches.  

Behavior modifications are changes that you can make in your everyday life or activities to help reduce the stressors that are contributing to your pain.  Posture plays a really big role in muscle tension, especially those muscles that can cause tension headaches. There are a few ways to reduce postural stress;  

1. Address your ergonomics or the positions you are in most hours of the day.  Make sure that when seated at the desk, the computer screen is sitting at eye level and high enough so that the chin can stay parallel to the ground. Ears, shoulders and hips should be stacked on top of one another when in an upright seated position. Any forward slumping of the head or shoulders can increase the tension in the muscles of the posterior neck and upper shoulders. 

2.  Make posture changes through the day (move your body!).  While sitting at the desk with great posture can help reduce a lot of the muscle tension that forms throughout the day, gentle movement throughout the day is best for overall muscle tension. I recommend standing up and moving your muscles through a pain-free and gentle range of motion at least once per hour. This will help increase blood flow to those muscles, reduce overall tone and therefore reduce the likelihood of trigger points and chronic muscle  tension.  

3.  Use a posture device.  It’s best to be mindful of your posture and positions throughout the day. There are posture devices that will remind you to sit up straight and help you learn how to maintain great posture throughout the day. We recommend electronic posture devices that send you a signal when you have deviated from an upright position. These devices help you activate and strengthen your back. On the other hand, posture devices, such as redementary back braces that strap your shoulders back, could actually decrease your body‘s ability to stabilize posture on its own. The key is to be active in correcting your posture, not passive.

Learning about the triggers and causes of your tension headache can help you prevent future ones from happening. But what about your current headache? Sports medicine chiropractic can help in many ways to relieve your current symptoms and improve overall muscle and joint strength and health.  

  1. Soft tissues manipulation of trigger points or tension within the affected muscle can alleviate pain directly on the muscle, but also relieve headache pain. A recent study by Spanish physiotherapists Espí-López et al assessed the effectiveness of manual techniques in the treatment of patients with tension-type headache. The study resulted in significant results in the intervention groups that were treated with both suboccipital soft tissue treatments and with chiropractic adjustments to the upper cervical spine. Improvements were maintained at the 8-week follow-up evaluation. (3)
  2. Rehabilitative exercises to strengthen the postural muscles can help increase your muscles tolerance to pain, improve their resistance to fatigue and therefore maintain proper posture for longer periods of time. Muscles that are resistant to fatigue tend to be more relaxed throughout the day.  
  3. Foam rolling, or any type of self-myofascial release, can be used by the affected person to help relieve muscle tension at home.  Directing your foam rolling attempts to superficial muscles such as the suboccipitals or the trapezius muscles can aid in muscle tension reduction.  the muscles are simply too tight or are in need of professional therapy and foam rolling is not enough, seek help from your local soft tissue provider (massage therapist, chiropractor, acupuncturist).  
  4. Research shows that spinal manipulation – one of the primary treatments provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck. A 2014 report in the Journal of Manipulative and Physiological Therapeutics (JMPT) found that interventions commonly used in chiropractic care improved outcomes for the treatment of acute and chronic neck pain and increased benefit was shown in several instances where a multimodal approach to neck pain had been used. Also, a 2011 JMPT study found that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. 


1. Bryans R, Descarreaux M, Duranleau M, et al. Evidence based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther 2014; 37: 42-63.

2. Bryans R, Descarreaux M, Duranleau M, et al. Evidence based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 2011; 34: 274-89.3.  The Journal of the American Osteopathic Association, May 2014, Vol. 114, 403-404

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