Tension headaches feel like tightness or pressure - like a tightening band - around your head. They’re the most common type of headache experienced in adults, affecting approximately 80% of people at some point in their life. As they cause pain in the head, neck and behind their eyes, that sometimes starts from the shoulder and neck, tension headaches can be debilitating and disruptive to everyday life including your sleep, work and exercise. They can also lead to you feeling tired, irritable, or sensitive to light or noise.
While it’s tempting to immediately reach for painkillers like ibuprofen or paracetamol, this is a very temporary solution that never gets down to the real cause of the problem, instead only temporarily masking the symptoms without ever giving you a pathway forward.
What Causes A Tension Headache?While the exact mechanism that causes tension headaches is not well understood in the research, muscle tension or spasms around your head, neck and jaw are considered to be a key factor in the development of tension headaches. This tension may be caused by:
- Stress - tension headaches are well documented in the research to be linked to stress, with the physical effects of stress leading to spasms in the neck and scalp. This may be ongoing stress related to work, anxiety or emotional stress, experiencing stressful events or having hectic, stressful days.
- Poor posture related to how you sit, stand or lie down. This includes sitting or standing with your head and neck in an awkward position for a prolonged period, as well as overuse of mobile devices where the neck is craned in a tech neck position.
- Eye strain - focusing on a computer screen or other device for a long period of time can cause eye strain and lead to muscle tension in the neck and scalp.
- Fatigue - not getting enough sleep, having disturbed sleep or general fatigue can cause muscle tension and increase the likelihood of tension headaches.
- Dehydration: not drinking enough water or fluids can cause dehydration and lead to tension headaches.
- Certain foods and beverages: Some people may experience tension headaches as a result of consuming certain foods or beverages, such as alcohol or caffeine.
Interestingly, recent thinking suggests that tension headaches may actually be linked to changes in brain chemicals (called neurotransmitters), and muscle tightness may help trigger the changes in the neurotransmitters, or muscle tightness may be a result of changing levels of brain chemicals. Vitamin deficiencies have also been implicated as a potential contributing factor.
Identifying Tension HeadachesMany people can tell when they are having a tension headache due to experiencing aching, tight pain on both sides of the head with tenderness in surrounding areas and other features like sensitivity to light or to sound (though not both light and sound). In 2018 the International Headache Society (IHS) developed a diagnostic criteria, as part of the International Classification of Headache Disorders. This includes:
- Having at least ten headache episodes that fulfil the following criteria
- Headaches that last between 30 minutes to as long as 7 days
- Exhibiting at least two of the following four characteristics:
- Bilaterally located
- Pressing or tightening (non-pulsating) quality
- Mild or moderate in intensity
- Not exacerbated by routine physical activity, e.g., walking or climbing stairs
- Exhibiting both of the following:
- No nausea or vomiting
No more than one of photophobia (light sensitivity) or phonophobia (noise sensitivity)
The headache is not better explained by a different kind of headache diagnosis.
- Infrequent episodic TTH: at least ten episodes of headache occurring on less than one day per month, and on average less than 12 days per year.
- Frequent episodic TTH: at least ten episodes of headache occurring between 1 to 14 days per month on average, for over 3 months (so greater than 12 episodes and on less than 180 days per year)
- Chronic TTH: headache occurring on more than (or equal to) 15 days per month on average, for more than three months (so greater or equal to 90 episodes occurring on 180 days per year)
How Does Physiotherapy Help A Tension Headache?It comes as a surprise to many to learn that tension headaches are a very common problem that our physiotherapists work with due to our experience in detecting muscle imbalances, and treating the muscles that are causing pain and tension. As such, when it comes to treating tension headaches, we may use:
- Mobilisation or manipulation of stiff neck joints, where we put gentle pressure on the vertebrae in the neck where stiffness or pain is present
- Soft tissue release: a massage technique that assists in stretching the muscle, fascia and ligaments that could potentially be causing tension and pain
- Posture improvement: as poor posture can lead to muscle strain and tension, correcting posture through technique modification, better ergonomics (including at the workstation), and specific exercises can help relieve tension headaches or reduce their incidence
- Addressing tight, weak or overactive muscles using stretching, strengthening, massage or dry needling. This may include working in areas like the shoulder blades and deep neck muscles
- Dry needling: there is consistent evidence that dry needling may be effective for tension-type headaches. The needles release a cascade of natural pain killers by triggering a response from the nervous system and relaxes muscular tension by directing blood flow to the area
- Education: a big part of what we do is teaching you about everything from the causes of tension headaches to help prevent future neck dysfunction, to lifestyle changes and stress management techniques. This even includes discussion on things like your pillow, as a non-supportive pillow or one that is poorly suited to your neck may contribute to the incidence of tension headaches.