Tension Headache

john miller physiotherapist

Article by John Miller

What is a Tension Headache?

tension headache

A tension headache is the most common form of a primary headache. It happens intermittently in up to 80% of the population. As the symptoms are not as severe as a migraine, Tension Headache is only considered a problem if it becomes frequent or chronic.

What are the Symptoms of a Tension Headache?

Frequent Tension Headache is recognised when the sufferer has experienced at least 10 headaches in a one month period. There are varying degrees of frequency and chronicity.

Chronic Tension Headache sufferers report headaches on more than 180 days in a year. Tension Headache pain tends to be bilateral, and pressing or tightening in nature. It is of mild to moderate intensity and will not tend to interrupt work. 

Tension Headache sufferers can experience symptoms associated with migraine such as nausea and photophobia (hypersensitive to light) or phonophobia (hypersensitive to sound), but usually only one of these symptoms.

How is a Tension Headache Diagnosed?

There is no one specific test that identifies tension-type headache. Your diagnosis will be made based on your health professional's interpretation of your symptoms and how you respond to different treatments

What about X-rays, CT-scans and MRI?

Unfortunately X-rays, CT-scans and MRI's are not diagnostic of a tension headache. You can suffer a tension type headache with or without some abnormal findings on X-rays or scans. Likewise, scan abnormalities do not guarantee that you will experience a tension headache.

However, X-rays and scans may identify structures that could potentially be causing your tension type headache. We recommend that you have at least cervical spine X-rays if you have been suffering headaches or head pain for any extended period.

How Can Physiotherapy or Massage Help You?

Quality neck physiotherapy or massage can have a very quick and effective result for relieving your tension headache through relaxation of muscles under excessive tension. It is also important to remember that excessive muscle tension will compress, distort or irritate joint structures that cause neck headache, which will further complicate your symptoms.

Your tension-type headache treatment may include all or some of the following techniques:

  • Stiff neck joints may need to be loosened or unlocked via joint mobilisation (gentle gliding techniques), joint traction or in specific cases a gentle and localised joint manipulation technique.
  • Hypermobile (or dynamically unstable) joints may require specific deep neck muscle strengthening exercises to stabilise, control and limit the joint movement available.
  • Tight or overactive muscles may require stretching, massage, acupuncture, dry needling, or other relaxation techniques.
  • Weak muscles may require specific strengthening exercises. This may include your postural shoulder blade and neck muscles.
  • Nerve dysfunction may be addressed by your physiotherapist depending upon your specific examination findings. Neurosensitivity is a common finding that needs to addressed with cautious professional care and attention.
  • Posture correction may be recommended via specific exercises, posture awareness techniques, taping or a posture brace.
  • Helpful advice on how to prevent neck dysfunction in the future eg awkward neck positions and postures to avoid.

What if Physiotherapy or Massage Can't Help You?

Since there are over 300 sources of a headache, and tension-type headache is responsible for some.

You may also be suffering from a mixed or a multi-source headache. In these instances, your neck headache may be solved but another source of your head pain could linger.

Your physiotherapist will advise you if you have symptoms that could indicate a different cause for your headache. In these instances, they will also direct you towards further investigations or tests that may assist your diagnosis and subsequent treatment.

Mixed Headache-Migraine Types

You can simultaneously suffer one, two or more types of a headache or a migraine.

One type may cause another or overlap with another. For example, a painful neck can cause an increase in muscular tension, which will increase your blood pressure. In this scenario, you would be suffering a neck headache + tension headache + migraine!

tension type headache

In our experience, finding the primary source of your headache or a migraine is the key to successful management.

What Else Could Be Causing Your Headaches or Migraine?

Your physiotherapist and doctor will be able to assist your diagnosis and headache source. Sometimes specific tests can confirm your diagnosis. On other occasions, it can be a process of elimination.

In a small percentage of patients, there is, unfortunately, a sinister cause of your head pain, which should be thoroughly investigated. These can include brain tumours, aneurysm, meningitis and other systemic illnesses.

Your physiotherapist or doctor may recommend that you complete a headache or migraine questionnaire that will assist in your headache classification, diagnosis and treatment. Once you complete these questionnaires please present the results to your physiotherapist or doctor to assist your diagnosis and treatment.

Headaches or Migraine Questionnaire

At PhysioWorks, we have a special interest in the assessment, diagnosis and treatment of a neck headache, tension-type headache, stress headache and jaw headache.

For more information, please ask your physiotherapist.

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Headache RED FLAGS!

If suffer any of the following symptoms, please notify your physiotherapist or doctor as soon as possible.

All Red Flags MUST be thoroughly investigated!

We urge you to check with your doctor or physiotherapist to investigate further if your headaches have any of the following characteristics:

  • Sudden or severe headache - “thunderclap” type headache.
  • New or "different" headache to your normal type.
  • Your “worst headache ever”!
  • Signs of neurological complications e.g. motor weakness, memory loss, confusion, behaviour changes, reduced alertness or meningismus (stiff neck + photophobia + headache).
  • New headache onset over the age of 40 to 50 years.
  • Headaches at night or waking in the morning.
  • Headache associated with systemic symptoms e.g. weight loss, fever, nausea or vomiting.
  • Onset of headache after cough or sneeze, exercise, coitus or head turning.
  • New onset of a headache during or following pregnancy.
  • A previous history of cancer.

If you have any of the above Red Flags symptoms, we strongly recommend that you inform your physiotherapist and seek the advice of your doctor or an emergency department immediately.

Can an Unsupportive Pillow Cause Tension Type Headaches?

neck headache

Yes. Unfortunately, a non-supportive pillow or one not suited to your neck can predispose you to neck pain or tension type headache.

If you suffer neck pain or headache, it is wise to ask for the professional advice of your physiotherapist regarding what pillow style and size they would recommend for you.

Pillows do vary and the best one for your neck shape and body size will help you prevent neck pain and neck headache.

More info: Best Pillows

Headaches and Migraine Questionnaires

Discover what is causing your Headache or Migraine...

Common Tension Type Headache Treatments

  • Early Injury Treatment
  • Avoid the HARM Factors
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Scapular Stabilisation Exercises
  • Closed Kinetic Chain Exercises
  • Biomechanical Analysis
  • Proprioception & Balance Exercises
  • Medications?
  • Ergonomics
  • Posture Correction
  • Soft Tissue Massage
  • Brace or Support
  • Deep Neck Stabilisation Exercises
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Physiotherapy Instrument Mobilisation (PIM)
  • Prehabilitation
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Helpful Products for Headaches & Migraine


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  • Headache - Migraine

    Common Causes

    General Information

    Specific Migraine - Headache Types

    Migraine - Headache Questionnaires

    Neck Conditions

    Jaw Conditions

    Systemic Conditions

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    Last updated 14-Feb-2019 11:08 AM

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