Tension headaches are the everyday headache most people know: a dull, pressing ache that can sit across the forehead, around the temples or at the base of the skull. They are usually not a sign of anything serious, but when they keep coming back they can wear you down. Understanding what tends to set them off can help you work out what may help, and when it is worth seeing a doctor.

This article is general information, not a diagnosis. If your headaches are severe, frequent or different from usual, see your GP.

What Are Tension Headaches?

Doctors call this kind of headache a tension-type headache. According to the international headache classification, it typically feels like pressure or tightening rather than throbbing, is mild to moderate, usually affects both sides of the head, and does not get worse with routine activity such as walking or climbing stairs [1]. Many people describe it as a tight band around the head.

Unlike migraine, it does not usually come with nausea, although some people find light or noise bothers them during an episode [1]. An episode can last from under an hour to several days [1]. If your headaches do not fit this picture, it is worth getting them checked.

Common Triggers

Tension headaches rarely have one single cause. Things people commonly notice before a headache include:

  • Stress. Busy periods, worry and long days are a common trigger, and many people hold that stress in their neck, shoulders and jaw.
  • Long hours at a screen. Desk work, laptops and phones keep the head and neck in the same position for hours, which some people find leaves their neck and shoulders tight by the end of the day.
  • Poor or short sleep. Not sleeping well, or sleeping in an awkward position, can leave you more prone to a headache the next day.
  • Jaw clenching. Clenching or grinding your teeth, often without realising, can make the muscles at the sides of the head feel tight and sore.
  • Missed meals and not drinking enough. Many people notice a headache on days when their routine slips.

The Neck-Headache Connection

Many people with tension headaches also notice tight, tender muscles in the neck, shoulders and around the head. Firm, sensitive spots in these muscles, often called trigger points, can send an ache towards the head when pressed. A 2018 review found these spots are common in people with tension-type headache [2].

The same review also found that trigger points tend to build up over time, which suggests they may partly be a result of ongoing headaches rather than only a cause [2]. So muscle tension is best seen as one piece of the picture.

Doctors also recognise a separate type, called cervicogenic headache, which comes from a problem in the neck itself [1]. Because the two can feel similar, a proper assessment matters.

How Treatment Can Help

What the research says. Exercise is a sensible starting point. A 2022 review found strength training reduced headache pain in people with tension-type headache, but the certainty of that evidence was very low, so more and better research is needed [3]. Research on hands-on (manual) therapy is more encouraging than many people expect: a 2021 review of ten trials found positive effects on headache intensity, frequency and quality of life. No single technique was better than the others, and combining techniques seemed to work best [4]. There is less research on massage on its own, and treatments aimed at trigger points still need to be tested against placebo [2].

That is why treatment here combines hands-on work with movement and practical advice. Many people find hands-on treatment eases neck and shoulder tension in the short term, which can make it easier to keep up the exercises and habits that help over time.

  • Trigger point therapy applies focused, sustained pressure to tender spots in the neck, shoulders and jaw that may be referring discomfort towards the head.
  • Remedial massage starts with an assessment of your posture and movement, then uses targeted soft tissue techniques on the areas contributing to your symptoms.
  • Deep tissue massage uses firmer pressure for tension that has built up in deeper muscles over a long time.
  • Exercise and movement advice. Our therapist's background in exercise science means you leave with simple strengthening and mobility exercises, so the benefits carry over between sessions. You can read more about her qualifications.

Simple Things That Often Help Day to Day

  • Keep moving. Regular exercise and short movement breaks during long screen sessions help many people feel less stiff.
  • Notice your jaw and shoulders. A quick check during the day to unclench your teeth and drop your shoulders can ease tension before it builds.
  • Look after sleep and routine. Regular sleep, meals and drinking water are simple habits many people find make headaches less frequent.
  • Make time to wind down. Relaxation, a walk or anything that lowers your stress levels may help.
  • Ask about pain relief. For advice on medicines, talk to your GP or pharmacist, especially if you find you need pain relief often [5].

When to See a Doctor First

Most headaches are not serious, but some need urgent medical assessment [5]. Call 000 if you have a sudden, severe headache that reaches its worst within seconds or minutes, or feels like the worst headache of your life. See a doctor urgently if your headache:

  • comes with fever, a stiff neck, a rash or confusion;
  • follows a knock to the head or another injury;
  • comes with weakness, numbness, changes in your vision or difficulty speaking;
  • is new after the age of 50, or is a clear change from your usual pattern;
  • wakes you from sleep or is worse when lying down.

See your GP if your headaches are becoming more frequent or severe, or are getting in the way of daily life. If you have been checked by a doctor and cleared for hands-on treatment, let us know so we can work with any advice you have been given.

What to Expect at Your First Appointment

Your first session starts with a conversation about your headaches, health history and daily routine, followed by a check of how your neck, shoulders and jaw move. Treatment is tailored to what we find, and you will leave knowing what may help between sessions and whether follow-up visits are worthwhile.

Remedial massage may be claimable through your private health fund extras cover, and we offer on-the-spot claiming with HICAPS. When you are ready, you can book online.

References

  1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. doi:10.1177/0333102417738202
  2. Do TP, Heldarskard GF, Kolding LT, et al. Myofascial trigger points in migraine and tension-type headache. The Journal of Headache and Pain. 2018;19(1):84. doi:10.1186/s10194-018-0913-8
  3. Varangot-Reille C, Suso-Martí L, Romero-Palau M, et al. Effects of different therapeutic exercise modalities on migraine or tension-type headache: a systematic review and meta-analysis with a replicability analysis. The Journal of Pain. 2022;23(7):1099–1122. doi:10.1016/j.jpain.2021.12.003
  4. Cumplido-Trasmonte C, Fernández-González P, Alguacil-Diego IM, et al. Manual therapy in adults with tension-type headache: a systematic review. Neurología (English Edition). 2021;36(7):537–547. doi:10.1016/j.nrleng.2017.12.005
  5. Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019;92(3):134–144. doi:10.1212/WNL.0000000000006697