Tension Headache


Tension headaches are the most common type of headache that afflicts 80% of U.S. population (1) and is sometimes called a “stress” headache. Generally, sufferers experience a tension headache once or twice a month, but 3% of the population experience daily tension headaches. For those who have suffered with tension headaches for at least 15 days per month for 3 months, then the term Chronic Tension Headache is applicable. Chronic Tension Headache is more common in females, but there does not appear to be a genetic link.


A tension headache is generally described as diffuse, mild to moderate pain that is often described as feeling like a tight band or vice around your head. However tension headaches can also be very severe and be confused for a migraine. Chronic fatigue, difficulty falling asleep, irritability, mild sensitivity to light/sound and poor concentration often accompany a Tension Headache. The pain may last from 30 minutes per episode or even up to a week. These types of headaches usually onset gradually and often in the middle of the day.

In many sufferers tight muscles in the neck and scalp seem to be the culprit. The following list illustrates potential causes of this tight musculature:

  • Inadequate rest
  • Cervical facet joint irritation (resulting from arthritic changes, trauma, posture)
  • Low blood sugar
  • Poor posture (often forward head shift – ears should align with shoulders)
  • Emotional or mental stress, including depression
  • Anxiety
  • Fatigue
  • Hunger
  • Overexertion

In others, tightened muscles are not part of tension headaches, and the cause is unknown.

Tension headaches are usually triggered by some type of environmental or internal stress. The most common sources of stress include family, social relationships, friends, work, and school. Examples of stressors include:

  • Having problems at home/difficult family life
  • Having a new child
  • Having no close friends
  • Returning to school or training; preparing for tests or exams
  • Going on a vacation
  • Starting a new job
  • Losing a job
  • Being overweight
  • Deadlines at work
  • Competing in sports or other activities
  • Being a perfectionist
  • Not getting enough sleep
  • Being over-extended (involved in too many activities/organizations)

Episodic tension headaches are usually triggered by an isolated stressful situation or a build-up of stress. Daily stress can lead to chronic tension headaches.


Therapy. Chiropractic care and physical therapy treatments designed to increase cervical spine mobility and correct bad posture are important for those who suffer Tension Headaches.* Forward head shift is one example of a postural abnormality that make the neck muscles have to work harder to hold the head up against the force of gravity and may contribute greatly to muscle tension.

Pharmacological Intervention. OTC and prescription drugs are available. OTC drugs are usually the first line of defense for Tension Headache. Aspirin, acetaminophen, naproxen, and ibuprofen are often utilized. Sometimes combination medications work best, such as aspirin/acetaminophen/caffeine/sedative.* Triptan drugs are often used for those who suffer from both Migraine and Tension type headaches.*

Occipital Nerve Blocks. Occipital neuritis often results from tight neck and head musculature and can perpetuate Tension Headache complaints. An injection of an anti-inflammatory medication mixed with a corticosteroid drug around the greater and lesser occipital nerves on the back of the head can dramatically improve symptoms of Tension Headache and help to break the headache cycle.*

Facet Injection. The moveable joints on the back of the neck, called facet joints, can be a source of irritation that increase neck muscle tightness, which can lead to Tension Headache. An injection into one or more of these joints can quickly reduce the neck pain and tension that triggers Tension Headaches.*

Radiofrequency Ablation.  Facet blocks can often identify the source of neck pain and tension that triggers a headache.* Facet blocks may offer only temporary relief for facet joint symptoms, however, and radiofrequency treatments can be used to gain much longer lasting relief.* Radiofrequency Ablation (RFA) also treats the facet joints by affecting the median branch nerve that innervates the joint capsule around the joint.* RFA is quickly accomplished and can provide an average of 6-12 months of relief for associated neck symptoms that may trigger Tension Headache.*

*Individual results may vary.

(1) https://my.clevelandclinic.org/health/articles/tension-type-headaches