Tension Headaches

Believe it or not there are at least 150 different types of headache.  Tension headaches are the most common, affecting about 4 out of 5 of people in their lifetime.  Wow - that's almost everyone at some stage in their life!  About 1 in 10 people can develop a chronic daily tension headache.  Again - incredibly common!  

As a result we have seen many patients with this type of headache and have extensive experience in successfully managing the different causes of tension headaches.

Many patients we see have had a negative experience when being diagnosed.  The common explanation they receive is that tension headache is a muscle tension headache, yet their only advice about management is reassurance they don't have a brain tumour, some prescription drugs and advice to reduce stress.  This is often the treatment offered by a neurologist.

As a musculoskeletal physiotherapist, I take a more detailed view on this condition.  One of the most important distinctions is that tension headache is most often a trigger point headache, caused by painful "knots" known as myofascial trigger points in the muscles of the head and neck region.  It is not typically some generalised tension in the scalp muscles.  Usually the cause is more specific and involves multiple trigger points in multiple muscles that together refer pain into the skull that is perceived as a headache.  

The figure below gives an idea as to how multiple trigger points in the cranial and neck muscles can combine to create a headache.


"Tension headaches are the most common, affecting about 4 in 5 people"

Diagnosis involves 2 key steps: identifying these trigger points, and identifying what the underlying causes of the trigger points are.  Identifying trigger points requires skilled palpation ("hands-on" assessment) of your neck, jaw and cranial muscles.  Identifying the causes requires a really thorough understanding and assessment of all of the possible causes.  

A few examples of causes include a head knock, postural issues such as a poor position on your bike, the way you hold your phone or slouch sitting at your laptop or tablet.  Other examples might be poor spinal extensor tone, excessive stress resulting in subconscious tightening of the jaw and neck muscles, anxiety disorders, or any of a huge number of neural or physical ways of overloading your muscles.  Note that I say causes not cause, as there are usually multiple factors which result in the development of pain.  

Treatment must also address the 2 key issues identified in your diagnosis.   It is not enough to systematically find and eliminate the trigger points.  You must also address the underlying causes otherwise the headache and the trigger points simply recur in time.  This is the key step that many people fail to address adequately.