Did you know that tension-type headaches account for a staggering 60% of all headaches? (13) Patients who suffer from these types of headaches often exhibit common factors such as a forward-head posture due to prolonged computer work, texting or other habitual postural factors. They may also experience chronic restrictions in the shoulder, neck, and jaw kinetic chains, which can result in limited mobility in the cervical and thoracic spinal joints, shoulder girdle, and temporomandibular joint (TMD).
These physical changes can lead to muscle imbalances, tissue thickening, and inflammatory reactions, ultimately resulting in nerve entrapment syndromes, vascular changes, and the release of hormones, neurotransmitters, and chemicals that impact the pain centers of the brain. By addressing these underlying factors, it may be possible to reduce the frequency and severity of tension headaches.
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CHEMISTRY OF TENSION HEADACHES
Through a literature review of tension headaches, it has been observed that changes in the levels of three specific chemical substances - Serotonin, Bradykinins, and Substance P - are often associated with these types of headaches. (11)
Serotonin acts as a chemical messenger that supports and transmits nerve signals between nerve cells. It also causes narrowing of blood vessels with the vasoconstriction causing nociceptive pain (11)
Bradykinins mediate the inflammatory response, increase vasodilatation (expansion of arteries and veins), and cause contraction of smooth muscle - which can lead to peripheral sensitization. (11)
Substance P functions as a neurotransmitter especially in the transmission of pain impulses from peripheral receptors to the central nervous system. (12)
Please note that while this article primarily discusses tension headaches, it's worth noting that the chemicals mentioned are also involved in migraine headaches.
Tension Headache Correlation!
Research has shown that irritated or inflamed soft tissue within the body can release chemicals such as Bradykinin, Serotonin, and Substance P, leading to sensitization of nerve endings and ultimately resulting in pain and headaches. (2) It is therefore hypothesized that by addressing physical restrictions caused by factors such as poor posture, muscle imbalances, and previous injuries, we may be able to eliminate associated pain, alleviate chronic headaches, and even prevent tension headaches from occurring altogether. (16)
SYMPTOMS & EXAMINATION
The duration of tension headaches typically ranges from half an hour to an hour, and they may recur over several weeks. Those who suffer from tension headaches often describe the pain as a dull ache of mild to moderate intensity, or as a sensation of pressure or tightness in a band around the sides of the head.
This band may feel like a vice compressing the skull, and in severe cases, the pain may even extend to the shoulders, resembling a hooded cape draped over them. In such instances, the causes of the tension headache may involve more than just the head and affect a larger kinetic chain. (3)
NOT a Migraine!
Tension headaches can typically be distinguished from other types of headaches by the absence of certain symptoms. For instance, tension headaches do not typically cause visual disturbances, nausea, vomiting, numbness on one side of the body, or slurred speech. To help identify tension headaches, here are some common symptoms to look out for: (3)
Band-like pressure around the head.
Difficulty concentrating.
Difficulty sleeping (insomnia).
Fatigue and irritability.
Loss of appetite.
Neck, jaw, or shoulder discomfort.
Severe pain behind the eyes or eye strain/fatigue.
Tenderness of the scalp.
Tension headaches are not worse with exercise, migraine headaches are worse with exercise.
Vomiting is not usually involved with tension headaches, whereas nausea and vomiting are often involved with migraine headaches.
Cervical Examination - Orthopaedic Testing
In this video, you'll be taken through a comprehensive examination of the cervical region, including inspection and observation, palpation, assessment of active and passive ranges of motion, and orthopaedic examination.
Cranial Nerve Examination - 12 Cranial Nerves
Conducting a Cranial Nerve examination is a method we use to evaluate for potential sensory and motor dysfunction in our patients. This examination is routinely performed on all new patients.
Upper Limb Neuro Examination
The upper limb neurological examination is a component of the comprehensive neurological examination, which aims to evaluate the motor and sensory neurons that serve the upper limbs. This assessment is useful for detecting any potential impairment of the nervous system, and serves both as a screening and investigative tool.
Peripheral Vascular Examination - Key Points
Conducting a peripheral vascular examination is an important technique that aids in ruling out signs of vascular-related pathology. Early detection and treatment of peripheral vascular disease (PVD) can potentially prevent cardiovascular and cerebrovascular complications. This video covers some of the common procedures we perform in our daily clinical practice to assess peripheral vascular function.
MANUAL THERAPY – A POWERFUL TOOL FOR RESOLVING TENSION HEADACHES
Resolving a tension headache often requires addressing physical restrictions throughout an extensive Kinetic Chain. Even minor changes in tissue tension can significantly impact the frequency and intensity of headaches. (4,5,16)
Studies have shown that tension in the kinetic chains of the shoulder, neck, and jaw can increase both the frequency and intensity of tension headaches. However, manual therapy and exercise have been demonstrated to significantly reduce the prevalence and severity of these headaches. (6,7,8,9,16)
Note: Some of the common postural factors that perpetuate chronic tension headaches are:
Forward head posture.
Rounded shoulders.
Increased thoracic spine curvature (Kyphosis).
In the following videos, we showcase some of the common procedures we employ to treat patients with tension headaches. We have found these techniques to be highly effective when combined with joint manipulation/mobilization and a functional exercise program. To achieve optimal results, it is crucial to assess soft tissue restrictions throughout the kinetic chains of the shoulder, neck, and jaw.
4 Point Neck Pain Protocol - Motion Specific Release
In this video, Dr. Abelson demonstrates a common MSR protocol utilized to address tension headaches. It's important to assess and treat each case of neck pain as a unique dysfunction that is specific to the individual. Some cases may only involve local structures, while others can involve a much larger kinetic chain.
MSR Ten‐Point TMJ Protocol - Part One
In the first part of this two-part video series, Dr. Abelson, the developer of MSR, demonstrates various external procedures to address the soft tissue structures of the jaw that can contribute to temporomandibular dysfunction.
TMD issues are often associated with a range of symptoms, including jaw pain, tension headaches, earaches, facial pain, vision problems, eye pain, balance issues, tinnitus, throat and neck pain, dizziness, and many others.
Note: Some of the common signs/symptoms of TMJ/TMD headaches are: Local tenderness over the jaw or temple region, trigger points in the jaw muscles, history of grinding teeth (bruxism), increased stress, or prior trauma.
ADDRESSING JOINT RESTRICTIONS IN THE CERVICAL SPINE
In addition to addressing soft tissue restrictions, it is equally important to address any osseous joint restrictions in the cervical spine. Without the removal of these restrictions, many patients may not experience a resolution of their tension headaches. The facet joints of the spine are known to cause pain in the head in specific patterns.
To release joint restrictions in the cervical spine, either Neck Adjustments or Neck Mobilization can be employed. Research has supported the effectiveness of both procedures in restoring mobility (Arthrokinematics) and reducing pain. (17,18,19)
The Power of Chiropractic Adjustments
Chiropractic adjustments can be powerful tools in managing tension headaches. Patients who receive chiropractic care often experience a reduction or elimination of their symptoms. In this video, Dr. Abelson demonstrates some common spinal adjustments that may be effective in treating tension headaches. Research has supported the use of spinal adjustments as a viable treatment option for tension headaches.
Neck Adjustments or Neck Mobilization - The Choice Is Yours!
Many patients are unaware that they have options when it comes to addressing restrictions in the joints of their neck. In this video, Dr. Abelson showcases examples of Cervical Joint Mobilization. This technique can be effective in treating tension headaches. Research has supported the use of spinal mobilization as a viable treatment option for addressing tension headaches.
EXERCISE RECOMMENDATIONS
In the treatment of Tension Headaches, incorporating supportive exercises is a crucial component. The specific exercises prescribed will vary based on each patient's unique needs and current phase of treatment.
Pain Relief For Problem Headaches
In the video "Pain Relief For Problem Headaches," Miki Burton RMT, an instructor, demonstrates an effective technique to alleviate headaches. This Headache Relief video focuses on releasing trigger points in the suboccipital region, located at the base of the skull. Releasing this area is an essential aspect of resolving headaches.
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Neck Stretching - PNF - Kinetic Health: The PNF technique can be an effective method for restoring neck motion. In this video, Dr. Evangelos Mylonas demonstrates how to improve your mobility through the four motions of the neck.
5 Minute Neck Pain Relief
If you're experiencing tension headaches and significant neck tension, consider trying our "5 Minute Neck Pain Relief" routine. In this video, Miki Burton RMT, an exercise instructor, demonstrates how performing this routine several times a day can make a significant difference in resolving your tension headaches.
6 Effective - TMJ Exercises
In this video, Miki Burton RMT, an exercise instructor, demonstrates six effective exercises for temporomandibular joint dysfunction. TMD/TMJ issues are often a critical aspect of addressing a patient's kinetic chain when they experience tension headaches.
CONCLUSION
Throughout thirty years of clinical practice, we've discovered that manual therapy and exercise can significantly reduce the intensity and duration of tension headaches, and even resolve them completely. In our experience, success often involves addressing a larger kinetic chain, rather than solely treating the site of pain.
This approach frequently necessitates addressing both soft tissue and osseous restrictions during treatment. Additionally, prescribing a personalized combination of exercises for each patient is essential for achieving optimal results.
DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical experience and a track record of treating more than 25,000 patients, Dr. Abelson developed the Motion Specific Release (MSR) Treatment Systems to provide powerful and effective solutions for musculoskeletal issues.
As an internationally best-selling author, he is passionate about sharing knowledge and techniques that can benefit the broader healthcare community. A perpetual student, Dr. Abelson continually integrates cutting-edge methods into the MSR programs, with a strong emphasis on multidisciplinary and patient-centered care.
Beyond his professional life, Dr. Abelson is a dedicated husband and father of two. He and his wife share a deep love for international travel, immersing themselves in different cultures, music, and the joy of connecting with people around the world. An Ironman triathlete and marathon runner for over 30 years, he is also a committed environmentalist with a passion for human rights. His practice, Kinetic Health, is based in Calgary, Alberta, Canada.
REFERENCES
Myofascial trigger points and sensitization: an updated pain model for tension-type headache Fernandez-de-las-Penas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. Cephalalgia. 2007 May;27(5):383-93. Epub 2007 Mar 14. inDepartment of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain.
Stress-induced pain and muscle activity in patients with migraine and tension-type headache. Leistad RB, Sand T, Westgaard RH, Nilsen KB, Stovner LJ. Cephalalgia. 2006 Jan;26(1):64-73. Department of Neuroscience, Norwegian University of Technology and Science and Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway.
Muscle pain in the head: overlap between temporomandibular disorders and tension-type headaches. Svensson P. Curr Opin Neurol. 2007 Jun;20(3):320-5. Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus, Denmark. psvensson@odont.au.dk
Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Cephalalgia. 2006 Mar;26(3):314-9. Department of Physical Therapy & Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Headache in patients with neck-shoulder-arm pain of cervical radicular origin. Persson LC, Carlsson JY. Headache. 1999 Mar;39(3):218-24. From the Department of Neurosurgery, Lund University Hospital, Sweden.
Neck flexor muscle fatigue in adolescents with headache: an electromyographic study.Oksanen A, Poyhonen T, Metsahonkala L, Anttila P, Hiekkanen H, Laimi K, Salminen JJ.Eur J Pain. 2007 Oct;11(7):764-72. Epub 2007 Feb 8. Department of Physical and Rehabilitation Medicine, Turku University Central Hospital, FIN-20521, Turku, Finland. airi.oksanen@tyks.fi
Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Headache. 2006 Sep;46(8):1264-72. Universidad Rey Juan Carlos, Physical Therapy, Alcorcon, Madrid, Spain.
Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache. Fernandez-de-Las-Penas C, Ge HY, Arendt-Nielsen L, Cuadrado ML, Pareja JA. Eur J Pain. 2007 May;11(4):475-82. Epub 2006 Aug 21. Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Fernandez-de-las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Headache. 2006 Mar;46(3):454-60. Department of Physical Therapy, University Rey Juan Carlos, Madrid, Spain.
von Piekartz H, Ludtke K. Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: A single-blind, randomized controlled study. Cranio 2011; 29: 43–56.
Levy D, Strassman AM. Distinct sensitizing effects of the cAMP-PKA second messenger cascade on rat dural mechanonociceptors.J Physiol.2002;538:483–493.
Carmody J, Pawlak M, Messlinger K. Lack of a role for substance P in the control of dural arterial flow.Experimental Brain Research.1996;111:424–428.
Swenson and Grunnet-Nilsson. The management of headache. Principles and practice of chiropractic, Ed Haldeman, 3rd ed. McGraw-Hill Medical Publishing Division, Toronto.
Castien RF et al. Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomized, clinical trial, Institute for Health and Care Research, VU University Medical Centre, Amsterdam,Cephalalgia 2011; 31(2): 133-43.
RRS Education Research Reviews,Manual Therapy for Chronic Tension-Type Headache.
Brian James Abelson, Kamali T. Abelson. Exercises for the Jaw to Shoulder ‐ Volume 1 of Release Your Kinetic Chain. Published by Rowan Tree Books Ltd. 2009.
Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. Themechanisms of manual therapy in the treatment of musculoskeletal pain:a comprehensive model. Man Ther. 2009;14(5):531-8.
Sterling M, Jull G, Wright A. Cervical mobilisation: concurrent effects onpain, sympathetic nervous system activity and motor activity. Man Ther.2001;6(2):72-81.
Schmid A, Brunner F, Wright A, Bachmann LM. Paradigm shift in manualtherapy? Evidence for a central nervous system component in the responseto passive cervical joint mobilisation. Man Ther. 2008;13(5):387-96.
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