Updated: Nov 1, 2022
Amazingly, 60% of all headaches are tension-type headaches. (13) Some common factors that are seen in patients who experience tension headaches include:
Forward-head posture is often related to computer work, texting, or other chronic postural factors.
Chronic myofascial restrictions in the shoulder, neck, and jaw kinetic chains. (16)
Lack of thoracic and cervical spinal joint mobility, decreased shoulder girdle mobility, and temporomandibular joint dysfunction (TMD).
Each of these factors leads to physical changes in the body. Some of these changes involve thickening of the tissue, muscle imbalances, and inflammatory reactions. These, in turn, are directly or indirectly related to nerve entrapment syndromes, vascular changes, and the production of hormones, neurotransmitters, and chemicals that affect the pain centers of the brain.
CHEMISTRY OF PAIN
A review of literature about tension headaches shows us that tension headaches are often associated with changes in the levels of three chemical substances in the body - Serotonin, Bradykinins, and Substance P. (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)
Note: This article focuses on tension headaches, but it should be noted that these chemicals are also involved in migraine headaches.
Irritated or inflamed soft tissue within the body releases Bradykinin, Serotonin, and Substance P, all of which can cause sensitization of nerve endings resulting in pain and headaches. (2)
Therefore, (it is hypothesized) if we remove the physical restrictions that are caused by poor posture, muscle imbalances, previous injuries, and other physical factors, we can often eliminate associated pain, resolve chronic headaches, and even prevent tension headaches from occurring in the first place. (16) This is what we have experienced in our clinical practice over the last three decades.
SYMPTOMS & EXAMINATION
Tension headaches usually last between half an hour to an hour, but can continue to return for weeks.
People who suffer from tension headaches often describe their headaches as a dull ache (mild to moderate intensity), or they may experience them as a band of tightness around the sides of their head (pressure or tightness). This band may even feel like a vice compressing the skull.
In severe cases the pain may even feel like a hooded cape that drapes over and across the shoulders. In such severe cases, the causes of the tension headache may involve more areas than just the head (basically affecting a larger kinetic chain). (3)
NOT a Migraine!
You can usually differentiate a tension headache from other types of headaches because there are many symptoms you will not experience. For example, tension headaches DO NOT cause visual disturbances, nausea, vomiting, numbness on one side of the body, or slurred speech.
The following is a list of some of the common symptoms of tension headaches: (3)
Band-like pressure around the head.
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
This video goes through inspection and observation, palpation, Active and Passive Ranges of motion, and orthopaedic examination of the cervical region. This video is a summation of Parts 1 to4 of the Cervical Examination Process. (Note: This video is available for the general public on July 8th 2022)
Cranial Nerve Examination - 12 Cranial Nerves
The Cranial Nerve examination is one of the ways that we assess sensory and motor dysfunction. We commonly perform this examination on all new patients. (Note: This video is available for the general public on September 2nd 2022)
Upper Limb Neuro Exam
The upper limb neurological examination is part of the over all neurological examination process, and is used to assess the motor and sensory neurons which supply the upper limbs. This assessment helps to detect any impairment of the nervous system. It is used both as a screening and an investigative tool.
Peripheral Vascular Examination - Key Points
A peripheral vascular examination is a valuable tool used for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications. In this video we go over some of the common procedures we perform in daily clinical practice. This video is available for the public on November 14/2022.
MANUAL THERAPY – A POWERFUL TOOL FOR RESOLVING TENSION HEADACHES
To resolve a tension headache, it is often necessary to remove physical restrictions throughout a number of structures within a rather extensive Kinetic Chain. Even a minor change in tissue tension can greatly affect the prevalence of a headache. (4,5,16)
Research has demonstrated that tension in the kinetic chains of the shoulder, neck, and jaw will cause an increase in both the intensity and frequency of tension headaches.
Fortunately, manual therapy and exercise can greatly reduce the intensity and prevalence of tension headaches. (6,7,8,9,16)
Note: Some of the common postural factors that perpetuate chronic tension headaches are:
Forward head posture.
Increased thoracic spine curvature (Kyphosis).
The following videos demonstrate some of the common procedures we use to treat patients who suffer from tension headaches. We have found these procedures to be very effective when combined with joint manipulation/mobilization and a functional exercise program. For best results, soft tissue restrictions must be assessed for the kinetic chains of the entire shoulder, neck, and jaw.
4 Point Neck Pain Protocol - Motion Specific Release
Each case of neck pain should be assessed and treated as a unique dysfunction that is specific to that individual. Certain cases will only involve local structures, while other cases can involve a much larger kinetic chain.
MSR Ten‐Point TMJ Protocol - Part One
In part one of this two-part video series, we focus on using external procedures to address the soft tissue structures of the jaw which are causing temporomandibular dysfunction.
TMD problems are often related to jaw pain, headaches, earaches, facial pain, vision problems, eye pain, balance issues, tinnitus, throat and neck pain, dizziness, and a multitude of other symptoms.
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 removing soft tissue restrictions, it is equally important to remove osseous joint restrictions in the cervical spine. Without the removal of these osseous restrictions, many of our patients would never have seen the resolution of their tension headaches. The joints of the spine (facet joints), cause pain in the head in very specific patterns.
Joint restrictions in the cervical spine can be released with either Neck Adjustments or through Neck Mobilization. Research supports the use of both procedures to restore mobility (Arthrokinematics), and reduce pain. (17,18,19)
The Power of Chiropractic Adjustments
Chiropractic adjustments are powerful tools. When patients who suffer from tension headaches receive care, they do much better at reducing or eliminating their headaches.
Neck Adjustments or Neck Mobilization - The Choice Is Yours!
Most patients do not realize that they have choices in how restrictions in the joints of their necks are addressed. In this video, Dr. Abelson shows you examples of Cervical Joint Mobilization.
Supporting exercises are a critical aspect of any treatment for Tension Headaches. The type of exercises that are prescribed varies based on each patient’s needs, and on their current phase of treatment.
Pain Relief For Problem Headaches
In this video "Pain Relief For Problem Headaches," we show you a great way to resolve your headache. This Headache Relief video shows you how to release trigger points at the base of your skull, the Suboccipital region. Releasing this area is a key aspect of resolving headaches.
EQUIPMENT: Double/Peanut Balls available at Amazon: https://amzn.to/3Sxoq1W
Neck Stretching - PNF - Kinetic Health: PNF technique is a great way to restore neck motion. In this video, we go through the four motions of the neck and show you how to increase your mobility.
5 Minute Neck Pain Relief
If are you suffering from a sore neck, try our "5 Minute Neck Pain Relief" routine. Doing this routine several times per day can make a huge difference in your neck pain (and headaches).
6 Effective - TMJ Exercises
The following video shows you how to perform 6 exercises for temporomandibular joint Dysfunction. These are some of the same exercises that we prescribe to our patients after performing Motion Specific Release - MSR TMJ procedures.
Manual therapy and exercise can reduce the intensity, and duration of tension headaches. In addition, the combination of both will often resolve even chronic tension headaches when a focused program of therapy and exercise is used. (10,14,15,16)
If you are suffering from a tension headache DO NOT delay in getting help.
DR. BRIAN ABELSON DC.
Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.
Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publication which will be available later this year.
Make Your Appointment Today!
Make an appointment with our incredible team at Kinetic Health in NW Calgary, Alberta. Call Kinetic Health at 403-241-3772 to make an appointment today, or just click the MSR logo to right. We look forward to seeing you!
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. email@example.com
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. firstname.lastname@example.org
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.