Updated: May 4

Amazingly, 60% of all headaches are tension-type headaches. (13) Some common factors that are seen in patients who experience tension headache include:

  • Forward-head posture, which 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.

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.


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)

  • 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 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.

The Correlation!

Irritated or inflamed soft tissue within the body releases Bradykinin, Serotonin, and Substance P, all of which can cause a 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.


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 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 concentrating.

  • Difficulty sleeping [insomnia].

  • Fatigue and irritability.

  • Loss of appetite.

  • Neck, jaw/TMJ, 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.


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, jaw will cause an increase 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.

  • Rounded shoulders.

  • Increased thoracic spine curvature (Kyphosis).

The follow videos demonstrate some of the common soft-tissue 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.

Releasing the Anterior Cervical Spine - MSR: This MSR (Motion Specific Release) protocol is designed to be integrated with the MSR Posterior Cervical Spine protocol, as well as, MSR Shoulder protocols, TMJ protocols and osseous manipulation/mobilization of the cervical, and thoracic spine, as well as the upper extremity joints.

Posterior Cervical Release - Part 1 - MSR: Besides the localized areas of pain, it is also important to consider the broader kinetic chain and address any myofascial or joint restrictions. A key concept is that you cannot treat any anatomical structure in isolation, all structures are interconnected, and thus, all related/affected structures must also be treated.

The MSR Ten‐Point TMJ Protocol - Part 1: 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.


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 resolution of their tension headaches. The joints of 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)

Neck Adjustments Verses Neck Mobilization