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

Your practitioner should always determine if neck adjustments are appropriate for your specific case. For patients who would prefer NOT to have their neck manipulated, we offer a safe, effective alternative with Neck Mobilization - to release restrictions in the neck area (cervical region).

Although Neck Manipulation is a great tool for removing restrictions, cervical manipulation is not always appropriate for many of our patients. For example, we do NOT manipulate the necks of patients over a certain age, patients with severe osteoarthritis or osteoporosis, patients with certain autoimmune conditions such as Rheumatoid Arthritis and many other conditions.

In the following video Dr. Abelson demonstrates some of the key Neck Mobilization procedures we use at Kinetic Health. (Practitioners can learn these safe effective methods at our Motion Specific Release courses.)

Cervical Joint Mobilization - MSR: In this video Dr. Abelson shows you examples of Cervical Joint Mobilization. This are examples of some of the procedures that we teach in our Motion Specific Release (MSR) courses.

Caution: These MSR Protocols should only be performed by certified MSR practitioners, and are not for practice by the general public. The videos we provide are strictly for demonstration purposes!


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.

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.

6 - Isometric Neck Exercises: Isometric exercises are a great way to gently strengthen the muscles of the neck.

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.

5 Great Daily Shoulder Mobilization Exercises: You can perform these exercises throughout your day for best results. These exercises can make a huge difference in your posture, especially if you have been sitting for a long period of time.


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 when a concentrated 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. With the right combination treatment and exercise even chronic tension headaches can often be resolved!


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 an appointment with our incredible team at Kinetic Health in NW Calgary. Just scan the QR code with your phones camera and click the link, or call Kinetic Health at 403-241-3772 to make an appointment today!


  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Levy D, Strassman AM. Distinct sensitizing effects of the cAMP-PKA second messenger cascade on rat dural mechanonociceptors.J Physiol.2002;538:483–493.

  12. 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.

  13. Swenson and Grunnet-Nilsson. The management of headache. Principles and practice of chiropractic, Ed Haldeman, 3rd ed. McGraw-Hill Medical Publishing Division, Toronto.

  14. 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.

  15. RRS Education Research Reviews,Manual Therapy for Chronic Tension-Type Headache.

  16. 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.

  17. 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.

  18. 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.

  19. 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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