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Breaking the Cycle of Tension Headaches with Manual Therapy and Exercise

Updated: Aug 14


Woman With Headache Image

Did you know that tension-type headaches make up 60% of all headaches? Often linked to forward-head posture from long hours at the computer or texting, these headaches can also involve tightness in the neck, shoulders, and jaw. This muscle tension can restrict movement in the spine, shoulders, and temporomandibular joint (TMJ), leading to inflammation and nerve irritation. The good news? By addressing these underlying issues, you can significantly reduce both the frequency and severity of tension headaches.


Our Success Rate is Over 90%

Our 90% success rate in treating tension headaches stems from our comprehensive, interdisciplinary approach, focusing on pain relief and improved function. By integrating Motion Specific Release (MSR) techniques with a customized program of functional exercises, we can often address the root causes of tension headaches, leading to longer-lasting relief and improved overall function


Article Index:


 

The Chemistry of Pain


A review of the literature on tension headaches highlights a common connection to changes in three key chemicals: Serotonin, Bradykinins, and Substance P. These headaches often occur when the levels of these substances are altered. (11)


Serotonin Pathway Image
  • Serotonin: Acts as a neurotransmitter that facilitates nerve signal transmission between neurons. It also causes blood vessels to narrow (vasoconstriction), which can trigger pain.

  • Bradykinins: Play a key role in the inflammatory response by promoting the widening (vasodilation) of blood vessels and stimulating muscle contractions, potentially leading to increased sensitivity.

  • Substance P: Crucial for transmitting pain signals from peripheral receptors to the central nervous system. Although this discussion focuses on tension headaches, these chemicals also significantly impact migraines. (11, 12)


The Tension Headache Correlation

Research shows that when soft tissue becomes irritated or inflamed, it can trigger the release of chemicals like Bradykinin, Serotonin, and Substance P. These chemicals sensitize nerve endings, leading to the onset of pain and tension headaches. Alleviating physical issues such as poor posture, muscle imbalances, and lingering effects from past injuries may offer a pathway to reducing or even eliminating this pain.


Improving posture can relieve the strain on muscles and nerves, reducing the frequency and intensity of headaches. Balancing muscle strength and flexibility helps prevent unnecessary tension that could trigger headaches. Additionally, addressing the root causes of previous injuries can decrease chronic inflammation or irritation, which might otherwise prompt the release of these pain-related chemicals. This comprehensive approach not only targets the immediate pain but also works to prevent tension headaches from occurring in the future. (2, 16)



 

Man With Headache Image

Symptoms and Physical Examination


Tension headaches typically last from 30 minutes to an hour, but in some cases, they can persist for weeks. The pain is often described as a dull, mild to moderate ache or a tight band of pressure around the head.


This sensation might feel like a vice gripping the skull, and in severe cases, the pain can extend to the shoulders, creating the impression of a heavy cloak draped over them. This suggests that tension headaches may involve a broader kinetic chain, affecting areas beyond just the head.


Tension Headache vs. Migraine


Tension headaches are distinguishable from migraines by the absence of certain symptoms. Unlike migraines, tension headaches don't typically cause visual disturbances, nausea, vomiting, one-sided numbness, or speech difficulties. Common symptoms of tension headaches include:


  • A band-like pressure around the head

  • Difficulty concentrating

  • Sleep disturbances (insomnia)

  • Fatigue and irritability

  • Reduced appetite

  • Discomfort in the neck, jaw, or shoulders

  • Intense pain behind the eyes or eye strain

  • Scalp tenderness


Unlike migraines, tension headaches usually do not worsen with physical activity, and nausea and vomiting are not typically present.


Cervical Examination - Orthopaedic Testing

In this video, you'll be guided through a detailed examination of the cervical region, focusing on how issues in the neck can contribute to tension headaches. The examination includes inspection, palpation, and assessment of both active and passive ranges of motion, as well as orthopaedic tests specifically aimed at identifying factors that might trigger or exacerbate tension headaches. Understanding the cervical spine's role in tension headaches is crucial for effective diagnosis and treatment.


Cranial Nerve Examination - 12 Cranial Nerves

Conducting a Cranial Nerve examination is a key part of evaluating potential sensory and motor dysfunction that may contribute to tension headaches. This examination is routinely performed on all new patients to identify any underlying neurological issues that could be linked to headache symptoms, ensuring a thorough assessment and targeted treatment plan.



Upper Limb Neuro Exam

The upper limb neurological examination is an essential part of assessing patients with tension headaches. By evaluating the motor and sensory neurons that serve the upper limbs, this exam helps detect any nervous system impairments that could contribute to or exacerbate tension headaches. This assessment is a valuable tool for both screening and investigating the potential neurological causes of headache symptoms.


Peripheral Vascular Examination - Key Points

A peripheral vascular examination is crucial for ruling out vascular-related issues that might contribute to tension headaches. Early detection of peripheral vascular disease (PVD) can help prevent complications that could exacerbate headache symptoms. This video highlights common procedures we use in clinical practice to assess peripheral vascular function, ensuring that any vascular factors contributing to tension headaches are identified and managed effectively.

 

Manual Therapy - A Powerful Tool


Addressing tension headaches effectively involves targeting physical restrictions throughout the kinetic chain. Even small changes in tissue tension can greatly impact headache frequency and severity.


Research shows that tension in the shoulder, neck, and jaw often amplifies tension headaches, but manual therapy and targeted exercises can significantly reduce their occurrence and intensity.


Common postural issues like forward head posture and hunched shoulders are major contributors to chronic tension headaches. The following videos demonstrate effective techniques, combining joint manipulation with functional exercises to treat tension headaches by resolving soft tissue restrictions in key areas.


4 Point Neck Pain Protocol

In this video, Dr. Abelson demonstrates the MSR protocol designed to address neck tension, a common contributor to tension headaches. Each case of neck pain is unique and should be treated accordingly. While some headaches originate from local neck structures, others are linked to a broader kinetic chain. This protocol targets the root causes of neck tension to alleviate headaches and improve overall neck function.


MSR Ten‐Point TMJ Protocol

TMD (Temporomandibular Disorder) is often linked to a variety of symptoms, including tension headaches, jaw pain, earaches, and facial discomfort. The MSR Ten-Point TMJ Protocol specifically targets the soft tissues involved in TMD, aiming to relieve the root causes of these issues. By addressing jaw dysfunction and muscle tension, this protocol helps reduce the frequency and intensity of tension headaches, which are frequently connected to TMD.


Fascial Expansion: MSR Headache Protocol

In this video Dr. Abelson discusses the fascial planes directly related to headaches in this video. He then demonstrates how practitioners combine this knowledge with Traditional Chinese Medicine (Acupuncture/Acupressure). By understanding the interconnected nature of fascial planes, their effect on jaw function, and the specific acupuncture points and techniques used in TCM, practitioners can effectively alleviate pain for patients with Headaches.



 

Joint Restrictions and Tension Headaches

Addressing joint restrictions in the cervical spine is crucial for relieving tension headaches. If not treated, these restrictions can prevent patients from finding relief. The facet joints in the spine often contribute to headache pain.


Practitioners use Neck Adjustments or Mobilization techniques to restore mobility and reduce pain. These methods, supported by research, target specific areas of the cervical spine to improve range of motion and alleviate tension on muscles and nerves that may cause headaches. Each treatment plan should be tailored to the individual's needs to ensure the best results.


Chiropractic Adjustments

Chiropractic adjustments can be highly effective in managing tension headaches. Many patients report a significant reduction in symptoms, and some even experience complete relief. In the attached video, Dr. Abelson demonstrates spinal adjustments that are particularly beneficial for tension headaches. Research supports spinal manipulations as a proven therapeutic option for alleviating tension headaches.


Neck Adjustments or Neck Mobilization - The Choice Is Yours!

Patients often aren’t fully aware of their options for addressing neck joint restrictions that contribute to tension headaches. In the attached video, Dr. Abelson demonstrates Cervical Joint Mobilization, a gentle, hands-on technique that can effectively relieve tension headaches.


Cervical Joint Mobilization involves controlled movements of the cervical spine to improve neck mobility and function. These movements help alleviate pain, reduce muscle tension, and enhance flexibility, making them an effective option for managing tension headaches.


 

Treatment Frequency Recommendations


For chronic tension headaches, the program should consist of 4 to 6 weeks of treatment, followed by a re-evaluation:


  • Initial Treatment Phase:

    • Duration: 4 to 6 weeks

    • Sessions: 2 sessions per week (or 1 session per week if opting for 30-minute appointments)

    • Focus: MSR Manual Therapy and daily home exercises.


  • Re-Evaluation:

    • Timing: After 4 to 6 weeks of treatment

    • Assessment: Review progress and adjust the treatment plan based on symptom improvement and functional goals.


The goal is to optimize symptom relief and improve function, with adjustments made as needed based on the patient’s response.



 


Exercise is Crucial


Exercise is vital in managing tension headaches. By strengthening muscles and improving flexibility, targeted exercises reduce strain on the muscles and nerves that trigger headaches. Aerobic exercises also help relieve stress, a common contributor to headaches.


These exercises range from gentle stretches to strength training, focusing on the neck, shoulders, and upper back. As patients progress, the regimen is adjusted to ensure ongoing relief and improved quality of life.


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 at the skull's base. Releasing this area is an essential aspect of resolving headaches.



PNF Neck Stretches

Welcome to this video highlighting the incredible benefits of PNF Neck Stretches - Mobility, Strength, and Power. Numerous studies have shown that PNF stretching techniques enhance and maintain flexibility, amplify muscular strength and force, and elevate overall athletic performance.


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 critical to addressing a patient's kinetic chain when they experience tension headaches.




 


Smiling Happy Woman

Why Choose Our Approach


Our comprehensive approach to treating tension headaches consistently achieves a 90% success rate in reducing pain and improving quality of life. Here's why our method stands out:


  • Established Expertise: Developed by Dr. Brian Abelson, our MSR methodology is backed by over 30 years of clinical experience and the successful treatment of more than 25,000 patients, ensuring you receive top-tier care.

  • Thorough Assessments: We conduct detailed evaluations to identify all contributing factors, including posture, muscle imbalances, and soft tissue restrictions, which are often linked to tension headaches.

  • Advanced MSR Procedures: Our Motion Specific Release (MSR) techniques precisely target areas of muscle tension and joint dysfunction, providing effective and lasting relief.

  • Customized Exercise Programs: We design individualized exercise plans that improve muscle strength, flexibility, and posture, reducing the frequency and severity of tension headaches.

  • Logical, Evidence-Based Approach: Our treatment protocols integrate manual therapy, exercises, and supportive measures, offering a well-rounded and sustainable solution.


Choose our proven, patient-centered approach for long-term relief from tension headaches. Take the first step toward living pain-free with confidence.



 

References

  1. Fernandez-de-las-Penas, C., Cuadrado, M. L., Arendt-Nielsen, L., Simons, D. G., & Pareja, J. A. (2007). Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia, 27(5), 383-393.

  2. Leistad, R. B., Sand, T., Westgaard, R. H., Nilsen, K. B., & Stovner, L. J. (2006). Stress-induced pain and muscle activity in patients with migraine and tension-type headache. Cephalalgia, 26(1), 64-73.

  3. Svensson, P. (2007). Muscle pain in the head: overlap between temporomandibular disorders and tension-type headaches. Current Opinion in Neurology, 20(3), 320-325.

  4. Fernandez-de-las-Penas, C., Alonso-Blanco, C., Cuadrado, M. L., & Pareja, J. A. (2006). Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Cephalalgia, 26(3), 314-319.

  5. Persson, L. C., & Carlsson, J. Y. (1999). Headache in patients with neck-shoulder-arm pain of cervical radicular origin. Headache, 39(3), 218-224.

  6. Oksanen, A., Poyhonen, T., Metsahonkala, L., Anttila, P., Hiekkanen, H., Laimi, K., & Salminen, J. J. (2007). Neck flexor muscle fatigue in adolescents with headache: an electromyographic study. European Journal of Pain, 11(7), 764-772.

  7. Fernandez-de-Las-Penas, C., Alonso-Blanco, C., Cuadrado, M. L., Gerwin, R. D., & Pareja, J. A. (2006). Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache, 46(8), 1264-1272.

  8. Fernandez-de-Las-Penas, C., Ge, H. Y., Arendt-Nielsen, L., Cuadrado, M. L., & Pareja, J. A. (2007). Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache. European Journal of Pain, 11(4), 475-482.

  9. Fernandez-de-las-Penas, C., Alonso-Blanco, C., Cuadrado, M. L., Gerwin, R. D., & Pareja, J. A. (2006). Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache, 46(3), 454-460.

  10. von Piekartz, H., & Ludtke, K. (2011). Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: A single-blind, randomized controlled study. Cranio, 29, 43–56.

  11. Levy, D., & Strassman, A. M. (2002). Distinct sensitizing effects of the cAMP-PKA second messenger cascade on rat dural mechanonociceptors. The Journal of Physiology, 538, 483–493.

  12. Carmody, J., Pawlak, M., & Messlinger, K. (1996). Lack of a role for substance P in the control of dural arterial flow. Experimental Brain Research, 111, 424–428.

  13. Swenson, R., & Grunnet-Nilsson, N. (Eds.). (n.d.). The management of headache. In S. Haldeman (Ed.), Principles and practice of chiropractic (3rd ed.). McGraw-Hill Medical Publishing Division.

  14. Castien, R. F., et al. (2011). Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomized, clinical trial. Cephalalgia, 31(2), 133-143.

  15. RRS Education Research Reviews. (n.d.). Manual Therapy for Chronic Tension-Type Headache.

  16. Abelson, B. J., & Abelson, K. T. (2009). Exercises for the Jaw to Shoulder - Volume 1 of Release Your Kinetic Chain. Rowan Tree Books Ltd.

  17. Bialosky, J. E., Bishop, M. D., Price, D. D., Robinson, M. E., & George, S. Z. (2009). The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual Therapy, 14(5), 531-538.

  18. Sterling, M., Jull, G., & Wright, A. (2001). Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity. Manual Therapy, 6(2), 72-81.

  19. Schmid, A., Brunner, F., Wright, A., & Bachmann, L. M. (2008). Paradigm shift in manual therapy? Evidence for a central nervous system component in the response to passive cervical joint mobilisation. Manual Therapy, 13(5), 387-396.

  20. Ge, H. Y., Nie, H., Graven-Nielsen, T., Danneskiold-Samsøe, B., & Arendt-Nielsen, L. (2012). Descending pain modulation and its interaction with peripheral sensitization following sustained isometric muscle contraction in fibromyalgia. European Journal of Pain, 16(2), 196-203.

  21. Shah, J. P., & Gilliams, E. A. (2008). Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies, 12(4), 371-384.

  22. Jensen, R., & Bendtsen, L. (2012). Tension-type headache: the most common, but also the most neglected, headache disorder. Current Opinion in Neurology, 25(3), 292-295.

  23. Mingels, S., Dankaerts, W., Granitzer, M. (2020). Is There Support for the Paradigm ‘Spinal Posture as a Trigger for Episodic Headache’? A Comprehensive Review. The Spine Journal, 20(3), 556-569.

  24. Van Der Meer, H. A., Speksnijder, C. M., Engelbert, R. H., Lobbezoo, F., Nijhuis-Van Der Sanden, M. W., Visscher, C. M. (2013). The association between headache and temporomandibular disorders is confounded by bruxism and somatic symptoms. Clinical Oral Investigations, 17(7), 1635-1642.

  25. Varatharajan, S., Ferguson, B., Chrobak, K., Shergill, Y., Côté, P., Wong, J. J., ... & Sutton, D. (2016). Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal, 25(7), 1971-1999.

  26. Bevilaqua-Grossi, D., Chaves, T. C., Gonçalves, M. C., Moreira, V. C., Canonica, A. C., Florencio, L. L., ... & Speciali, J. G. (2016). Additional effects of a physical therapy protocol on headache frequency, pressure pain threshold, and improvement perception in patients with migraine and associated neck pain: a randomized controlled trial. Archives of physical medicine and rehabilitation, 97(6), 866-874.

  27. Castien, R. F., van der Windt, D. A., Grooten, A., & Dekker, J. (2011). Effectiveness of manual therapy for chronic tension-type headache: a randomised controlled trial. Cephalalgia, 31(2), 133-143.

  28. Cho, S. J., Song, T. J., Chu, M. K. (2019). Outcome of Tension-Type Headache After Short-Term Prednisolone Treatment (STOP-TTH): A Randomized, Double-Blind, Placebo-Controlled Trial. Headache: The Journal of Head and Face Pain, 59(2), 182-191.

  29. Fernández-de-Las-Peñas, C., Alonso-Blanco, C., Miangolarra, J. C. (2007). Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study. Manual therapy, 12(1), 29-33.

  30. Rozenfeld, E., Finestone, A. S., Moran, U., Damri, E., Kalichman, L. (2020). The prevalence of myofascial trigger points in neck and shoulder related disorders: a systematic review of the literature. BMC Musculoskeletal Disorders, 21(1), 1-10.

  31. Sand, T., Zhitniy, N., Nilsen, K. B., Helde, G., Hagen, K., Stovner, L. J. (2008). Thermal pain thresholds are decreased in the migraine preattack phase. European Journal of Neurology, 15(11), 1199-1205.

  32. Sluka, K. A., Clauw, D. J. (2016). Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience, 338, 114-129.

  33. Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3), S2-S15.


 

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DR. BRIAN ABELSON DC. - The Author


Photo of Dr. Brian Abelson

Dr. Abelson is dedicated to using evidence-based practices to improve musculoskeletal health. At Kinetic Health in Calgary, Alberta, he combines the latest research with a compassionate, patient-focused approach. As the creator of the Motion Specific Release (MSR) Treatment Systems, he aims to educate and share techniques to benefit the broader healthcare community. His work continually emphasizes patient-centred care and advancing treatment methods.



 


MSR Instructor Mike Burton Smiling

Join Us at Motion Specific Release


Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.


Join MSR Pro and start tapping into the power of Motion Specific Release. Have access to:

  • Protocols: Over 250 clinical procedures with detailed video productions.

  • Examination Procedures: Over 70 orthopedic and neurological assessment videos and downloadable PDF examination forms for use in your clinical practice are coming soon.

  • Exercises: You can prescribe hundreds of Functional Exercises Videos to your patients through our downloadable prescription pads.

  • Article Library: Our Article Index Library with over 45+ of the most common MSK conditions we all see in clinical practice. This is a great opportunity to educate your patients on our processes. Each article covers basic condition information, diagnostic procedures, treatment methodologies, timelines, and exercise recommendations. All of this is in an easy-to-prescribe PDF format you can directly send to your patients.

  • Discounts: MSR Pro yearly memberships entitle you to a significant discount on our online and live courses.


Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.



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