Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Tension Headache Physical Therapy Guide

What Is A Tension Headache?

Headaches have been described as the “most common complaint of humanity,” affecting approximately two thirds of the global population. Tensions headache is a term used to describe headaches that are caused by abnormalities of the joints, muscles, fascia and neural structures of the cervical region and are the most common cause of head and neck pain. Tension headaches are classified as episodic or chronic depending on how long they last for. If you suffer from a tension headache for less than 15 days per month it is episodic, more than this makes them chronic. Tension headaches can last anywhere between 30 minutes to 3 days. The episodic kind usually start gradually, often in the middle of the day whilst working or performing repetitive motions.

What Causes A Tension Headache?

Tension headaches are often associated with an underlying neck pain or cervical stiffness and may be aggravated by neck or head movements, such as jolting when traveling in a car or bus. It is often associated with a feeling of light-headedness, dizziness and tinnitus. Nausea may be present but vomiting is rare. The patient often complaints of impaired concentration, an inability to function normally, and depression. A tension headache is typically described as a steady dull ache, often one sided but sometimes bilateral. It can be intermittent or constant in nature, depending on specific factors contributing to the headache such as mechanical factors, chronicity of the condition, or psychosocial or pain disorder overlay. The individual often describes a pulling or gripping feeling or, alternatively, may describe a tight band around the head. Tension headaches normally come on gradually. The patient often wakes with the headache and it may improve during the day. Alternatively, it may be brought on later in the day as a result of occupational factors such as repetitive movements or sustained poor postures. Tension headaches may be present for days, weeks or even months. Tension headaches are often associated with neck pain or stiffness and may be aggravated by neck or head movements, such as jolting when traveling in a car or bus.

Tension Headache Symptoms

Approximately two thirds of the Earths population will experience a form of headache, it is considered an average ailment that comes and goes throughout day to day life. The main tension headache symptoms include:

  • Dull, aching head and upper neck pain.
  • Tightness or pressure across your forehead or on the sides and back of your head.
  • Tenderness in the neck and shoulder muscles.
  • Light headedness
  • Dizziness
  • Tinnitus
  • Impaired concentration

Red Flags

A “red flag” is the term given to the identification of dangerous or potentially dangerous findings during an examination. If a red flag is present during this examination, patients are usually referred to medical specialists for immediate assessment and treatment. When examining the head and cervical spine there are many red flags to look out for, these include:

  • Diplopia (double vision)
  • Dysphasia (difficulties speaking)
  • Dysphagia (discomfort swallowing)
  • Dizziness
  • Dysarthria (unclear articulation of speech)
  • Drop attack (fainting)
  • Fever
  • Unintentional Weight loss
  • Neurological symptoms
  • Pain increasing over multiple days with a very sudden onset

If you present with any of these symptoms you should seek medical assessment immediately.

Posture Training Device

Upright Posture is a novel postural training device that is also piece of wearable technology. You attach the device to your lower lumbar spine and it is configured in such a way that it alerts you when you slouch! It does this by gently vibrating. The Upright posture device is a very interesting piece of tech, and invaluable for people suffering from tension headaches who need to improve their poor posture.

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What Are The Treatments & Remedies For Tension Headaches?

The treatment options for tension headaches are based upon an early return to normal daily activities and early mobilisation / stretching. In many cases, tension headaches will eventually solve themselves, however more often than not, people require some basic treatment and advice, this can be found below.


Poor posture is often associated with tension headaches. This may be either a contributory factor or an effect of the headache. The abnormal posture typically involves rounded shoulders, head forward posture with extension through the upper cervical spine, and a protruded chin. This results in shortening and increased tone through the upper cervical extensor muscles and a weakness of the flexor muscles. Treatment of a tension headache therefore requires correction of the abnormalities of the joints, muscles and neural structures found on examination, as well as correction of any problems such as postural abnormalities. Physical Therapy treatments include:
  • Exercise: This involves gentle range of motion in all directions, trying to find a light stretch and holding it for a few seconds at a time.
  • Soft tissue therapy to the muscles and the fascia of the neck region is aimed at releasing tight muscles and trigger points.
  • Posture retraining to prevent the tension headaches from coming back in the future.

Tension Headache Exercises

1) Neck ROM 

Early mobilisation and stretching of tight neck muscles is highly recommended in the management of tension headaches.  Although the neck may be slightly painful, keeping it mobile from an early stage will improve its movement and speed up the recovery. Failure to move your neck adequately and following immobilisation protocols is likely to prolong the symptoms of tension headaches and delay recovery rates. As a result, wearing neck braces / collars is not recommended.

How to do it:

  • Flexion: The movement in which the chin is lowered down towards the chest, stretching the neck extensors and opening up the spinal joints.
  • Extension: The movement in which the neck is extended and the patient is looking upwards towards the ceiling. In doing so, closes down the spinal joints and stretches the neck flexors.
  • Rotation: The movement in which the neck is rotated around the its axis and the patient is looking directly to their side or over their shoulders. In doing so, closes down the spinal segments to the side you have looked, and stretches the soft tissue on the opposite side.
  • Side Flexion: The movement in which the neck is laterally flexed. Best described as trying to place the ear upon the shoulder through sideways movement of the neck. In doing so, closes down the spinal segments to the side you have flexed, and stretches the soft tissue on the opposite side.

2) Nod Stretch

The most common cause of tension headaches is muscular tightness of the anterior/posterior neck, upper back and shoulder muscles, which in turn can make it harder for your neck to mobilise. The muscle group most commonly requiring a stretch is the upper trapezius.

How to do it:

  • Sit with a good posture
  • Slowly rotate your head / neck so that you are facing left or right; as far as you can.
  • Once in this rotated position, slowly nod your head up and down, holding the stretch for 1 second at the top or bottom of each movement.

Repeat 10 nods up and down for 3 sets. Try to do 3 times per day.

3) Side Flex Nods

This exercise works in the same way as the rotation with nods; mobilising the joints in your cervical spine whilst stretching the muscles in the surrounding area.

How to do it:

  • Sit with good posture
  • Slowly side flex your head as if you are trying to place your ear upon your shoulder.
  • Once in this side flexed position, slowly try and take your chin towards your nearest armpit; holding for 1 second.
  • Slowly return back to neutral.
  • This exercise can be progressed by holding a small weight in the hand opposite to the side you are side flexing to encourage a bigger stretch!

Repeat 10 times for 3 sets. Try to do 3 times per day.

4) Shoulder Shrugs

A simple yet fantastic exercise to loosen up the upper trapezius and rhomboid muscles, whilst opening up the upper spinal joints.

How to do it:

  • Sit with good posture
  • Raise your shoulders up towards your ears; holding for 2 seconds

Repeat 20 times, every hour, aiming for 5 or more sets per day.

The “Ugly” Exercises

It is vitally important that we strengthen the stability muscles that hold our head on top of our neck. A weakness of these deep stabilising muscles means that we place an extra load onto “non stability” muscles, causing poor posture, pain and headaches. The ugly exercises are so called simply because you can look silly doing them.

5) Deep neck flexors

This exercise works by completing the movement in which you give yourself a double chin, thereby activating the deep neck flexors. The exercise is completed with a 2 second hold to isometrically strengthen the muscle fibres and it should be felt at the base of your skull.

How to do it:

  • Sit with good posture
  • look down very slightly towards the floor
  • place your index finger on your chin.
  • Imagine you are trying to push your chin through your spine behind you until you feel the muscle tense in your posterior neck; holding for 2 seconds

Repeat 8 times for 3 sets, Try to do 3 times a day.

6) Deep neck extensors

This exercise is the opposite to the deep neck flexor exercise. This time activating the deep neck extensors and isometrically holding only for a couple of seconds.

How to do it:

  • Sit with good posture
  • Poke your chin forward as far as comfortable
  • try and look up towards the ceiling, holding for 2 seconds.

Repeat 8 times for 3 sets, try to do 3 times a day.

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Headache Hats

Wearing headache hats has become a novel treatment to reduce pain and relieve tightness in tension headaches. You attach the ice wrap band around your head which can be adjusted to sit on pain and trigger points, and the individual plastic coated cubes inside the wrap won't get you wet when they melt, meaning it can be reused time and time again. The headache hat device is a very interesting piece of tech, and will help sufferers of tension headaches find some relief.

You can buy the Headache Hat here!