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  • Writer's pictureJon Duellman PT

Tension Headaches: Pain in the Neck

Updated: Jun 25, 2020

Tension headaches are extremely common. Many people live with this either by ignoring it or popping headache meds multiple times each week. Totally unnecessary! I'll give you a few ways to stop tension headaches both in the moment and how to prevent them in the first place.

What are tension headaches?

Tension headaches are diffuse headaches that are usually on both sides feeling tightness or pressure with pain of mild to moderate quality lasting minutes to days. Often patients will describe that they feel tightness in their shoulders and neck muscles going alongside the headaches.

Forward Head Posture - LEARN MORE!

What can cause them?

The relationship to prolonged forward head postures that tend to go along with sitting at a desk and the overuse of muscles like the upper trapezius and the small muscles at the back of the base of the skull. The prolonged forward head posture perpetuates the tightness in the neck. Sometimes poor endurance of these muscles at the skull or of the shoulder muscles leads to these headaches.

What should I do?

If you are having these headaches often at 3 times weekly, I recommend being assessed by a medical provider such as myself or your primary doctor. It is unlikely to be anything more, but it is optimal to make sure it is a tension headache to provide the best treatment.

Can Physical Therapy or Chiropractic care help?

Yes! There is research that supports both physical therapy and chiropractic care for neck related headaches. Seeking this help will provide a directed approach to your specific issues that have caused your headaches. Joint mobilizations, soft tissue massage, and other manjal therapy can help improve your symptoms and get you on the right track.

Let's assume you have tension headaches...

What should I do while I have a headache?

  • Neck Stretches - particularly the upper trapezius, levator scapulae muscles

  • Avoid Forward Head Posture

  • Self-Massage to the Base of the Skull Muscles

  • Self-Massage to the Upper Trapezius and Levator Muscles (top of the shoulders)

Now, if the headache has worsened or been present for long enough, these techniques may not eliminate the headache completely. However, it can significantly reduce your pain and symptoms. This is why prevention is much better and so important.

How do I prevent tension headaches?

Prevention is reducing the risk factors that produce these headaches. First off, try your best to avoid the forward head postures for prolonged periods. While avoiding it completely is unrealistic (and not necessary), try your best and get up and walk around more often which naturally will get you out of the positions that make it worse. Exercises that produce improved endurance of the neck and shoulders are even better. We know that these factors can affect your pain and headaches.

  • Front Neck Flexor Endurance Chin Tuck and Lift Exercise Lift 1-3 inches off the pillow or floor. This can be surprisingly challenging to hold. 5-10 sets of 10-30 seconds

  • Posterior Neck Endurance Quadruped Extensor Lift I recommend this exercise as an option. I prefer the slow movement and focus on control with the chin tucked. If needed, you can perform this laying down with your head off the bed as well. 2 sets of 1 minute

  • Shoulder Endurance Exercises While I recommend that everyone should be performing general resistance training of the arms, here is a simple exercise to get you started that hit the shoulders in multiple areas including the upper trapezius. Lateral Raises Simple shoulder lift that incorporates the total shoulder and upper trapezius. 3 sets of 15-20 is recommended. A muscle burn or fatigue should be present for the best effect.

Another factor is potentially the strength of your upper back and shoulder blade muscles. So I personally recommend the addition of exercises that focus on strength to this area to promote better posture. This has not been well researched at this time but makes logical sense as the posture is correlated to this dysfunction.

While there are many shoulder blade exercises, I recommend these two.

Scapular I's T's and Y's

You can perform this on a ball like shown, bent over forward, or off of the corner of a bed for options. I recommend performing 10-20 reps each position.

High Row

The low and high row exercise helps promote strength in the middle and upper back. However, the high row engages a greater portion of the musculature and make it more challenging. Skip ahead to 15 seconds in the video to reach the high row portion.

Phew! That's a lot to take in. I hope you learned more about tension headaches and how you can improve them today. Please share this with anyone you know who has headaches. Reach out to me in the comments or my email with any questions.




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