August 7, 2020

Tension Headaches: Why So Tense?

Ozark Holistic Center

I think it is safe to say we have all experienced these types of headaches. They are quite prevalent. It is estimated that 80% of the population will experience a tension headache at some point in their life. Maybe you experienced it after a long day at work or after a stressful event. Maybe it was after sitting too long binge watching a show. 😉 Suffice it so say they are common.

In this post, I will break down what is going on with tension headaches and how to tell them apart from other headaches like migraines. It is important to understand them and how they differ. I have personal experience with both of these chronically. So, I have spent a lot of time researching and trying to understand them.

What Is A Tension Headache?

Pain distribution in tension headaches

A tension headache has a typical pattern to it, though generally speaking what causes it is in still unknown. Often the pain is distributed across the forehead, scalp, and neck. Most people describe it as dull rather than a sharp pain. The pain is quite diffuse too, harder to pinpoint to a specific spot. It can be unilateral (one-sided) or bilateral (both sides), though bilateral is much more common. The intensity of the pain varies. It can be a mild ache. But for some people it is much more than that.

Mine would often start mild but would progress to moderate. They could be pretty bad. This is where it can get confused with migraines. Which all true migraine sufferers have had an experience where someone told them they were having a migraine and they were not. Usually they were having a bad tension headache. It is a common frustration to migraine sufferers.

Differentiating It From A Migraine

A tension headache is often a pressure feeling or tightening. It is constant. It can be felt around the head but usually the forehead. It does not have a throbbing feeling like migraines often do. Migraines also get rather severe. The pain can be very intense. Whereas the pain is not nearly as severe with tension headaches. Yes, what you are feeling can be much, much worse with migraines comparatively.

Another way to tell the difference is related to the non-throbbing, pressure feeling. In migraines, movement often makes it worse. Whereas in tension headaches the pain is more constant and does not generally vary with movement. For instance, when I have had a migraine standing up would make the pain much more intense. The throbbing would increase and sometimes I would have to lean on something for a second before taking a few more steps.

Lastly, there typically is no nausea or vomiting with tension headaches. Migraine sufferers often experience one or both. I have had both. Often times its the worst part of a migraine. Tension headaches generally do not have these symptoms. Though you can get sensitivity to light or sound, but usually not both. Migraines oftentimes is both. Yeah, migraines suck.

Hopefully this helps to differentiate the two. It is in no way meant to diminish what you are feeling. Tension headaches are often quite painful in their own right.

What Else Could It Be?

Another two types of headaches could be at play, cervicogenic and caffeine withdrawal. Each of these are similar enough to cause confusion and prevalent.

Cervicogenic Headaches

A cervicogenic headache is in the name. Cervico- referring to the neck and -genic meaning producing. There is irritation in the upper neck which refers pain into the structures of the head causing a headache. It may be from an injury, sitting too long, or any number of things. Whiplash is a very common cause of a cervicogenic headache.

These are usually only one-sided and can be quite severe like migraines. They can last a short period of time to weeks on end. The pain usually starts in the neck and gradually goes into a full headache. Often times people will feel tenderness on the back of their head just below their skull.

As you can see it can be similar to a tension headache. The key differences are it is unilateral and the pain starts in the neck. It is less diffuse as well, easier to pinpoint.

Caffeine Withdrawal Syndrome

Another common occurrence is caffeine withdrawal syndrome. This is very similar to tension headaches. Often a dull headache that can be on both sides of the head. But there are some key differences.

First, only 50% of people suffer a headache from withdrawal. The most common symptom is fatigue. However, those who do get a headache, it can be intense. Some have described it as the worst headache they have had, thought that is an embellishment for sure. There are much worse headaches. And if you have a headache that comes out of nowhere and it is severely painful and you never have had it before, seek medical help immediately.

That being said there is something characteristic about caffeine withdrawal headaches. They often start in the morning and you wake up with it or possibly in the evening. The reason being it has been long enough since you have had caffeine that withdrawal has started. So if you drink caffeine regularly and you wake up with a headache, it could very well be it.

Another characteristic is withdrawal also comes with a variety of other symptoms, nausea and vomiting being among the worst. You may also experience mood changes, difficulty concentrating, and muscle aches and stiffness. Let me tell you from personal experience, it is NOT fun. And these symptoms can last for days.

You may be asking why talk about this? A simple relief many people use is a OTC medication that has caffeine in it. If you get tension headaches frequently then you may be using this medication frequently. Further, we live in a high-stress society that demands much. So we have become caffeine addicts. Though often touted as not very harmful, caffeine has major downsides as I mentioned above.

So What Is Going On?

Early I described the characteristics of a tension headache. But what is really going on? How did it start?

First, it is important to understand we don’t fully know yet. Researchers have shown that in tension headache patients their pain sensitivity is heightened and myofascial tissues are more tender and contracted than normal. That is they are more tense.

That being said, it is also important to remember we do live in an incredibly stressful society. Stress is not just simply emotional stress either. There is physical stress, chemical stress, and mental stress too. We work long hours and have a lot of demands placed on us. This taxes every aspect. You may have to drive a long way to work in traffic, that is physical due to sitting in the car and emotional due to traffic. It could also be mental and chemical if you are also running late and you grab some fast food on the way. All these things stress us out.

This stress can present in the form of tension in the muscles and fascia (the connective tissue layers that cover your muscles and organs, it’s important!). A lot of people talk about carrying their stress in their shoulders, it’s true! It can also heighten our pain sensitivity. There is a lot at play. And each form of stress can add its own issues. So let me break down each stress a little bit more for you.

Emotional Stress

Emotional stress can be caused by many different things. It could be that you have some family issues going on or you do not get along with your boss. Whatever it is, it takes its toll. High stress levels cause a lot of things from memory issues to decreasing the immune system, but in relation to what we are talking about it causes neck, upper back, and shoulder tension. It also increases the overall stress load we are carrying.

I am sure when you have been in an argument you notice how tense your muscles get. Your blood pressure is sky rocketing and you can hear your heart beating inside your chest indicating a stress response from your hormones. Afterwards, you may be physically exhausted and you may even have a headache. This is emotional stress’ relation to tension headaches.

Mental Stress

Work can be taxing depending on what we do. Sometimes it can very taxing mentally. I have had days and cases that really racked my brain. It is tiring. If I get back to back cases like this with phone calls and other things happening I can get a headache. It takes a lot of mental energy to deal with some of these things, going down biochemical pathways or what have you.

I am not alone. Many jobs can be very mentally taxing, a tax preparer nearing April 15th, an ER nurse hit with multiple emergencies, or a student on finals week. And guess what? It can cause tension in the same places. That is one reason why the headache ensues. Mental fatigue is hard in its own right, but coupled with a headache it is much harder.

Chemical Stress

Oh man, we got a lot of chemical stress in our society too. I am not referring to the chemicals you have under your sink alone. Rather everything we are surrounded with. Chemicals are all around us, water is a chemical! So what we eat, drink, spray on, lather on, whatever it may be has an effect on our bodies for good or bad.

If we eat poorly, our body responds poorly. We are less able to fight of infection, heal and maintain, and respond to stress. We need proper nutrition, if not we start to spiral downhill. We have gotten too used to the new “normal.” We think it is normal to be in pain, have indigestion, and to be tired all the time. Chemical stress is hard on our body.

So, if we are less able to function properly due to chemical stress, you can imagine what can result. You will have less of an ability to deal with the stress you have in life leading to more tension and more headaches. Without the proper nutrition your muscles do not work as well leading to more inflammation leading to the possibility of more pain and tension. Catching a pattern here? This doesn’t even touch on food sensitivities that can heighten pain.

Food sensitivities are becoming all too common. One in particular, nightshade sensitivity, is problematic. Tomatoes, peppers, and potatoes, along with others, belong to the nightshade family. These fruits and vegetables carry a neurotoxin called solanine. Solanine is implicated in chronic pain issues. I have seen it in several patients.

Physical Stress

Probably, the most obvious. Though as you have seen it is not that simple. It comes in two forms. Namely, being sedentary and lack of proper movement.

We do not move like our ancestors. Our ancestors walked on average 5-6 miles every day. They lifted, pulled, pushed, threw, and sometimes jumped. We rarely get off the couch. We almost never reach our arms overhead for any adequate period of time. When we do get up it is only to get back down quickly. From the couch to the car, from the car to the office chair, and then it reverses on the way home. We on average sit more that ~80% of the day. Maybe more. Calculate how much you sit. It is surprising.

We often use cushions to decrease the discomfort of sitting in the same position for too long. A nice recliner or a soft couch does the trick. If you don’t think this is true, try sitting on the floor without cushions and a back rest for 30 minutes. Then record how often you need to change positions. It gets uncomfortable, but that is a good thing! Our bodies were designed to move and to move well. All this sitting causes changes to our posture and the loads on our body which increases the tension, yep there’s that word again.

I separated out lack of proper movement from being sedentary because many people do improper exercise. Maybe they exercise too much, maybe its only supplemental and that is the only movement they get all day, or maybe they are doing bad exercises. Either way, it causes a tremendous amount of stress to the body.

I am a huge proponent of natural movements such as walking, lifting, carrying, etc. What you would do if you were off in a forest somewhere. But how we generally exercise is not natural whether it is shoulder shrugs, bench press, or heel-toe running. All these exercises take their toll as well. They beat you up and after a period of time you are in trouble. It may take a month, a year, a decade, but at some point you hit the wall.

Improper movement whether from being sedentary or exercising poorly can lead to chronic tension in your upper back and neck. This increases your overall stress load.

De-stress Now

First things first, take a breather. Wherever you are stop what you are doing (unless you are driving, don’t do anything dangerous!) and take a few deep breaths. Focus on your breathing as you inhale and then exhale. Listen to the sound of your breathing. Allow it to be the only thing on your mind. You feel better right? This is your first step towards meditation.

Meditation comes in a variety of forms and I am not here to tell you which way is the best way. But spend some time alone. Maybe going on a quiet walk or sit alone in your office (on the floor!) and relax. Quiet your mind. If you are out in nature, focus on the noise around you, the birds chirping, the crickets, the cicadas, and the tree frogs. I love it. My wife and I went to Devil’s Den last night and just listened for awhile. It was beautiful. Nature has a powerful, calming effect.

Lastly, go on a walk. Make it a daily routine. Maybe go on multiple walks. I am a big proponent of walking. I love it. Especially if you can get out on a trail somewhere. Let the stress of the day disappear. Maybe go with a loved one or a friend. The point is just enjoy it.

Stress as a Jar

Now, I want you to imagine your stress load like a jar. When the stress builds it is like water filling the jar. When it hits the threshold and overflows you are in trouble. So what you need is to decrease the water, AKA the stress.

I already mentioned walking above and spending time with loved ones. Another big part is diet. We need good nutrition. Start by eating more fruits and vegetables or making better choices at lunch. Get a salad instead of the hamburger and fries. If you really want to go all out try something Whole30. Click the link it will take you to the program rules. It is essentially a nutrient-dense diet that is also anti-inflammatory. Lots of vitamins and minerals and lower inflammation, sounds great, right?

Between diet, walking, meditative practices, and being with loved ones your stress will decrease dramatically. The water in your jar will decrease and you will be able to handle things better and hopefully the headaches will decrease or go away altogether.


Tension headaches are hard to deal with and I know personally what you are going through. We may not understand fully what is going on but decreasing your overall stress load helps tremendously. And every person is unique, so what may work for one person may not work for the next. Be patient. It is not the end of the world. And remember, there is hope. There is relief. There is a light at the end of the tunnel.

There is much more to diet just as there is much more to each type of stress. So, if these tips don’t do the trick come on in and we can help. Give us a ring, shoot us an email, or reach out to us on social media. Either way we want to be of service.


  1. Rizzoli, Paul, and William J. Mullally. “Headache.” The American Journal of Medicine 131, no. 1 (2018): 17–24.
  2. Sajadi-Ernazarova KR, Anderson J, Dhakal A, et al. Caffeine Withdrawal. [Updated 2020 Jun 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
  3. Physiopedia contributors, “Tension-type headache,” Physiopedia, , (accessed August 10, 2020).

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