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Breaking the Cycle of Tension Headaches with Manual Therapy and Exercise

Updated: Mar 27

Did you know that tension-type headaches account for 60% of all headaches? (13) Patients who suffer from headaches often exhibit common factors such as a forward-head posture due to prolonged computer work, texting or other habitual postural factors. They may also experience chronic shoulder, neck, and jaw kinetic chain restrictions, resulting in limited mobility in the cervical and thoracic spinal joints, shoulder girdle, and temporomandibular joint (TMD).

These physical changes can lead to muscle imbalances, tissue thickening, and inflammatory reactions, ultimately resulting in nerve entrapment syndromes, vascular changes, and the release of hormones, neurotransmitters, and chemicals that impact the brain's pain centers. The good news is that by addressing these underlying factors, it may be possible to reduce the frequency and severity of tension headaches.

Article Index:


Examination & Diagnosis



Conclusion & References


The Chemistry of Pain

A comprehensive review of the literature on tension headaches revealed a common link to alterations in the concentrations of three distinct chemicals - Serotonin, Bradykinins, and Substance P. It appears that these headaches frequently correlate with changes in the amounts of these particular substances. (11)

  • Serotonin serves as a biochemical courier, facilitating the transmission of nerve impulses between neurons. Additionally, it induces a narrowing of blood vessels, a process known as vasoconstriction, which can trigger nociceptive pain. (11)

  • Bradykinins are agents that orchestrate the inflammatory response, promote the widening (vasodilation) of arteries and veins, and stimulate the contraction of smooth muscle. These actions can result in peripheral sensitization. (11)

  • Substance P operates as a neurotransmitter, playing a crucial role in transferring pain signals from peripheral receptors to the central nervous system. (12) It's important to mention that even though this piece mainly focuses on tension headaches, the aforementioned chemicals also play significant roles in the occurrence of migraines.

The Tension Headache Correlation

Studies indicate that when soft tissue within the body is irritated or inflamed, it can trigger the release of certain chemicals including Bradykinin, Serotonin, and Substance P. This, in turn, sensitizes nerve endings, paving the way for the onset of pain and headaches. (2) Consequently, it is proposed that alleviating physical impediments — such as inadequate posture, muscular imbalances, and residual effects of prior injuries — could potentially be a strategy to eliminate the accompanying pain.

Addressing these physical issues may not only help in mitigating the frequency and intensity of chronic headaches, but it could also aid in preventing the occurrence of tension headaches. Improving posture can relieve strain on the muscles and nerves that may be contributing to these headaches. Balancing muscle strength and flexibility can help avoid undue tension that may trigger headaches. Likewise, treating the underlying causes and effects of previous injuries can reduce the persistent inflammation or irritation that could be provoking the release of pain-related chemicals. This multifaceted approach could provide a more holistic and effective method for the treatment and prevention of tension headaches. (16)


Symptoms and Physical Examination

Tension headaches are usually characterized by a duration that spans from half an hour to an hour, and these episodes may persist for several weeks. Those affected often report the pain as a dull, mild to moderately intense ache, or they may feel as though there's a band of pressure or tightness wrapping around the sides of their head.

This band of discomfort could be likened to a vice tightly gripping the skull, and in extreme instances, the pain could radiate to the shoulders, giving the impression of a cloak draped over them. In such scenarios, the factors causing the tension headache could be broader than the head itself, impacting a more extensive kinetic chain. (3)

Tension Headache NOT a Migraine!

Tension headaches can often be differentiated from other headache types by the absence of particular symptoms. For example, they don't usually induce visual issues, nausea, vomiting, one-sided numbness, or speech difficulties. To help recognize tension headaches, here are some frequently reported symptoms: (3)

  • The sensation of a band-like pressure encircling the head.

  • Trouble with concentration.

  • Sleep issues (insomnia).

  • Feeling fatigued and irritable.

  • A decreased appetite.

  • Discomfort in the neck, jaw, or shoulders.

  • Intense pain located behind the eyes or eye strain/fatigue.

  • Scalp sensitivity.

  • Unlike migraines, tension headaches do not typically worsen with exercise.

  • Nausea and vomiting, often associated with migraines, are typically not seen in tension headaches.

Cervical Examination - Orthopaedic Testing

In this video, you'll be taken through a comprehensive examination of the cervical region, including inspection and observation, palpation, assessment of active and passive ranges of motion, and orthopaedic examination.

Cranial Nerve Examination - 12 Cranial Nerves

Conducting a Cranial Nerve examination is a method we use to evaluate for potential sensory and motor dysfunction in our patients. This examination is routinely performed on all new patients.

Upper Limb Neuro Exam

The upper limb neurological examination is a component of the comprehensive neurological examination, which aims to evaluate the motor and sensory neurons that serve the upper limbs. This assessment is useful for detecting any potential impairment of the nervous system, and serves both as a screening and investigative tool.

Peripheral Vascular Examination - Key Points

Conducting a peripheral vascular examination is an important technique that aids in ruling out signs of vascular-related pathology. Early detection and treatment of peripheral vascular disease (PVD) can potentially prevent cardiovascular and cerebrovascular complications. This video covers some of the common procedures we perform in our daily clinical practice to assess peripheral vascular function.


Manual Therapy - A Power Tool

Successfully dealing with tension headaches often necessitates focusing on physical limitations that extend throughout an expansive Kinetic Chain. Subtle alterations in tissue tension can dramatically influence headaches' occurrence rate and severity. (4,5,16)

Research has established that tension within the shoulder, neck, and jaw kinetic chains can amplify the frequency and intensity of tension headaches. However, the implementation of manual therapy and physical exercise has been proven to lower the incidence and severity of these headaches considerably. (6,7,8,9,16)

Take note: Some common postural issues that contribute to the persistence of chronic tension headaches include:

  • Protruding head posture.

  • Hunched shoulders.

  • Excessive thoracic spine curve (Kyphosis).

In the subsequent videos, we will present some of the routine techniques we utilize for treating patients suffering from tension headaches. Combined with joint manipulation/mobilization and a functional exercise regimen, these methods have proven highly successful. For the best outcomes, evaluating any soft tissue restrictions within the kinetic chains of the shoulder, neck, and jaw is crucial.

4 Point Neck Pain Protocol - Motion Specific Release

In the accompanying video, Dr. Abelson illustrates a typical application of the MSR protocol designed for tackling tension headaches. It is crucial to approach and manage each instance of neck pain as a distinct issue, unique to the individual concerned. While some tension headache cases might be confined to local structures, others may implicate a broader kinetic chain.

MSR Ten‐Point TMJ Protocol - Part One

In the first part of this two-part video series, Dr. Abelson, the developer of MSR, demonstrates various external procedures to address the soft tissue structures of the jaw that can contribute to temporomandibular dysfunction.

TMD issues are often associated with a range of symptoms, including jaw pain, tension headaches, earaches, facial pain, vision problems, eye pain, balance issues, tinnitus, throat and neck pain, dizziness, and many others.

Fascial Expansions

Using fascial expansions to treat headaches is an innovative approach that combines the latest research in fascia, kinetic chain connections, and primary concepts found in acupuncture or traditional Chinese medicine. This article will discuss how integrating fascial planes with acupuncture points GB20, B60, TH5, LI4, and Yin Tang can effectively relieve headache, including tension, migraine, and cervicogenic headaches. Fascial expansions are part of Dr. Abelson's MSR programs that he teaches to multidisciplinary groups of practitioners. Click the image to learn more.


Joint Restrictions

In managing tension headaches, it's just as crucial to address any rigid restrictions in the cervical spine's osseous joints as it is to target soft tissue restrictions. Failing to remove these obstructions could lead to many patients not achieving a resolution for their tension headaches. The facet joints in the spine cause head pain, often following specific patterns.

To alleviate joint restrictions in the cervical spine, practitioners can use either Neck Adjustments or Neck Mobilization techniques. These methods are not arbitrarily chosen but are backed by scientific research that attests to their efficacy in restoring mobility, a concept known as arthrokinematics, and decreasing pain. (17,18,19)

When neck adjustments or neck mobilizations are used, the patient is often placed in a comfortable position. At the same time, the practitioner applies controlled force to a specific region of the cervical spine. The aim is to improve the range of motion, realign the joints, and restore their normal function, alleviating the strain and tension on surrounding muscles and nerves that could contribute to tension headaches.

Remember that each case is unique. The chosen therapeutic approach should be customized to each individual's condition, history, and comfort level, ensuring the best possible outcome for the patient.

The Power of Chiropractic Adjustments

Chiropractic adjustments can be highly effective in treating tension headaches. Many patients who undergo chiropractic treatment frequently report a decrease in their symptoms, or even complete resolution. In the attached video, Dr. Abelson shows a few standard spinal adjustments that can be beneficial in managing tension headaches. Scientific research endorses the use of these spinal manipulations as a legitimate therapeutic option for alleviating tension headaches.

Neck Adjustments or Neck Mobilization - The Choice Is Yours!

Often, patients are not fully informed about the array of choices available to them for tackling joint restrictions in their necks. In the attached video, Dr. Abelson exhibits examples of a method known as Cervical Joint Mobilization, which can be an effective solution for tension headaches.

Cervical Joint Mobilization is a hands-on therapy where gentle movements of the cervical spine are applied in a controlled manner to improve the function and mobility of the neck. These movements are designed to relieve pain, reduce muscle tension, and enhance flexibility.


Treatment Frequency Recommendations

The proposed treatment regimen is designed to traverse the varying response trajectories to manual therapy for tension headaches, ensuring a tailored approach that evolves with the patient's progress and comfort level. Sustained dialogue between the patient and healthcare provider is pivotal in fine-tuning the treatment frequency and strategy for enhanced tinnitus management.

Below, a potential treatment plan is presented based on either a positive response to treatment or the persistence of symptoms. For achieving optimum outcomes, patient adherence to both treatment sessions and home exercise is crucial.

Initial Treatment Phase:

  • MSR Manual Therapy: 2 sessions per week for two weeks.

  • Home Exercises: Daily functional exercise programs as prescribed by the MSR practitioner.

Response Assessment:

  • Evaluate the patient's response to therapy during follow-up appointments, typically after two weeks of treatment.

Positive Response:

  • MSR Manual Therapy: Reduce to 1 session per week as symptoms alleviate.

  • Home Exercises: Continue daily routines; adjust as necessary based on professional advice.

Persistent Symptoms:

  • MSR Manual Therapy: Maintain or increase frequency to 2-3 weekly sessions, reassessing the treatment approach weekly.

  • Home Exercises: Re-evaluate and modify exercises under professional guidance, ensuring correct technique and adherence.

When performing manual therapy for Tension Headaches, treatment should continue as long as there's an improvement in symptoms and function. If progress is noted and functional goals aren't yet met, ongoing therapy can be beneficial. If there are no noticeable results, only marginal improvements, or if progress plateaus, then treatment should be reconsidered or halted.

You should transition to maintenance care once the patient has achieved consistent symptom relief and optimal functional levels, ensuring that the achieved progress is sustained and potential recurrences are minimized. All decisions should be based on regular assessments and patient feedback.

Maintenance Phase:

  • MSR Manual Therapy: Monthly sessions or as needed for symptom management.

  • Home Exercises: Daily routines to maintain benefits and prevent symptom recurrence, with periodic reviews by healthcare professionals.

When considering treatment for Tension Headaches using MSR protocols, the primary focus is on achieving optimal results. The treatment plan is tailored, starting with four sessions in the initial phase. Based on the patient's response, sessions may be adjusted. The number of required visits is based on achieving the best possible outcome for the patient.


Exercise is Crucial

In the realm of tension headache management, the integration of supportive exercises is an essential aspect. The particular exercises advised will be individualized, considering each patient's distinct requirements and the current stage of their treatment.

The role of exercises in the treatment plan is multifaceted. Firstly, they help improve muscle strength and flexibility, which assists in maintaining proper posture and reducing undue strain on the muscles and nerves that can trigger tension headaches.

Secondly, exercises, especially aerobic ones, have a stress-relieving effect, which can also contribute to tension headache relief, given that stress is often a contributing factor. Lastly, consistent exercise can promote overall health and well-being, indirectly reducing the frequency and severity of tension headaches.

The exercise regimen can vary based on the patient's condition and comfort level, from gentle stretches to strength training exercises targeting specific muscle groups such as the neck, shoulders, and upper back. Moreover, the exercise regimen might evolve as the patient progresses through the different phases of treatment, adjusting to their changing needs and improvements. The goal remains to provide relief and improve the patient's 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 located at the base of the skull. Releasing this area is an essential aspect of resolving headaches.

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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 are highly effective in enhancing and maintaining flexibility, amplifying muscular strength and force, and elevating 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 a critical aspect of addressing a patient's kinetic chain when they experience tension headaches.



Tension-type headaches, constituting 60% of all headaches, often stem from poor posture during prolonged computer use, texting, or other customary activities and may also emerge from chronic shoulder, neck, and jaw kinetic chain restrictions. This results in limited mobility in relevant spinal joints, shoulder girdle, and temporomandibular joint (TMD). Additionally, biochemical alterations in Serotonin, Bradykinins, and Substance P concentrations play a part, contributing to tissue irritation, nerve sensitization, and, consequently, pain and headaches.

These headaches exhibit a distinct symptom set, differing from the severe symptoms associated with migraines, necessitating a thorough understanding for accurate diagnosis and management. Manual therapy, like chiropractic adjustments and cervical joint mobilizations, can offer significant relief by restoring normal function and alleviating muscular tension. Complementing manual therapy with supportive exercises aimed at enhancing muscle strength, flexibility, and stress relief forms a holistic treatment strategy. Managing tension headaches requires a multifaceted approach addressing physical and biochemical factors, encompassing manual therapies, tailored exercises, and posture improvement, paving the way for substantial symptom relief and enhanced quality of life.



Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.


Revolutionize Your Practice with Motion Specific Release (MSR)!

MSR, a cutting-edge treatment system, uniquely fuses varied therapeutic perspectives to resolve musculoskeletal conditions effectively.

Attend our courses to equip yourself with innovative soft-tissue and osseous techniques that seamlessly integrate into your clinical practice and empower your patients by relieving their pain and restoring function. Our curriculum marries medical science with creative therapeutic approaches and provides a comprehensive understanding of musculoskeletal diagnosis and treatment methods.

Our system offers a blend of orthopedic and neurological assessments, myofascial interventions, osseous manipulations, acupressure techniques, kinetic chain explorations, and functional exercise plans.

With MSR, your practice will flourish, achieve remarkable clinical outcomes, and see patient referrals skyrocket. Step into the future of treatment with MSR courses and membership!



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