Massage for tension headaches

Why it happens

A tension headache feels like pressure rather than throbbing: a tight band around the forehead, a dull ache at the back of the head, or pressure behind the eyes. It usually builds slowly, often through the afternoon, and it does not usually come with nausea or make light and sound unbearable the way a migraine can.

The muscles involved are the ones you rarely think about until they hurt:

• The suboccipitals, small muscles at the base of the skull that fine-tune the position of the head. When the head drifts forward toward a screen, they shorten and work constantly to keep your eyes level.
• The upper trapezius, from the neck to the top of the shoulder. Tender spots in it can refer pain up the side of the neck to the temple and behind the eye.
• The sternocleidomastoid, the strap muscle on each side of the front of the neck. It can send pain to the forehead, around the eye and toward the ear.
• The jaw and temple muscles. If you clench your teeth under stress or grind them at night, the temporalis and masseter tire out and ache along the side of the head.

These muscles tighten for ordinary reasons: long hours at a screen, stress, poor sleep, holding one position, skipped meals, not drinking enough water. When they stay tight, the tender spots within them send pain into the head. The nervous system can also become more sensitive over time, so that headaches come more easily and more often.

Some headaches come from the neck itself, from its joints and muscles, and feel similar. Massage looks at the neck either way, because the muscles around it are usually involved.

What massage can do about it

Massage can ease the muscle tension that feeds tension headaches, and for many people that means headaches that come less often or hurt less. It does not work like a painkiller. A headache in full swing may ease during a session, but the main value is in reducing the tension that keeps setting them off.

A therapeutic massage session for headaches spends most of its time on the base of the skull, the neck, the tops of the shoulders and the upper back, and often on the jaw and temples. The pressure is steady but not heavy. The neck responds better to slow, careful work than to force, and the front and sides of the neck carry arteries and nerves that are never worked deeply.

What to expect, honestly:

• Pressing on the right spot often reproduces your headache, briefly. That suggests the muscle may be part of it.
• One session can bring relief, but a pattern of regular headaches usually needs a course, with the exercises in between.
• Massage does not replace medical care for migraine, and it will not change a headache that comes from something other than muscle tension.
• A headache diary helps. Noting when headaches start, and what you were doing, often shows the pattern faster than anything I can find with my hands.

If your headaches come with a stiff neck and aching shoulders from desk work, neck and shoulder pain and desk-work posture cover those patterns in more depth.

What my physical-therapy training adds

My physical-therapy training from Ukraine taught me to look at where the head sits and how the neck moves, not only at where the headache is felt.

I look at how you sit and stand, how far your head is forward of your shoulders, and how far you can turn, tilt and nod your head. A neck that turns less on one side often matches a headache that sits on that side. I also ask about your working day, your sleep and whether you clench your jaw.

Then I explain in plain words which muscles seem to be feeding the headaches and why they keep tightening.

Between sessions you get one or two small exercises, such as a gentle chin tuck to bring the head back over the shoulders, a stretch for the top of the shoulder, and a reminder to let the jaw hang loose. They take a minute or two, several times a day. That is often what changes how often the headaches come.

When to see a doctor first

Most recurring headaches are not dangerous, but some are. Get emergency care, or call 911, if you have:

• A sudden, severe headache, the worst of your life, that reaches full strength within seconds or a minute.
• A headache with fever and a stiff neck, a rash, or confusion.
• A headache after a blow to the head, a fall or an accident.
• A headache with weakness, numbness, drooping of the face, trouble speaking, loss of vision or double vision.

See a doctor before booking a massage if your headaches are new and you are over fifty, if they come during pregnancy or in the weeks after giving birth, if you have cancer or a weakened immune system, if they have changed in pattern or are steadily getting worse, if they wake you from sleep or are worse on coughing or straining, or if you are taking painkillers for headaches on more than a few days a week.

If you are over fifty and a headache comes with jaw pain when chewing, a tender scalp or any change in your vision, get medical care the same day.

Massage therapy is not medical care.