Tension Headaches: The Surprising Suspects

Many people struggle with tension headaches but aren’t sure why they happen or how to alleviate them. There are three areas I usually look at when someone suffers from tension headaches. We’ll dive into those below.

But first, let’s review what a tension headache means.

What is a Tension Headache?

You can usually differentiate a tension headache from others based on where you feel the pain. It covers the area where a headband would go: at the base of your skull where it meets your neck, coming up over your ears to the temporal muscle area and then across your forehead. 

What Causes a Tension Headache?

In my experience, there are three major players contributing to this kind of headache. And then, there are other potential causes that vary by person and their postural or stressor situations.

Here are the top places I always check out if someone comes in with a tension headache (or history of them):

1. Sternocleidomastoid (SCM)

I have a special place in my heart for this muscle. It’s the first one we learned about in massage class because it’s the perfect example of how some muscles are named for their location.

The SCM begins at the sternum and clavicle (collarbone) and ends at the mastoid process, which is the boney nub you feel just behind your earlobe. This ropey muscle is responsible for:

• Flexion in the neck (looking down)

• Rotation from side to side, and

• Lateral flexion (ear to shoulder)

The SCM muscle gets tight from constantly looking down at smartphones or craning our heads forward to look at a computer screen.

If this muscle has postural tension, it’s pulling on the temporal bone and puts strain on the….

2. Temporalis

The temporalis is a flatter muscle that spreads over and a little beyond your temporal bones (found at the sides and base of your skull, covering the areas of your ears and temples) and connects to the coronoid process on your mandible (jaw bone).

You can feel the temporalis muscle if you put your hand just above your ear and clench your teeth. You’ll feel movement because it’s affected by the actions of the jaw.

During that same jaw clench, if you put your hand between your cheekbone and lower jaw bone, you’ll feel the…

3. Masseter

The masseter is your primary chewer (and, fancy science term: muscle of mastication). These baddies do so much work! Your masseters are responsible for chewing, talking, and showing off stress when you clench your teeth.

The tension in your masseter can go one of two directions:

• If you’re one to clench your teeth, you’re in a high-stress situation, or you even just chew a lot of gum, tension can originate in your masseters, pull on the temporalis, and put a strain on the SCM. This pulls your head forward and down.

• It could also go the other direction. Your SCM could be tight from craning forward at a computer, as shown in this study of FHP and neck pain in office workers, or looking down at your phone constantly, which in turn puts the tension on the temporalis and into the masseters.

Forward head posture (FHP) is a big part of why tension headache pain will present in the back of the skull. Your head is heavy.

When your head is in a forward position and not balanced over our shoulders, that puts a lot of strain on the posterior (back) neck muscles to pull your head back to an upright position. The posterior muscles get “stuck long” in a constant state of contraction. They’re always fighting the strength of the anterior (front) neck muscles like the SCM.

If someone is presenting with tension headaches, regardless if it’s a one-off issue or if something chronic we’re working to diminsh long-term, I will check in with all three of these muscles. From there, we can uncover the tension headache culprit(s) and move towards relief.

I also check on the pecs and shoulders, because the shoulders and chest play a valuable role here too. But we’ll save that for another post!