Tension headaches and a stiff neck

Tension headache is the most common type of headache. It is usually bilateral, pressing or squeezing — like a tight band or a helmet — of moderate intensity, without nausea or light sensitivity (this is what distinguishes it from migraine). It often builds up towards the evening and is linked to fatigue and stress.

Where to look for the cause. The head rarely aches on its own. More often the muscles of the neck, back of the head and shoulder girdle are tense — and they react to posture, stress and breathing.

What usually contributes: long hours at a screen with the head pushed forward; tension in the masticatory muscles and the TMJ (especially if you clench or grind your teeth at night); shallow breathing and a restricted diaphragm; consequences of old neck injuries; chronic stress.

What I do. First I look for where the tension comes from: it may be the neck, but often it is the thoracic region, the diaphragm or the jaw. Then comes gentle work with those areas: releasing muscles and fascia, restoring mobility, working with breathing. No abrupt manipulations of the neck.

We usually also go through everyday things: how your workplace is arranged, how you breathe, whether you have a habit of clenching your jaw. Without that, the tension comes back.

What I do not promise. Instant and final relief from headaches. The timeline depends on how long ago it started and what exactly keeps the tension going.

When you need a doctor, not an osteopath. Seek medical help urgently if the pain came on suddenly and is the worst of your life, comes with fever and neck stiffness, appeared after a head injury, is combined with weakness or speech or vision problems, or if the character of your usual headache has changed sharply. Osteopathy does not replace examination here.