Tension-Type Headache ChiropractorAdelaide

What Tension-Type Headache Looks Like

Tension-type headache is typically bilateral, pressing or tightening rather than pulsating, mild to moderate in intensity, and is not aggravated by routine physical activity. Pericranial muscle tenderness on manual palpation is the most consistent clinical finding.

Typical features, based on ICHD-3 section 2 criteria, include:

• Location on both sides of the head, often a band-like pressure across the forehead, temples, and base of the skull.
• Quality that is pressing or tightening, not pulsating or throbbing.
• Intensity mild to moderate, usually not disabling.
• Activity not aggravated by routine activity such as walking or climbing stairs.
• Associated features no nausea or vomiting (mild nausea may occur in chronic forms), and at most one of photophobia or phonophobia.
• Duration 30 minutes to 7 days per episode in the episodic forms.

How It Differs from Migraine and Cervicogenic Headache

Tension-type headache can look similar to migraine or cervicogenic headache at first glance, but the pattern of laterality, quality, and aggravating factors usually tells them apart.

• Versus migraine (ICHD-3 section 1): migraine tends to be unilateral, pulsating, moderate to severe, aggravated by routine activity, and often paired with nausea plus both light and sound sensitivity. Tension-type headache is bilateral, pressing, milder, not aggravated by activity, and without nausea.
• Versus cervicogenic headache (ICHD-3 section 11.2.1): cervicogenic headache is typically side-locked and reproduced by neck movement or sustained posture, with cervical joint findings on assessment. Tension-type headache is bilateral and more diffuse, with pericranial muscle tenderness the most common clinical feature.
• Overlap: some adults experience both migraine and tension-type patterns at different times. A careful history helps clarify which pattern dominates on which days.

Sources: Headache Classification Committee of the International Headache Society. ICHD-3, Cephalalgia 2018. Bendtsen L. Central sensitization in tension-type headache. Cephalalgia 2000. Ashina et al. Tension-type headache. Nat Rev Dis Primers 2021.

What the Research Suggests

Conservative, hands-on care for tension-type headache is supported by moderate evidence across systematic reviews of manual therapy, soft tissue techniques, and multimodal approaches. The studies below summarise what the research suggests, not what any individual person will experience.

How Chiropractic Care May Help

Research suggests that conservative, hands-on care may help some adults reduce the frequency and intensity of tension-type headache, particularly where pericranial or cervical muscle tenderness is a feature. At Stapleton Chiropractic, the approach is multimodal and tailored to what the assessment finds.

At Stapleton Chiropractic, care for tension-type headache typically includes:

• Detailed history and red flag screen to clarify the pattern and rule out anything that warrants urgent medical review.
• Physical assessment including cervical range of motion, pericranial muscle palpation, and a few simple orthopaedic and neurological checks.
• Soft tissue techniques including myofascial work, trigger-point techniques, and sub-occipital release applied to the pericranial and cervical musculature.
• Low-force adjustment using an Activator instrument or drop-piece table where appropriate. Both are well-tolerated and suited to a sensitised neck or jaw.
• Diversified manual adjustment for patients comfortable with hands-on adjusting, applied to the cervical and upper thoracic spine as clinically indicated.
• Posture, movement, and stress-management guidance you can use between visits, such as simple desk adjustments, brief neck and shoulder mobility routines, hydration and sleep reminders, and paced breathing or short movement breaks.

Progress is reviewed at each visit. There are no lock-in plans, and the decision to continue is always yours. NICE guideline CG150 suggests manual therapy may be considered for chronic tension-type headache alongside behavioural strategies. Where your presentation includes features that warrant medical review, Dr Sam Johnson (Chiropractor) will say so and recommend a GP follow-up.

Chiropractic vs other common approaches

If we feel you would benefit from a different approach, we will always let you know.

Why Stapleton Chiropractic

Adult-first, evidence-informed, and family-run since 1972. No lock-in plans, clear pricing, and the decision is always yours.

What Your First Visit Looks Like

Four straightforward steps. No paperwork marathons, no surprises.

Transparent, Affordable Fees

No lock-in plans, no pressure. Fees sit well below the South Australian average.

Source: Australian Chiropractors Association Consultation Fee Survey 2025 (SA data). All major health funds accepted.

Warning Signs That Warrant Urgent Medical Review

Most tension-type headaches are benign, but some headache presentations need medical assessment first.

Please see your GP or seek urgent medical care if you notice any of the following:

• Sudden, severe headache that reaches peak intensity within seconds or minutes, sometimes called thunderclap headache
• New neurological symptoms such as weakness, numbness, difficulty speaking, visual loss, or altered consciousness
• Fever with neck stiffness, rash, or feeling very unwell
• Recent head or neck trauma
• A new or different headache pattern after age 50
• A headache that is getting progressively worse over days or weeks
• Headache associated with pregnancy, cancer history, immune suppression, or anticoagulant use

Persistent chronic tension-type headache, meaning 15 or more days per month for more than three months, also warrants a GP review to exclude medication-overuse headache and consider a broader management plan. If any of the above apply, contact your GP, call healthdirect on 1800 022 222, or attend your nearest emergency department. Conservative chiropractic care is not a substitute for medical assessment.

Frequently Asked Questions