Tension headaches that start in your neck: what a myotherapist looks for, and what you can do at home
That band of pressure around your head often begins somewhere else entirely — in the small muscles at the base of your skull and across your shoulders. Here is how to tell, what treatment involves, and a ten-minute routine that helps.
It builds through the afternoon. By the time you shut the laptop there is a tight band from your forehead to the back of your head, your shoulders are up near your ears, and turning to check a blind spot on the drive home feels like more effort than it should. You take something for it, it eases, and tomorrow it is back.
That pattern is the most common headache there is. It is also one of the most treatable, because in a large share of people the pain is not coming from the head at all. It is being sent there by overworked muscles in the neck and upper back — and muscles respond to hands-on treatment and to the right exercise.
The short version
- Most tension headaches are driven, at least in part, by tight and sensitive muscles in the neck and shoulders.
- The spot that hurts (your temples) is often not the spot that needs treating (the base of your skull).
- A few minutes of the right exercises, done most days, changes how often the headaches come.
- Some headaches need a GP first. The warning signs are listed below — read them before anything else.
Where a tension headache really starts
Muscles that stay switched on for hours — holding your head forward over a screen, bracing your shoulders against stress — develop small, tender, taut areas often called trigger points. Pressing on one reproduces a familiar ache, and very often that ache is felt somewhere else. The muscles at the base of the skull send pain over the top of the head to the forehead and behind the eyes; the upper trapezius sends it up the side of the neck to the temple.
Where you feel it, and where it comes from
Solid dots are the muscles we usually find working too hard. Dashed rings are where people feel the pain they send.
- 1
Neck · source
Suboccipital muscles
Four small muscles under the base of the skull that hold your head level while your eyes read a screen.
- 2
Shoulder · source
Upper trapezius
The ridge between neck and shoulder that rises when you are stressed, cold or typing.
- 3
Upper back · source
Levator scapulae and the shoulder-blade muscles
Tender to press between the shoulder blades, and a common reason the neck will not turn fully.
- 4
Head / temples · felt here
Band around the forehead and temples
The classic tension-headache feeling — pressure, not throbbing.
- 5
Jaw · felt here
Jaw and behind the eyes
Often joined by clenching or grinding, which loads the same system from the front.
This is why rubbing your temples feels good for a minute and changes nothing. The temples are where the signal arrives, not where it starts.
How common this is
adults worldwide has an active tension-type headache in any given year.
more tender neck and shoulder muscles found in people with frequent tension headaches than in people without them.
headache days a month is the point at which it is called chronic — and worth a proper plan rather than more painkillers.
Tension headache, migraine, or something else?
The three most common recurring headaches overlap, and plenty of people have more than one. The table below is the quick version of what a practitioner asks about in the first ten minutes of an appointment.
| Tension-type | Migraine | From the neck (cervicogenic) | |
|---|---|---|---|
| Where it hurts | Both sides, like a band | Usually one side, often behind the eye | One side, starting at the back of the head |
| What it feels like | Pressing, tightening | Throbbing, pulsing | Deep ache that spreads forward |
| Made worse by | Stress, long desk days | Light, noise, movement | Certain neck positions or movements |
| Nausea or light sensitivity | Rarely | Commonly | Occasionally |
| Hands-on treatment helps? | Often, with exercise | As one part of a medical plan | Often — it is the main treatment |
- Tension-type
- Both sides, like a band
- Migraine
- Usually one side, often behind the eye
- From the neck (cervicogenic)
- One side, starting at the back of the head
Where it hurts
- Tension-type
- Pressing, tightening
- Migraine
- Throbbing, pulsing
- From the neck (cervicogenic)
- Deep ache that spreads forward
What it feels like
- Tension-type
- Stress, long desk days
- Migraine
- Light, noise, movement
- From the neck (cervicogenic)
- Certain neck positions or movements
Made worse by
- Tension-type
- Rarely
- Migraine
- Commonly
- From the neck (cervicogenic)
- Occasionally
Nausea or light sensitivity
- Tension-type
- Often, with exercise
- Migraine
- As one part of a medical plan
- From the neck (cervicogenic)
- Often — it is the main treatment
Hands-on treatment helps?
A guide to the conversation, not a diagnosis. Your GP or practitioner will ask more than this.
See a GP or go to emergency first if
The headache is sudden and severe (the worst of your life), follows a knock to the head, comes with fever and a stiff neck, weakness, numbness, confusion, slurred speech or changes in vision, or is new and you are over 50. These are not muscle headaches, and hands-on treatment is not the place to start.
What happens in a myotherapy session
A myotherapist treats the muscles and joints that are sending the pain, not the headache itself. That means the first session is part detective work and part treatment: finding which muscle reproduces your headache when it is pressed, then easing it and giving you something to keep it eased between visits. Most people leave the first appointment with a looser neck and a short list of things to do at home.
Assessment first, then hands on
The first appointment starts with questions — when the headaches come, how long they last, what you do all day — and a look at how your neck and shoulders move. Then the practitioner presses on the muscles that commonly refer to the head, looking for the one that reproduces your headache.
- Soft tissue and trigger point release to the neck and shoulders
- Gentle joint mobilisation of the upper neck where it is stiff
- Dry needling, if you are comfortable with it
- Two or three exercises to take home, not twelve
A typical plan
Everyone differs, but this is the usual shape.
- Week 1–2
Settle the pain
One session a week. Release the muscles that reproduce your headache and start the home routine below.
- Week 3–5
Restore movement
Sessions move to fortnightly. Neck rotation and shoulder position improve, and the headaches usually thin out.
- Week 6+
Keep it away
The exercises become a habit, your desk gets a once-over, and treatment drops to as-needed.
The ten-minute routine
None of these need equipment. Do the routine once a day for two weeks and keep a note of your headache days — that note is the most useful thing you can bring to an appointment. Watch the video first if you have not done a chin tuck before; it is the one people most often get wrong.
See the exercises done
Your home routine
Slow and comfortable. A stretch should feel like a stretch, never a pain.
Once a day · about 10 minutes · for two weeks
01
Chin tuck
- 3 sets
- 10 reps
- Hold 5 sec
Sit tall. Keeping your eyes level, glide your chin straight back as if making a double chin. You should feel a gentle stretch at the base of your skull. Relax and repeat.
Stop if: Pins and needles or pain travel down an arm.
02
Upper trapezius stretch
- 2 sets
- Each side reps
- Hold 30 sec
Hold the edge of your chair with your right hand. Tilt your left ear towards your left shoulder, then turn your nose slightly down. Swap sides.
Stop if: You feel dizzy or the stretch turns sharp.
03
Shoulder blade squeeze
- 2 sets
- 12 reps
- Hold 3 sec
Let your arms hang. Draw your shoulder blades back and slightly down, as if tucking them into your back pockets. Do not shrug.
04
Belly breathing
- 10 breaths reps
One hand on your chest, one on your belly. Breathe in through your nose so only the lower hand rises. Stressed breathing uses the neck muscles; this gives them a rest.
- 05
Doorway chest stretch
- 2 sets
- Hold 30 sec
Forearms on either side of a doorway at shoulder height, step one foot through until you feel a stretch across the front of the chest. Tight chest muscles pull the shoulders forward and the head with them.
Stop if: Your shoulder feels unstable or clicks painfully.
Small habits, both ways
Habits that feed it
- Laptop flat on the desk, head craned down to it
- Phone wedged between ear and shoulder
- Four hours without standing up
- Skipping lunch and water on a busy day
Habits that ease it
- Screen raised so your eyes meet the top third
- A headset for calls
- A two-minute movement break every hour
- Regular meals, water on the desk, a consistent bedtime
“The spot that hurts is where the signal arrives. Treatment goes where it starts.”
Find someone who treats this
If the headaches have been around for more than a few weeks, or the routine helps but not enough, an assessment is the next step. These practitioners regularly treat neck-driven headaches.
Live from the directory
Practitioners who treat headaches
Verified listings, straight from the directory.
Elizabeth Ruach
Founder, Senior Myotherapist
North Melbourne VIC
- Manual Lymphatic Drainage
- Sports Massage
- Myotherapy
From $140 · 60 min
View profile
Sunny Wongphumee
Myotherapist
North Melbourne VIC
- Manual Lymphatic Drainage
- Dry Needling
- Myotherapy
From $140 · 60 min
View profile
Priyanka Joshi
Physiotherapist
North Melbourne VIC
- Physiotherapy
- Dry Needling
From $160 · 60 min
View profileCommon questions
About tension headaches and treatment.
Do I need a referral to see a myotherapist?
No. You can book directly. If you have any of the warning signs above, see your GP first — they can refer you on once the serious causes are ruled out.
How quickly will I notice a difference?
Most people feel looser after the first session, and many notice fewer or milder headaches within two to four weeks of treatment plus the home routine.
Is dry needling necessary?
No. It is one option among several and is only used if you are comfortable with it. Manual release and exercise work well on their own.
Can I claim it on private health insurance?
Usually, under extras, for remedial massage or myotherapy. Check your level of cover — most clinics can claim on the spot.
Headaches most days? Get the neck checked.
No referral needed. Most practitioners have appointments this week.
Sources
5 referencesThe research and guidance this article draws on.
- 1
Manipulative therapy and exercise for cervicogenic headache
Myotherapy research summary · 2026Our research
Our plain-English summary of the trial behind the "treat the neck" approach.
- 2
The Journal of Headache and Pain · 2022pubmed.ncbi.nlm.nih.gov
Where the one-in-four figure comes from.
- 3
Myofascial trigger points and sensitization: an updated pain model for tension-type headache
Cephalalgia · 2007pubmed.ncbi.nlm.nih.gov
- 4
International Classification of Headache Disorders, 3rd edition
International Headache Society · 2018ichd-3.org
The definitions of tension-type, migraine and cervicogenic headache used above.
- 5
healthdirect Australia · 2024healthdirect.gov.au
Find a myotherapist near you
Every practitioner in the directory is verified before their listing goes live. Search by suburb, therapy or health fund.
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