Anatomy of a Tension Headache. It’s not Just in Your Head.

Headaches caused by excessive muscle tension are the most common type of headache not caused by an underlying medical condition and are reported by about 38% of the US population. (1) Having worked with many people experiencing tension headaches, it is my observation that although clients report an association with excessive tension in the neck and shoulders, an exclusively localized focus on these areas does not provide a full picture of the problem.

There are misconceptions about muscles and connective tissues that need to be addressed to construct a better picture of how a tension headache develops. One primary misconception is that muscles function as isolated blocks creating movements mostly independent of the rest of the body. For example, we say that the deltoid muscle raises the arm with the help of the trapezius. However,

"It is clear that muscle fibers from the occiput (head) to the toes, and from both sides of the body, all must cooperate to 'raise the right arm.' It is utterly arbitrary, and possible only in the rarefied laboratory of the imagination, to say that it is the 'deltoid' which is solely--or even primarily--responsible for any part of this gesture." (2)

When we decide to raise our right arm, not every fiber within the deltoid contracts simultaneously like a block unit. Instead, fibers throughout the shoulder will alternately contract at various rates. At the level of individual muscles cells contraction is either on or off but at the level of a whole muscle, contraction is partial and depends on the direction and the level of strain.  Additionally, to raise an arm while keeping our body upright, muscle fibers throughout our body must balance and counterbalance the pull created as our weight distribution shifts in alignment with gravity. Therefore, movement is created by muscle fibers within a body-wide network, not by independent muscles moving as block units. Muscle names simply indicate location in the body.

Muscles cells are shaped as thread-like fibers and composed of thinner myofibrils arranged in parallel wherein the mechanics of muscle contraction occur. Each muscle cell is wrapped in a sheath of fascia (connective tissue) that is made of collagen fibers within a gooey ground substance. Muscles cells are bundled into fascicles which are wrapped with more fascia and then fascicles are bundled into what we recognize as individual muscles and again wrapped with an outer fascial sheath. All the fascial sheaths blend at the ends of the muscles and the quality of the fascia changes from a more loosely knit wrapping into a tightly packed tension cable which we call a tendon. Tendons do not attach muscles to bones as if one separate piece of something is being stitched onto something else. Tendons blend into the periosteum, or outer wrapping, of a bone, in a continuity of structure. (Image courtesy of https://www.visiblebody.com/)

This last point is vital to a better understanding of how tension and force are transmitted through the body. The body needs to be viewed as a suspension and tension wire system instead of a stack of blocks that are moved like levers. There is not a single flat surface where two bones could stack nor are bones pulled by single, independent lines. They are instead held in suspension by the tension created within the soft tissues that surround the bones in a continuum. Muscles fibers contract to adjust tension levels transmitted by lines of pull within the fascial system that adjust the position of structures. (3)

Fascia, as a system comprising all the connective tissue within the body, is a continuous 3-dimensional matrix that envelopes every structure of the body, from vessels to organs to muscles and bones. (4) Tension and force flows through the fascial system along lines developed using varying densities and arrangements of collagen fibers. These lines exist through the muscular system as structural continuities spanning the entire length of the front, back and sides of the body. For example, along both sides of the back of the body there is a continuous fascial line that begins on the bottom of feet, travels up the back of the leg, along the back of the pelvis and the entire spine, and goes over the head to end at the brow line just above the eyes. (5)

This view of the body has a few primary implications. First, every single structure of the body is held within a matrix that directly connects it to every other structure. This means the condition of each structure can affect the condition of every other structure. Second, when an area of fascia becomes compacted or tightened because of scar tissue from injury or surgery, or from habitual postures and movements it creates a pull that can affect the alignment of the entire system. Depending on the size of the distortion, this can lead to counterbalancing compensations. Lastly, pulling from a restriction in one area of the system can create pain symptoms in another area far from it. (6)

The head is not just connected and controlled by the muscles of the neck and shoulders. Our entire body is engaged in an incredibly complex balancing and counter-balancing dance of tension adjustment to keep us upright and balanced against gravity with our eyes level. Looking at the muscular structure of the entire back and then up a side and over the top of the head, you can start to appreciate the continuity of muscle. In the picture of the back, the outer layer of muscles on the right side is removed to reveal the mid-layer of muscle. There is another deeper layer of smaller muscles that is not visible. It must be remembered that the muscles are wrapped in a continuous fascial matrix, which is not shown. Only the large sheets in the low back and on top of the head are made visible. (7) (Images courtesy of https://www.visiblebody.com/)

Now, let’s consider a common scenario to illustrate the development of an excessive

muscle tension pattern that can lead to a tension headache. When we sit for long periods of time at a desk using a computer, there is a strong tendency for the abdominal muscles to soften, allowing the thoracic curve of the spine to increase, bending us forward and taking our head and shoulders with it into a forward position. “The average weight of the head is 10 to 14 pounds. It has been estimated that as the head migrates forward, it becomes the equivalent of a 30-pound weight.” It is not just the neck and shoulders that bear the strain of this added weight but the entire spine. The upper back tends to become overstretched and weakened while the lower back is working overtime to keep us from falling forward on our face. “Studies have demonstrated that for every centimeter that the cranium shifts forward, the lumbar musculature must work 3 times as hard to maintain erect posture.” (8)

When certain postures and movements are held or repeated over prolonged periods, this changes how the muscles function and the shape of the fascia that holds them. Improperly or overly used muscles fatigue and become increasingly unable to return to their optimal relaxation length, creating chronic shortening in the muscle. This shortening affects muscle balance and, therefore, postural alignment. Fascia responds to this misalignment by packing collagen fibers more tightly in areas put under new strain to compensate for the rebalancing required to pull against the misalignment.

“These changes in collagen binding begin to occur within 20 minutes of an injury or sustained postural distortion. The longer the distorted, immobile position is maintained, the more collagen fibers will crosslink to form newer, tighter bonds. These bonds will spread within days to adjacent joints above and below the site of the injury.” (6)

To put all the pieces of the picture together, first, we have a posture that is putting incredible strain on the entire spine and down into the hips. Next, we see muscles in a chronically shortened position and compacted fascia compensating for the strain. Add to this the effects of stress, which heightens the rate of muscle contraction, and negative emotions, which further distort posture. Taken together this is a potent cocktail of factors exerting pull on the lines of tension running through the fascia up the length of the spine and anchoring all around the head.

The solution to the problem of tension headaches is not localized to the head, neck and shoulders. It is also not resolved solely by stretching or medication. Areas with shortened muscles and compacted fascia, such as in the chest and lower back, need to be opened and lengthened. However, areas that have weakened and are being overstretched, such as the abdominal core and upper back, need to be strengthened to achieve better postural alignment. Most importantly, habitual postural and movement patterns need to be analyzed and optimized, and stress needs to be mitigated. Tension headaches are a full-body and mind problem that requires an integrated approach to eliminate their root causes.

Notes:

1. The Journal of the American Board of Family Medicine, July 2024. https://www.jabfm.org/content/37/4/737

2. Job’s Body, A Handbook for Bodywork, by Deane Juhan, Barrytown/Staton Hill Press, 2003, 3rd edition.

3. This view of the body arises out of an incorporation of the idea of tensegrity coined by Buckminster Fuller, an architect and systems theorist among other things, by scientists and bodyworkers studying fascia and other aspects of human biology.

“Tensegrity, tensional integrity or floating compression is a structural principle based on a system of isolated components under compression inside a network of continuous tension and arranged in such a way that the compressed members (usually bars or struts) do not touch each other while the prestressed tensioned members (usually cables or tendons) delineate the system spatially.” (https://en.wikipedia.org/wiki/Tensegrity)

“…as one of nature's favorite devices for achieving a maximum of stability with a minimum of materials…This principle of tensegrity describes precisely the between the connective tissues, the muscles, and the skeleton…As weight bears down, the solid beams tend to spread; this they are prevented from doing by the tension of the wires, and it is this tensional force, not the compressional strength of the beams, which keeps the structure rigid. Fuller has demonstrated that this simple tensegrity cube can be expanded into large and complex cubes, spheres, cylinders, and masts, architecturally capable of supporting far heavier loads than solid supports of equal weight” (1)

These images show a simple tensegrity model and one designed to display the tensegrity principle in the structure of the spine.

4. Definitions of the fascial system:

Robert Schleip, Phd, MA

“The fascial body is one large networking organ, with many bags and hundreds of rope-like local densifications, and thousands of pockets within pockets, all interconnected by sturdy septa as well as by looser connective tissue layers.” (Fascia; The Tensional Network of the Human Body: The Science and Clinical Applications in Manual and Movement Therapy, Elsevier, 2nd Edition, 2022.)

Jean-Claude Guimberteau, MD

“Fascia is the tensional, continuous fibrillar network within the body, extending from the surface of the skin to the nucleus of the cell. This global network is mobile, adaptable, fractal, and irregular; it constitutes the basic structural architecture of the human body.” (Architecture of Human Living Fascia: The Extracellular Matrix and Cells Revealed Through Endoscopy, Handspring Pub Ltd, 2024.)

5. Thomas Meyers, LMT, has created a map of these fascial continuities based on observations from many human dissections, which he calls “trains.” (Anatomy Trains, Myofascial Meridians for Manual Therapists and Movement Professionals, Elsevier, 2021, 4th edition.)

6. Myofascial Release Therapy: A Visual Guide to Clinical Applications, by Michael J. Shea PhD, North Atlantic Books, 2014

7. It is only in recent years that fascia has started to come under study and serious consideration of its involvement in healing and disease. Historically fascia has been tossed out of human dissections as meaningless packing material that needed to be removed so that the “important” anatomy could be viewed. The First International Fascia Research Congress wasn’t until 2007.

Fascia has fascinating qualities like being a piezoelectric semiconductor (when distorted or compressed an electrical charge is created that draws water into it allowing nutrients, wastes, and information signals to flow), being a fluid crystal capable of transforming from a sol to a gel state and back again and being key in our proprioceptive sense. Cross these qualities of fascia with the work of scientists like Candace Pert, PhD in neuropeptides and Steven Porges, PhD in polyvagal theory, fascia becomes the ground in which body and mind are bridged and healing of both can occur. All of this has huge implications for understanding how manual, movement, breath, vibration and energy therapies work to support healing. It’s an immensely exciting new field of study that can potentially revolutionize the way we understand our bodies, minds, and healing abilities.

8. Myofascial Release, the Search for Excellence, by John F. Barnes, PT, Myofascial Release Seminars, 1990.