You take a painkiller. The headache fades. A few days later it is back. You take another painkiller. This cycle is familiar to hundreds of millions of people — and it is one of the most effectively managed problems in physiotherapy, yet one of the least referred to it.

Here is what is actually happening, and what you can do to break the cycle.

What Is a Tension Headache, Really?

Tension-type headache is the most prevalent headache disorder in the world. It is characterised by a dull, pressing pain — often described as a tight band around the head — that can last from 30 minutes to several days. Unlike migraines, it is typically bilateral, not aggravated by physical activity, and not accompanied by nausea or light sensitivity.

Despite the name, tension headaches are not simply caused by stress. Stress is a trigger — but the underlying mechanism is musculoskeletal. Specifically, they are driven by referred pain from trigger points in the muscles of the neck, upper back, and jaw.

The Role of the Neck

The suboccipital muscles — the small muscles at the base of the skull — are among the most trigger-point-prone muscles in the body. When they are chronically shortened or overloaded, they refer pain directly to the head: across the top of the skull, behind the eyes, and along the temples.

The upper trapezius and sternocleidomastoid follow the same pattern. The upper trapezius refers to the temple and behind the ear. The sternocleidomastoid — the long muscle running down the side of the neck — refers to the forehead, the eye socket, and the top of the head.

This is why tension headaches so often feel like they are coming from the head when the source is entirely in the neck and upper back.

Why Posture Makes It Worse

For every centimetre the head moves forward from its neutral position over the spine, the effective load on the cervical spine approximately doubles. In a typical office worker with moderate forward head posture, the neck muscles are managing a load equivalent to 20 to 30 kilograms rather than the 5 to 6 kilograms of the head's actual weight.

This chronic overload leads to:

  • Shortening and trigger point development in the suboccipital and upper trapezius muscles
  • Inhibition of the deep cervical flexors — the stabilising muscles that should be holding the head in position
  • Increased tension across the entire cervical and upper thoracic region
  • Sensitisation of the pain pathways, meaning smaller triggers produce bigger headaches over time

Screens make this significantly worse. Looking slightly downward at a laptop for hours at a time is one of the most reliable ways to develop chronic suboccipital tension.

Why Painkillers Don't Solve It

Painkillers reduce the perception of pain. They do not address the trigger points, the muscle imbalances, or the postural load that generated the headache. The moment the medication wears off, the underlying problem is exactly where it was.

Frequent painkiller use for tension headaches also carries the risk of medication overuse headache — a condition where the headaches become more frequent as a direct consequence of taking pain relief too often. This is a well-documented clinical phenomenon and one of the more frustrating traps people fall into.

What Physiotherapy Targets

Effective physiotherapy for tension headaches works on three levels simultaneously:

Trigger point release. Deactivating the active trigger points in the suboccipital, upper trapezius, and sternocleidomastoid muscles that are referring pain to the head. This can produce immediate relief and, done consistently, reduces the frequency of headache episodes over time.

Deep cervical flexor retraining. Strengthening the small stabilising muscles of the anterior neck that have become inhibited by chronic forward head posture. When these muscles function correctly, the load on the posterior neck muscles is significantly reduced.

Upper thoracic mobility. Restoring movement in the upper back, which directly affects the position and load of the cervical spine. A stiff thoracic spine forces the neck to compensate, maintaining the tension that drives the headaches.

How Often and How Long

This is where most people underestimate the commitment required. Trigger points that have been present for months or years do not resolve after two or three sessions. The research on cervicogenic and tension headache management consistently shows that meaningful reduction in frequency and intensity requires a minimum of four to six weeks of consistent daily practice.

Consistent means daily — or close to it. The nervous system adapts through repetition. Doing the exercises twice a week produces minimal results. Doing them every day produces lasting change.

The Reliev program for tension headaches is structured around this reality. It is designed to take less than fifteen minutes per day, to be done without any equipment beyond the resistance bands, and to be sustainable as a long-term daily practice rather than an intensive short-term intervention.

The headache is in your head. The cause is in your neck. The solution is consistency.

If you have been managing tension headaches with painkillers for months or years, it is worth trying a different approach — one that addresses what is actually generating the pain rather than suppressing the signal.