Tension Headache: Causes, Symptoms and Treatment

Anne, 44, accountant from Nordhavn, had been having headaches at least three times a week for more than two years. It started as a pressing sensation in the temples that came in the afternoon at work and continued at home. She thought it would go away on its own. It just didn't.

She tried what many do. Massage with a physiotherapist every two weeks for months. A new office chair and ergonomic assessment at work. Over-the-counter painkillers nearly every week. She went to a chiropractor five times and got a new causal explanation every single time. Nothing lasted. The massage relieved for two days. Painkillers dampened the symptoms but didn't do anything about the underlying issue. She gradually got used to having headaches — that was just how her daily life was now.

One day she read that headache could be related to physical capacity in the neck and shoulder muscles, not just stress and working position. She had never thought of it as a training issue. She read our client stories and Google reviews and booked an introductory consultation.

The first thing we explained to Anne was that her headache is not a disease in itself — it is a signal. Her neck and shoulder muscles had for years been asked to tolerate more than they had the capacity for. 40 hours of screen work per week. Minimal physical activity. A body that hadn't trained in many years. The solution was not more rest or more passive treatments. The solution was to build capacity.

We started gently and progressed systematically, with particular focus on exercises that loaded her neck and shoulder area — Cable Pulldown, Chest Press, Lateral Raise — while simultaneously building general physical capacity in the rest of the body.

After three months, the headaches had dropped from three times a week to approximately one. After six months, she was down to 1-2 times per month. After nine months, she hadn't had a headache in several weeks and was now only focused on staying strong and pain-free.

Anne is no longer afraid to use her body. What before felt like something she needed to protect herself against has become what protects her.

"We see it often: office work, headaches for years, and everything tried from massage to new chairs to painkillers. The explanation is the same every time — stress, working position, tense muscles. But that is rarely the whole story. More often the body simply doesn't have enough capacity for what daily life demands. And that can be addressed — not by loosening up, but by building up. Then there's what people underestimate: almost everyone has been told they need to take care of themselves. My most important job is to give them permission to use their body again." — Kasper Vinther, personal trainer & physiotherapist

What is tension headache?

Tension headache strikes broadly, but some groups are more vulnerable. Women are affected approximately twice as often as men. The prevalence typically peaks between the ages of 30 and 50, where working life, family life and physical inactivity are often combined in a way the body isn't built for. It is also a group where office work and screen time often take over — and where strength training has often been neglected over the years.

That matches Anne. Woman, mid-40s, office work, minimal physical activity over the years. It is not coincidental, but the classic profile.

Symptoms

• Dull, pressing pain throughout the entire head
• Bilateral location (both sides)
• Mild to moderate intensity
• Not worsened by physical activity
• No nausea or vomiting
• Tenderness in the neck and shoulder muscles

How to distinguish from migraine

If your headache picture matches migraine, this article is not the right starting point.

Why do you get tension headache?

The classic explanation — stress, bad working position, tense muscles — is not entirely wrong, but it is not actionable. If you tell a person who has had headaches for two years that she "just needs to have less stress," you haven't given the person a solution.

The newer understanding points in a different direction: tension headache is often about a mismatch between the loading the body is subjected to and the capacity the body has to tolerate it.

It is the same fundamental idea we work with for nearly all musculoskeletal problems. Shin splints in runners. Runner's knee. Hamstring strain. The problem is not that something is "wrong" with the affected structure. The problem is that the structure is being asked to tolerate more than it can handle.

With tension headache, it typically looks like this: 40+ hours of sedentary screen work per week, static loading of the neck and shoulders for many hours daily, and minimal general physical activity. The body is not built to be static. When there isn't enough capacity to tolerate the static loading, the body sends a signal. That signal is often headache.

Stress plays a role. Sleep plays a role. But the factor most people overlook, and which paradoxically is the easiest to do something about, is physical capacity.

We should be honest about one thing: no one knows the precise mechanism behind tension headache. The capacity explanation is the one that fits best with what we see in practice and with the research that exists — but it is a model, not a fact. You will meet many who explain your headache with great certainty. Be a bit skeptical of all of them, including us.

What we can say with reasonable certainty, however, is this: structured strength training reduces headache in most people. We don't need to know the entire explanation to use what works.

What does the research say?

There is a growing evidence base that strength training is effective against tension headache.

A study from 2023 compared a 12-week strength-based training program with usual treatment for chronic tension headache. The training group showed significant reduction in both intensity and duration. A systematic review of the overall evidence from 2025 confirms the same pattern: physiotherapy-based approaches — including strength training — have positive effects on both frequency and intensity of chronic tension headache.

What the research has not determined is whether one type of training is better than another. Much of the literature uses neck-specific exercises; we use a full-body program. Both work. We choose full-body because it gives everything else along with it — general capacity, conditioning, bone strength, muscle mass — and because it is something people actually stick with. A set of neck exercises is something you finish. Strength training is something you have.

Treatment of tension headache

The most important point first: you should not try to relax muscles that have too little capacity. You should give them more capacity.

It is the opposite approach of the classic one. And let us be fair: massage, relaxation, stretching and manual treatment actually work — people often get real relief afterwards. The problem is not that it doesn't work. The problem is that there is nothing left when the effect has worn off, and that you therefore have to go again in 14 days.

After three months of strength training, you have a body that can do more than before. That is not true for very many other treatments.

What works

Structured strength training of the entire body — particularly the upper body. The single intervention with the best documentation for chronic tension headache is structured strength training. We target the neck and shoulder area through exercises like Cable Pulldown, Chest Press, Cable Row and Lateral Raise — as part of a full-body program, not as isolated rehabilitation exercises.

Realistic expectations. Most people get markedly better within 6-12 weeks. In the first 4-6 weeks, it is primarily about building confidence in the exercises and teaching the body to tolerate increased loading. The actual reduction in headache typically comes from week 6 onward, and becomes more pronounced the longer you work progressively. For some it takes longer — particularly if the headache has been there for years and has become embedded in the body's pain system. But the effect is real and lasting when the capacity has been built up.

Effect over time. Strength training is not something you do for 6 weeks and then stop. A body that has become strong remains strong as long as it continues to be loaded.

What is not in the program

Part of the treatment cannot be written down as sets and repetitions.

When you have been in pain for two years, you have usually also accumulated a number of explanations along the way. That the neck is locked. That the posture is wrong. That you need to be careful. It sticks. You begin to move less and to be on guard against what hurts — and a body that is used less tolerates less over time.

That is why a large part of the work is about something other than exercise selection. About explaining what is going on without making the body less robust than it is. About movements that previously felt risky slowly becoming normal again. And about there being a fixed time in the calendar and a physiotherapist who knows the story and doesn't get worried if it hurts a bit on a Tuesday.

This is not something we add on top of the training. It is part of why the training works. We honestly don't believe the same program alone in an app gives the same results — and the research on pain treatment points in the same direction: how the treatment is delivered, and by whom, matters for the outcome.

What you should not prioritize as your primary treatment

Massage and stretching can provide real relief, but the effect doesn't last because nothing is being built up in the meantime. Ergonomic adjustments reduce the static loading marginally but don't make the body more robust.

Pain medication can relieve acute episodes but can paradoxically worsen the situation with prolonged use. If you are taking over-the-counter painkillers several times a week for months, you should talk to your doctor about medication overuse headache.

How to train with tension headache

We don't have a special "tension headache protocol." We have a structured full body program that we adapt to the individual client.

Upper body training that targets the neck and shoulder area:

• Cable Pulldown or Cable Row — for the muscles on the back of the upper body and the neck-shoulder area
• Machine Chest Press or Dumbbell Chest Press — for the muscles on the front of the upper body
• Dumbbell Lateral Raise or Cable Y-Raise — for the shoulder and neck region

Lower body training as supplement:

• Hack Squat, Pendulum Squat or Split Squat — for the lower body
• Leg Curl — for the hamstrings and posterior chain
• Glute Bridge — for glute and hip strength
• Leg Extension — for the quadriceps and knee strength

We don't only train the upper body. Strength training has a documented pain-dampening effect that is not limited to the area being trained. A generally stronger body is a more robust body.

We use double progression: you work your way up in repetitions with the same weight, and when you hit the top of the range, you increase the weight. It is the simplest and most sustainable way to build strength over time.

These exercises fit easily into our standard full body program. You don't need a separate "headache rehabilitation program" — you need structured strength training of the entire body.

Stress, sleep and daily habits

Strength training is the intervention we see moves the most for most people with tension headache — but it is not the only thing that plays a role. Stress, sleep, fluid intake and screen time also play a role.

We are not stress coaches or sleep experts. But we can say: strength training has a documented pain-dampening effect, not only because the muscles become stronger, but also because strength training positively affects the body's pain regulation and stress system. And what you can do something about, you should do something about. You can't always change a stressful workplace or get 8 hours of sleep every night. But you can build a body that is more robust against the loading you are subjected to.

When should you see a doctor?

Most people with tension headache do not need medical follow-up, but some situations require evaluation:

• Sudden, very severe headache ("thunderclap"), particularly without previous headache history
• Headache that is markedly different from what you usually have
• Neurological symptoms: visual disturbances, loss of strength, speech disturbances, numbness
• Headache with fever, neck stiffness or rash
• Headache that starts after the age of 50 without previous history
• Frequent use of over-the-counter painkillers for months

If you are in doubt, contact your doctor.

Frequently asked questions about tension headache

Where is tension headache located?

Typically as a pressing band around the entire head, on both sides simultaneously — often originating from the neck, temples and forehead. This distinguishes it from migraine, which is more often one-sided and pulsating. Tenderness in the neck and shoulder muscles often accompanies it.

What can you do about tension headache?

Strength train. The single intervention with the best documented effect is structured strength training — particularly of the neck and shoulder area combined with general physical activity. Massage, relaxation and painkillers can provide short-term relief but don't build the capacity that reduces headache long-term.

How long does tension headache last?

Between 30 minutes and several hours for the acute episode. The condition itself can be episodic (fewer than 15 days per month) or chronic (15 days or more per month). For most people who begin structured strength training, a clear reduction is seen within 6-12 weeks.

Is tension headache dangerous?

No. Tension headache is not dangerous and does not cause damage to the brain. The exception is if you experience sudden, severe headache or headache with neurological symptoms — that should be evaluated medically.

Does massage help with tension headache?

In the short term yes, long-term no. Massage does not address the underlying cause — lacking capacity in the neck and shoulder muscles combined with static loading in daily life.

Does stretching help with tension headache?

In the short term yes, long-term no. Stretching can feel nice and provide short-term relief but doesn't address the actual problem. Muscles don't need to be "loosened up" — they need to have capacity built up.

Can you strength train when you have a headache?

Yes, in most cases. Tension headache is not worsened by physical activity, in contrast to migraine. In fact, many experience that light to moderate activity reduces the headache.

Ready to train your way out of the headache?

If you have had tension headache for months or years and have tried everything from massage to new chairs to painkillers — without anything really working — we understand. It is a frustration we encounter often.

It is also a frustration that typically disappears when you experience that the headache can actually be reduced — not through passive treatment, but by making your body stronger, together with someone who knows what they are doing.

The most important things are two. The first: That it is structured strength training of the entire body with gradually increased loading — meaning something that builds capacity and not just relieves. The second: That it is something you can stick with for the rest of your life — so the headache doesn't come back when you let go of the training.

Book a free start-up conversation and hear how our personal trainers and physiotherapists in Copenhagen can help you — either by showing up at our private training center or as a call, if that suits you better.

References

Martín-Vera, D., Sánchez-Sierra, A., González-de-la-Flor, Á., García-Pérez-de-Sevilla, G., Domínguez-Balmaseda, D., & del-Blanco-Muñiz, J. Á. (2023). Efficacy of a strength-based exercise program in patients with chronic tension type headache: A randomized controlled trial. Frontiers in Neurology, 14, 1256303. https://pubmed.ncbi.nlm.nih.gov/37789886/

Onan, D., Arıkan, H., Ekizoğlu, E., Taşdelen, B., Özge, A., & Martelletti, P. (2025). The efficacy of physiotherapy approaches in chronic tension-type headache: A systematic review and meta-analysis. Journal of Oral & Facial Pain and Headache, 39(1), 34-48. https://pubmed.ncbi.nlm.nih.gov/40129422/

Repiso-Guardeño, A., Moreno-Morales, N., Armenta-Pendón, M. A., Rodríguez-Martínez, M. C., Pino-Lozano, R., & Armenta-Peinado, J. A. (2023). Physical therapy in tension-type headache: A systematic review of randomized controlled trials. International Journal of Environmental Research and Public Health, 20(5), 4466. https://pubmed.ncbi.nlm.nih.gov/36901473/

Powell, J., Wood, L., Cashin, A. G., & Lewis, J. S. (2026). It is not all about strength: Rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief. British Journal of Sports Medicine, 60(6), 407. https://pubmed.ncbi.nlm.nih.gov/41475974/

Hall, A. M., Ferreira, P. H., Maher, C. G., Latimer, J., & Ferreira, M. L. (2010). The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: A systematic review. Physical Therapy, 90(8), 1099–1110. https://pubmed.ncbi.nlm.nih.gov/20576715/