Tension Headache Management in Melbourne: Expert Physiotherapy Solutions
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on July 10th, 2025
Expert physiotherapy treatment for tension-type headaches in Melbourne
Why choose Keilor Road Physiotherapy for tension headache relief?
When should you see a physiotherapist for tension headaches?
Do you often experience a dull, aching headache that wraps around your head like a band? You could be dealing with a tension-type headache—the most common type of headache, especially among adults in Melbourne. At Keilor Road Physiotherapy, we offer expert assessment and treatment plans tailored to help you find long-lasting relief from tension-type headaches.
What are tension headaches?
A tension-type headache (TTH) is characterised by a mild to moderate, pressing or tightening sensation on both sides of the head. Unlike migraines, it typically does not cause nausea or sensitivity to light and sound. Many people describe it as a feeling of tightness or pressure, like a band around the forehead or at the back of the head and neck.
Tension-type headache (TTH) is defined by the International Classification of Headache Disorders, 3rd edition (ICHD-3) as a primary headache disorder—meaning it’s not caused by another condition like an infection or brain lesion. TTH is the most common headache globally, affecting up to 78% of the population at some point in their lives (Stovner et al., 2007).
At Keilor Road Physiotherapy, we regularly see patients presenting with symptoms consistent with this condition—often triggered by poor posture, work-related stress, or muscle tightness in the neck and shoulders.
According to ICHD-3, tension-type headaches are divided into three main subtypes:
1. Infrequent Episodic Tension-Type Headache
Occurs less than once per month (fewer than 12 days per year).
Short-lasting and mild in intensity.
Minimal impact on daily function.
2. Frequent Episodic Tension-Type Headache
Occurs on 1–14 days per month for at least three months.
May interfere with concentration and productivity but generally does not cause disability.
3. Chronic Tension-Type Headache
Occurs 15 or more days per month for more than three months.
Can be constant and disabling.
Often associated with psychological stress, sleep disturbance, and anxiety or depression.
Common causes of tension headaches
Understanding what causes tension-type headaches involves looking at how pain signals are generated and processed. These are broadly divided into peripheral mechanisms (outside the brain and spinal cord) and central mechanisms (within the central nervous system).
Peripheral mechanisms refer to processes occurring in the muscles, joints, and soft tissues around the head, neck, and shoulders.
In tension-type headaches, increased muscle tension and tenderness—particularly in the trapezius, suboccipitals, and temporalis muscles—can irritate local nerve endings. This irritation can generate pain signals that travel to the brain, producing the characteristic head pressure or tightness.
Some examples of peripheral contributors include:
Poor posture at desks or during sleep
Sustained neck or jaw muscle tension
Myofascial trigger points
Teeth grinding (bruxism) which affects the TMJ
These signals can often be addressed with hands-on physiotherapy, postural correction, and muscle relaxation techniques.
Central mechanisms involve the way the brain and spinal cord process pain. In chronic tension-type headaches, the brain may become "sensitised", meaning it overreacts to normal signals from the body—even those that wouldn’t typically cause pain (Bendtsen et al., 2010)..
This condition is called central sensitisation, and it can result in:
Increased sensitivity to pressure or touch (e.g., tender scalp or neck)
Pain that persists even after the original trigger is gone
More frequent or longer-lasting headaches
In central sensitisation, the nervous system essentially amplifies the pain experience, and managing it often requires a more comprehensive, long-term approach.
Physiotherapy helps reduce central sensitisation through:
Graded exercise
Manual therapy
Stress management and relaxation techniques for improved sleep
Education to reduce fear and pain catastrophising
Common causes of tension headache.
Symptoms of tension headaches
Tension-type headaches (TTH) present with a unique set of features that help distinguish them from migraines or cluster headaches. The symptoms can range from mild discomfort to persistent pressure that interferes with daily life—especially when episodes become frequent or chronic.
Dull, Aching Head Pain
The pain is typically described as a constant, dull pressure rather than throbbing or pulsating. It often feels like a tight band or vice around the head.
Bilateral Distribution
Pain usually occurs on both sides of the head, unlike migraines which are more commonly one-sided. It may be felt across the forehead, temples, or the back of the head and neck.Tightness in the Neck and Shoulders
Many patients also report muscle tightness or stiffness in the neck, shoulders, or jaw. This is often linked to posture, stress, or prolonged screen time.Scalp or Neck Tenderness
Light pressure on certain areas of the scalp, especially around the occipital region (back of the skull), may feel unusually sensitive or tender.No Nausea or Vomiting
Unlike migraines, tension headaches do not cause nausea or vomiting, making them easier to manage in day-to-day activities.Minimal Sensitivity to Light or Sound
While migraines often involve photophobia (light sensitivity) and phonophobia (sound sensitivity), these are either mild or absent in tension-type headaches.Gradual Onset and Duration
Tension headaches often develop gradually and can last from 30 minutes to several hours. In chronic cases, they may persist for days at a time.No Worsening with Physical Activity
Activities like walking or climbing stairs do not typically worsen the headache, which contrasts with migraine episodes where physical exertion often exacerbates symptoms.
How are tension headaches diagnosed?
To be classified as a tension-type headache according to the International Classification of Headache Disorders, 3rd edition (ICHD-3), the patient must have at least two of the following:
Bilateral location (on both sides of the head)
Pressing or tightening (non-pulsating) sensation
Mild or moderate intensity
Not aggravated by physical activity
Additionally, the headache must be free of:
Nausea or vomiting
Both photophobia and phonophobia (only one is allowed in chronic cases)
These criteria help differentiate TTH from migraines and other secondary headaches.
Expert physiotherapy for tension headache in Melbourne
Modern physiotherapy management for tension-type headaches (TTH) focuses on addressing muscle tension, postural dysfunction, central sensitisation, and stress-related triggers.
1. Manual Therapy
Manual therapy remains a cornerstone of TTH treatment, especially in patients with neck and shoulder muscle tightness.
Techniques include soft tissue massage, cervical spine mobilisations, and trigger point release
Improves neck mobility and reduces muscle hypertonicity
Studies show it reduces headache frequency and intensity (Castien et al., 2011)
2. Exercise Therapy
A structured, progressive exercise program is vital for long-term management.
Cervical and scapular strengthening: Targets muscle imbalances that contribute to postural strain
Deep neck flexor activation: Shown to reduce headache symptoms (Ylinen et al., 2007)
Stretching: For the upper trapezius, levator scapulae, and suboccipitals
Exercise therapy improves posture, muscle endurance, and stress resilience.
3. Postural Retraining and Ergonomic Advice
Poor posture is a common trigger for TTH, especially in desk workers.
Real-time feedback and cueing help correct forward head posture
Ergonomic modifications (e.g. monitor height, chair support) reduce strain on neck and shoulders
Combining posture correction with active exercise is more effective than passive treatment alone (Fernández-de-las-Peñas et al., 2009)
4. Dry Needling
Dry needling targets myofascial trigger points linked to referred head and neck pain.
Often used alongside manual therapy
May reduce muscle tension and improve pressure pain thresholds
Recommended in chronic TTH with persistent myofascial sensitivity (Gallego-Sendarrubias et al., 2020)
5. Pain Neuroscience Education
Educating patients about pain mechanisms—especially in chronic TTH—helps reduce fear and catastrophising.
Explains how stress and sensitisation affect the nervous system
Supports self-management and reduces reliance on passive care
Helps patients regain confidence in movement and exercise
6. Stress Management Strategies
Since emotional stress is a key trigger for TTH, physiotherapy may also include:
Breathing control and relaxation exercises
Sleep hygiene education
Collaboration with psychologists or GPs if needed
These help reduce headache frequency and support long-term management.
Why choose Keilor Road Physiotherapy for tension headache relief?
At Keilor Road Physiotherapy, diagnosing a tension-type headache involves a thorough clinical assessment to identify the underlying musculoskeletal, postural, and lifestyle factors contributing to your pain. Since TTH is a diagnosis of exclusion, it's crucial to rule out other headache types like migraines, cervicogenic headaches, or cluster headaches.
We begin by understanding your symptoms—where the pain occurs, how often, how it feels (e.g., dull, pressing), and what triggers or relieves it. We also explore lifestyle factors like stress, posture, and sleep. Following this, we perform a thorough postural assessment and workstation setup to identify ergonomic factors which can contribute to TTH. We also check for muscle tightness and trigger points in the neck, shoulders, scalp, and jaw. Cervical spine mobility and range of motion are also tested to detect stiffness or tension patterns. If needed, we assess reflexes, strength, and sensation to rule out migraines, cervicogenic headaches, or other serious causes.
Once other causes are excluded, we match your symptoms to recognised criteria, such as those outlined in the International Classification of Headache Disorders (ICHD-3). If your pain is bilateral, pressing, mild-to-moderate, not worsened by physical activity, and not accompanied by nausea or both light/sound sensitivity, TTH is a likely diagnosis.
As part of our expert treatment of tension headaches, which includes hands on mobilisation and massage to relieve your symptoms, Keilor Road Physiotherapy also uses the:
The Watson Headache® Approach
We specialise in the Watson Headache® Approach, which is tailored to reduce the hypersensitivity of the nerve pathways that contribute to TTH. This approach is designed to address the root causes of headache rather than just alleviating symptoms. It has been shown to effectively decrease the sensitivity of the TCC, which is often central to the pathology of TTH.
You can also expect:
Manual therapy: We apply precise and gentle techniques focusing on the neck, avoiding aggressive manipulations that could exacerbate symptoms.
Exercise programs: Custom exercises aim to strengthen the neck muscles and improve posture, tackling one of the common triggers of TTH.
Lifestyle modifications: Advice on managing stress, optimizing sleep, and improving ergonomic setups at work or home, all of which can influence the frequency and severity of headaches.
We also believe in empowering our patients through education, helping them understand their condition and how lifestyle factors can impact their symptoms. This approach not only helps in managing the current symptoms but also in preventing future episodes.
Our clinic is among the most experienced in Melbourne and Australia in using the Watson Headache® Approach, offering a path to reduced pain and improved function. We understand the complexities of TTH and provide a level of care that goes beyond typical treatment for headache, focusing on a reduction in headache frequency and intensity.
Long term management and prevention tips
Preventing and managing tension-type headaches (TTH) over the long term requires a multifactorial approach. Research shows that a combination of lifestyle changes, exercise, postural correction, and stress management leads to the most sustained improvement in headache frequency, duration, and severity.
1. Maintain Regular Exercise
Aerobic exercise and targeted neck and shoulder strengthening have been shown to reduce both frequency and intensity of TTH (Holroyd et al., 2001).
Improves blood flow and reduces muscle tension
Enhances endorphin release, which helps with natural pain regulation
Best results come from consistent, moderate-intensity activity (e.g. walking, swimming, cycling 3–5x/week)
2. Correct Posture and Ergonomics
Forward head posture and slouched sitting are common triggers for TTH, especially in sedentary office workers (Fernández-de-las-Peñas et al., 2006).
Use a neutral spine position during sitting and standing
Adjust screen height, chair support, and keyboard placement
Take regular microbreaks (every 30–45 mins) to reset posture
3. Manage Psychological Stress
Emotional tension and poor coping strategies are major drivers of chronic TTH. Studies show stress reduction techniques reduce headache frequency (Cathcart et al., 2010).
Effective methods include:
Diaphragmatic breathing
Progressive muscle relaxation
Mindfulness or meditation
Establishing clear work-rest boundaries
4. Prioritise Sleep Hygiene
Inconsistent or poor-quality sleep can lower your pain threshold and increase TTH risk (Brennan et al., 2009).
Recommendations include:
Maintain a regular sleep schedule
Limit screen time before bed
Create a quiet, dark sleep environment
Avoid caffeine late in the day
5. Avoid Medication Overuse
Frequent use of over-the-counter pain relievers (e.g., paracetamol, ibuprofen) can lead to medication overuse headache (MOH) and worsen TTH (Olesen et al., 2018).
Use analgesics sparingly and only on your GP’s or pharmacists advice.
Work with a GP or physiotherapist for non-pharmacological strategies
Educate patients on rebound headaches
6. Consistent Physiotherapy Follow-Up
Patients with chronic or recurrent TTH benefit from (Castien et al., 2011):
Periodic reassessment of neck, jaw, and upper back mechanics
Updates to their exercise program
Ongoing education about triggers, posture, and stress
Early intervention when symptoms start to return
When to see a physio for tension headaches?
You should consider seeing a physiotherapist if your tension-type headaches are recurring, affecting your daily routine, or not improving with rest or over-the-counter medication. Physiotherapy can provide a clear diagnosis, relieve underlying musculoskeletal causes, and prevent chronic patterns from developing.
Book an assessment if you experience:
Headaches that occur frequently (more than once a week)
A persistent tight, band-like pressure across your head
Neck or shoulder stiffness before or during headaches
Increased headache intensity with prolonged sitting or screen time
A desire to manage headaches without relying on painkillers
Early intervention is key. Physiotherapists at Keilor Road Physiotherapy are trained in headache management and can tailor a plan that addresses both the source of your symptoms and your long-term prevention.
FAQ's
What is the best treatment for tension-type headaches in Melbourne?
The best treatment for tension-type headaches typically involves physiotherapy, including manual therapy, postural correction, and targeted exercises. At Keilor Road Physiotherapy in Melbourne, our expert team tailors your treatment to address muscle tension, poor posture, and stress—helping you achieve long-term relief without relying on pain medication.
Can a physiotherapist treat tension headaches effectively?
Yes, physiotherapists are highly effective in treating tension-type headaches. They use evidence-based techniques like soft tissue massage, dry needling, ergonomic advice, and strengthening exercises to reduce headache frequency, duration, and intensity. Physiotherapy is also useful in preventing headaches from becoming chronic.
How do I know if I have a tension-type headache or a migraine?
Tension-type headaches feel like a dull, steady pressure on both sides of the head, often accompanied by neck or shoulder tension. Migraines, on the other hand, usually involve one-sided throbbing pain, nausea, and sensitivity to light or sound. A qualified physiotherapist can assess your symptoms and provide a proper diagnosis and treatment plan.
How many physiotherapy sessions do I need for tension headaches?
Most patients notice improvement within 2–4 sessions. However, chronic tension-type headaches may require a longer management plan. Your physiotherapist will tailor the treatment based on your condition, posture, lifestyle, and how long you’ve been experiencing symptoms.
Can poor posture cause daily headaches?
Yes, poor posture—especially forward head posture and rounded shoulders—can increase strain on the neck and upper back muscles, leading to daily or frequent tension headaches. Physiotherapy can correct postural imbalances and provide ergonomic advice to reduce headache triggers at work or home.
Is it safe to use physiotherapy instead of medication for tension-type headaches?
Absolutely. Physiotherapy is a safe, non-invasive, and drug-free alternative to pain relief for tension-type headaches. It helps address the root causes rather than just masking the symptoms, reducing the need for over-the-counter medications and the risk of medication overuse headaches.
When should I see a physiotherapist for headaches in Melbourne?
You should see a physiotherapist if you have frequent headaches, tight neck or shoulder muscles, or if your headaches worsen with screen time, stress, or poor posture. Keilor Road Physiotherapy in Melbourne offers expert care to assess, treat, and prevent tension-type headaches.
References:
Bendtsen, L., & Fernández-de-la-Peñas, C. (2011). The role of muscles in tension-type headache. Current Pain and Headache Reports, 15(6), 451–458. https://doi.org/10.1007/s11916-011-0220-7
Brennan, K. C., & Charles, A. (2009). Sleep and headache. Seminars in neurology, 29(4), 406–418. https://doi.org/10.1055/s-0029-1237113
Castien, R. F., van der Windt, D. A., & Dekker, J. (2011). Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomized controlled trial. Cephalalgia, 31(2), 133–143. https://doi.org/10.1177/0333102410373151
Cathcart, S., Winefield, A. H., Lushington, K., & Rolan, P. (2010). Stress and tension-type headache mechanisms. Cephalalgia, 30(10), 1250–1267.
Fernández-de-las-Peñas, C., Alonso-Blanco, C., Cuadrado, M. L., & Pareja, J. A. (2006). Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Cephalalgia : an international journal of headache, 26(3), 314–319. https://doi.org/10.1111/j.1468-2982.2005.01042.x
Gallego-Sendarrubias, G. M., Rodríguez-Sanz, D., Calvo-Lobo, C., & Martín, J. L. (2020). Efficacy of dry needling as an adjunct to manual therapy for patients with chronic mechanical neck pain: a randomised clinical trial. Acupuncture in medicine : journal of the British Medical Acupuncture Society, 38(4), 244–254. https://doi.org/10.1136/acupmed-2018-011682
Holroyd, K. A., O'Donnell, F. J., Stensland, M., Lipchik, G. L., Cordingley, G. E., & Carlson, B. W. (2001). Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA, 285(17), 2208–2215. https://doi.org/10.1001/jama.285.17.2208
Olesen, J. (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1–211. https://doi.org/10.1177/0333102417738202
Stovner, L. J., Hagen, K., Jensen, R., Katsarava, Z., Lipton, R. B., Scher, A. I., Steiner, T. J., & Zwart, J. A. (2007). The global burden of headache: A documentation of headache prevalence and disability worldwide. Cephalalgia, 27(3), 193–210. https://doi.org/10.1111/j.1468-2982.2007.01288.x
Ylinen, J., Häkkinen, A., Nykänen, M., Kautiainen, H., & Takala, E. P. (2007). Neck muscle training in the treatment of chronic neck pain: a three-year follow-up study. Europa medicophysica, 43(2), 161–169.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.