Tension headache: the band around the head, and what is holding it
Pressure round the whole head like a hat one size too small. Both sides, dull rather than sharp, worse by the afternoon. Your neck and shoulders are rock hard and you had not connected the two.
Do this now
Unload the neck, five minutes
5 minutes
- Sit back, head supported if possible. Let the jaw drop slightly so the teeth part.
- Shrug the shoulders up hard for five seconds, then drop them completely on a long exhale.
- Three times. Then the same with the jaw, and then a gentle press of the tongue to the palate and release.
- Now five minutes of nasal breathing, in for four and out for six, with one hand on the belly so the breath stays low.
- Get water and step away from the screen for the rest of the five minutes. Both are part of the dose.
What the band is
Tension-type headache is bilateral, pressing rather than pulsating, mild to moderate, and not worsened by routine activity — which is what distinguishes it from migraine. Pericranial muscle tenderness is a common feature: the muscles of the scalp, temples, jaw and neck are genuinely tender to press. Whether that tension causes the headache or accompanies it is still debated, and either way it is where the available leverage is.
Where breathing comes in
Two routes. The accessory breathing muscles — scalenes, sternocleidomastoid, upper trapezius — attach to the neck and skull, and when upper-chest breathing recruits them for eight hours they become another source of load on exactly the structures that hurt. And low carbon dioxide from over-breathing alters cerebral vessel tone, which is a recognised contributor to headache in people who over-breathe. Moving the breath low and slow addresses both.
The one thing to be careful about
Medication-overuse headache. Taking simple painkillers on more than about ten to fifteen days a month can convert episodic headaches into a daily headache that only stops when the medication does. It is one of the most common reasons a tension headache becomes chronic, and it is invisible from the inside — which is why counting the days is on the list below.
What changes it, over a week
Hourly
Shoulders down, teeth apart, three low nasal breaths. Thirty seconds, done often, beats a long session once.
Twice a day
Five minutes of tense-and-release for shoulders and jaw plus low, slow nasal breathing.
Count your painkillers
Write down every day you take one. More than ten days a month needs a doctor's conversation, not a higher dose.
Desk and sleep
Screen at eye height, water within reach, and a consistent sleep schedule. All three are established triggers and all three are boring.
When this is not a breathing pattern
See a clinician — promptly, and before assuming any of this applies to you — if any of these describe you:
- A sudden, severe headache reaching maximum intensity within a minute — emergency assessment
- Headache with fever, neck stiffness, rash, confusion or seizure — emergency
- A new headache with weakness, numbness, visual loss or difficulty speaking
- Headache that is worse on coughing, bending or lying down, or that wakes you from sleep
- A new or changed headache pattern over the age of 50, in pregnancy, or with cancer or immune suppression
This page is education, not medical advice, and no part of it is a diagnosis. Full disclaimer.
Questions people ask
- Is it a tension headache or a migraine?
- Tension-type is usually both sides, pressing, mild to moderate, and not made worse by walking around. Migraine is more often one side, throbbing, worsened by activity, and comes with nausea or light sensitivity. They can coexist, and the distinction changes the treatment.
- Can breathing exercises stop a headache?
- They can reduce the muscular and arousal components, and relaxation training has a reasonable evidence base as part of tension-headache management. For an established headache, expect help rather than a switch.
- Why is it always late afternoon?
- Because it accumulates: hours of upper-chest breathing, a clenched jaw, a slumped neck, a screen at the wrong height, and not enough water. That is also the list of things that are fixable.
What this page is built on
- — Bendtsen & Jensen, 2011, Handbook of Clinical Neurology — tension-type headache and pericranial muscle tenderness
- — Diener et al., 2019, Nature Reviews Neurology — medication-overuse headache
- — Kim & Kim, 2018, and the wider relaxation-training literature in tension-type headache
Named by author and year. The DOIs live in the journal.
Put a number on it
Most of what is on this page tracks one measurement: the Control Pause. It takes sixty seconds, needs no account, and it is the thing that tells you whether any of this is working.
Take the free testGo deeper
- Coherent breathing: six breaths a minuteFor people who want the best-evidenced daily practice for HRV, stress resilience and a calmer baseline.
- Breathing for anxiety: calming the body firstFor people whose anxiety has a physical edge — tight chest, air hunger, sighing, a mind that will not settle.
- The Control Pause: measure your breathing in 60 secondsFor anyone who wants one honest number for how well they breathe — and a way to watch it change.
From the journal
What the body is doing
Chest, throat, gut, jaw, hands, head — the physical side of stress. All topics