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The link between stress, muscle tension and chronic headaches

A significant number of the clients I counsel experience muscle tension and neck pain, and can benefit from seeing a physiotherapist. A physiotherapist that I work closely with recently shared that all the clients I refer to him from my practice have the same problem with muscle tension when they first arrive at his office.

The physiotherapist explained that it is common for people to carry tension in the muscles of the neck near the top of the spine. Since people often seek counselling when they are dealing with something stressful, it makes sense for muscle tension to be the norm in the population I work with.

Muscle tension in the upper neck can trigger headaches, which are referred to as “tension headaches.” Working together, psychologists and physiotherapists can help their clients to reduce or eliminate tension headaches by helping them to better manage their stress levels, and to not carry the stress they do have as muscle knots.

Early in my career, I worked at a chronic pain clinic. Some of the patients who came to the clinic had problems with chronic headaches – sometimes for years. I watched as a physiotherapist at the clinic helped a client stop having headache after 17 years of chronic pain. This experience laid the foundation for my work with physiotherapists because it showed me that some chronic physical conditions may still be treatable.

I have worked with physiotherapists on several different cases in which clients have had chronic headaches. Coming at the problem from two directions, rather than from just the psychological side or just the physical side, can play a critical role in helping these individuals.

As a psychologist, I help clients learn how to better manage the stress in their lives so they can stop carrying it around in their bodies – especially in the muscles of the neck. A physiotherapist can help them learn how to relax the muscles of their neck to prevent knots from forming, and to break the knots that do form.

A key for many of these clients is to learn to recognize how they experience stress psychologically, and how they can deal with their stress differently – to reduce it. A second key is to learn in their bodies how their reaction to stress leads to the formation of muscle knots, so that they can feel the knots starting to form, and use this early information to motivate themselves to bring their stress levels down.

Details in the story that follows have been changed to protect privacy.


Samantha was a working mother who had three school-aged children at home. She held a research position at a university that was demanding. Her husband was a good man but Samantha carried the brunt of the work of parenting on her shoulders, without communicating her need for help to her husband.

Beginning at age 16, Samantha experienced tension headaches roughly 50 percent of the time. Her headaches sometimes remitted but would invariably come back. She worked with a number of different helping professionals over the years but had not found lasting relief.

Samantha did her best not to take medication for her headaches because many pain medications are often opioid-based and addictive. Instead, Samantha would soldier on through her pain. She would seldom slow down. 

I recommended that Samantha visit a physiotherapist to see whether there was anything the physiotherapist could do for her. Samantha was willing to try anything because her headaches interfered so much with her quality of life.

Something that made a huge difference in Samantha’s recovery was her motivation to get better, and her willingness to be 100 percent compliant with the suggestions that both her psychologist and her physiotherapist made.

Samantha started to document her headaches at my suggestion. She recorded variables on a daily basis including the date and duration of each headache, its intensity, her stress level each day, how well she had slept, and other variables we determined might be worth looking at over the course of several months. In short, Samantha actively participated in the search, with my help, to uncover factors that correlated closely with her headaches.

Samantha made a significant number of changes in how she worked, both at home and at the university. She stopped checking her cell phone for emails outside of regular work hours. She stopped emotionally looking after people who reported to her to such a high degree. She put her children into after school care for longer hours so that she could have time to look after herself. She stopped jumping to anticipate her parents’ needs at the expense of her own.

Samantha did similar work with her physiotherapist. He asked her to observe her own behaviours so they could uncover what she was physically doing during the day that contributed to the formation of muscle knots in her neck. Here, too, she worked hard to effect change. She started a regular exercise program once her physiotherapist gave her the go ahead.

One day early on, after Samantha had started to experience headache-free days, I suggested that Samantha shoot for a 7-day period that would be headache free. She was only experiencing relief for two days at a time at this point, and later confided she had thought that a goal of seven headache-free days wouldn’t be achievable. But she achieved it. And then she achieved a period of 22 days that was headache free. And then she realized that living headache free was a possibility.

I tell the story of Samantha to encourage you to work to achieve goals that others may have told you that you will never achieve. It is possible that you might be able to achieve them, if you can find help from a good team who will work well with you, and if you do the work they ask you to do.

I don’t want to suggest that psychologists and physiotherapists can help everyone become headache free, but I do anticipate they may be able to help you improve your quality of life to some degree if you experience chronic pain.

— Dr. Patricia Turner, Registered Psychologist, Calgary, Alberta

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