We now know that headaches are not "just in the head." They are biological reprimands, warnings that something else in a person's body is out of balance and needs to be fixed. And, while analgesics such as aspirin can mask the symptoms, they don't tackle the real problem. Researchers and clinicians have unearthed a number of clues as to the physiology of headaches, what triggers them, and what we might do to ease or even prevent them.

The physical or psychological stress that makes those back, neck, and head muscles contract and cause headache pain are not always obvious.

Tension headaches most commonly begin with physical and mental stress that causes prolonged muscle contraction in the neck, back, and head. These long-lasting contractions starve those muscles of oxygen, temporarily injuring them and releasing chemicals that transmit referred pain signals to the brain.

Researchers have traced these referred pain signals. For example, contractions in the trapezius, the large flat muscle on either side of the back, can send pain messages to the neck and temples. The temple muscle sends pain signals to areas over the eyes and near the mouth. The sternocleidomastoid muscles on the sides of the neck can cause pain in the forehead, face, chin or ear. The muscle in the back of the neck, the splenius capitas, transmits pain to the top of the head.

In order to provide a thorough evaluation of treatment for tension headaches, many of the common options will be discussed. These include spinal manipulation, physical therapies, exercise, psychological intervention, and occupational and lifestyle changes.

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