Tension headaches can cause pressure, tightness, or aching around the head, often with neck, shoulder, jaw, posture, stress, sleep, or muscle tension overlap.
Tension headaches are one of the most common causes of head pain. Dr. Siefferman discusses what causes them, how they're diagnosed, and the treatments that can help reduce pain and prevent future headaches.
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Hi, I’m Dr. Jason Siefferman, interventional pain specialist and board certified headache specialist. Tension headache by the book is the most common kind of headache. Yet, also by definition, it is the kind of headache that does not require treatment. So, it’s a little bit like if a tree falls in the wild. So, when someone comes in saying they have tension headaches, what I hear is they have pressure in their head that feels like tension.
It’s important to know that this does not make it a tension headache. Many other kinds of headache like migraine, chronic migraine, cervicogenic headache can present as tension in the head. So just because it feels like a tension headache or you think a tension headache should feel doesn’t necessarily make it a tension headache. So if you come to see me with tension headaches, know that I’m going to do a thorough evaluation and make sure that there’s not something else going on that will actually be treatable. If you are having tension headaches and they are affecting your life, please come see us. We will look to understand what’s happening and get you on a right path towards treatment.
Tension headache, also called tension-type headache, is one of the most common headache patterns. It often feels like pressure, tightness, aching, or a band-like sensation around the head. Some patients also feel pain at the temples, forehead, back of the head, neck, shoulders, or jaw.
Although tension headaches are common, recurring or chronic symptoms should not be dismissed as “just stress.” Pressure-type headaches can overlap with migraine, cervicogenic headache, TMJ dysfunction, neck and shoulder myofascial pain, sleep disruption, medication overuse, posture strain, stress physiology, and chronic pain sensitization.
At Manhattan Pain Medicine (MPM), evaluation begins by confirming the headache pattern and identifying the factors that may be driving or maintaining symptoms. The goal is to determine whether the pain fits tension-type headache or whether another headache, neck, jaw, nerve, or medical condition is contributing.
For patients looking for tension headache treatment in NYC or Manhattan, MPM evaluates the full headache pattern, including frequency, duration, location, associated symptoms, neck and shoulder involvement, jaw tension, medication use, sleep patterns, stress triggers, posture demands, and prior treatment response.
Care may include medication management, musculoskeletal assessment, trigger point evaluation, biofeedback, pain psychology, acupuncture, movement-based strategies, and trigger point injections when a myofascial pain generator is identified. When symptoms suggest migraine, cluster headache, hemicrania, TACs, cervicogenic headache, TMJ-related headache, or another condition, MPM coordinates care and adjusts the treatment plan accordingly.
Tension headaches may be episodic, happening occasionally, or chronic, occurring frequently over time. In some patients, symptoms return because multiple contributors are active at once, such as neck tension, shoulder muscle guarding, jaw clenching, stress physiology, poor sleep, prolonged screen work, medication overuse, migraine overlap, or sensitized pain pathways.
MPM’s diagnosis-first approach is designed to identify the pattern behind the headache. The evaluation considers whether the pain is truly tension-type headache, whether migraine or cervicogenic headache is present, and whether musculoskeletal factors such as neck mobility, trigger points, TMJ dysfunction, posture load, or shoulder tension are playing a meaningful role.
This helps guide a stepwise plan rather than relying only on over-the-counter medication or generic headache advice.
Tension headache fits within MPM’s Headache Zone of Expertise, with strong overlap in Musculoskeletal issues when neck pain, shoulder tightness, posture strain, jaw tension, trigger points, or myofascial pain are contributing.
For some patients, pressure-type headaches are part of a broader pattern that includes migraine, TMJ dysfunction, cervical pain, sleep disruption, stress physiology, chronic pain sensitization, or medication overuse. MPM evaluates these factors together to determine the most appropriate next step.
This coordinated approach helps avoid treating tension headache as only stress, only posture, or only muscle tightness when the full pattern may be more complex.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
A tension headache often feels like pressure, tightness, aching, or a band-like sensation around the head. Some patients feel pain in the forehead, temples, back of the head, neck, shoulders, or jaw. The pain is often mild to moderate, but it can become frequent or chronic and interfere with work, sleep, concentration, and daily function.
Tension headaches may be related to muscle tension, neck and shoulder strain, jaw clenching, TMJ dysfunction, stress physiology, sleep disruption, prolonged screen work, posture load, medication patterns, or headache sensitivity. In many patients, there is more than one contributor. A careful evaluation helps determine whether the headache is truly tension-type or whether migraine, cervicogenic headache, TMJ-related headache, or another condition is involved.
A tension headache may last from 30 minutes to several days. Some patients have occasional episodes, while others develop frequent or chronic tension-type headaches. When headaches happen often, last longer than expected, or begin affecting function, a specialist evaluation can help clarify the diagnosis and identify contributing factors.
Tension headache usually causes pressure, tightness, or aching on both sides of the head and is often associated with neck, shoulder, or jaw tension. Migraine is a neurological headache disorder that may cause throbbing pain, nausea, light sensitivity, sound sensitivity, aura, dizziness, and significant functional impairment. Some patients have both patterns, which is why accurate diagnosis matters.
Yes. Some patients develop chronic tension-type headache, with symptoms occurring frequently or on many days. Daily or near-daily headaches should be evaluated carefully because they may involve medication overuse, migraine overlap, sleep disruption, neck pain, TMJ dysfunction, stress physiology, or another headache disorder.
Neck pain, shoulder tightness, muscle guarding, trigger points, and posture strain can contribute to tension-type headache patterns in some patients. Pain may start in the neck or shoulders and refer into the head, temples, forehead, or base of the skull. MPM evaluates the neck, shoulders, jaw, posture load, and muscle referral patterns when these factors appear relevant.
Yes. TMJ dysfunction, jaw clenching, bruxism, chewing muscle tension, and jaw joint irritation can overlap with tension headache, facial pain, ear pressure, neck pain, and migraine. MPM considers jaw and orofacial contributors when patients report jaw pain, clicking, clenching, chewing pain, facial pressure, or morning headaches.
You should consider medical evaluation if headaches are frequent, worsening, disabling, new, different from your usual pattern, not improving with appropriate self-care, or requiring frequent medication. Evaluation is also important when headaches occur with neck pain, jaw pain, neurologic symptoms, sleep disruption, medication overuse concerns, or unclear overlap with migraine or other headache disorders.
Treatment depends on the cause and contributing factors. Options may include medication management, trigger review, sleep support, neck and shoulder-focused care, TMJ coordination, biofeedback, pain psychology, acupuncture, movement-based strategies, and trigger point injections when myofascial pain is part of the pattern. The plan should be individualized and based on diagnosis.
Yes. Frequent use of headache medication, including over-the-counter pain relievers, can contribute to medication overuse headache in some patients. This can make headaches more frequent or harder to manage. MPM reviews medication use carefully and helps determine whether a different treatment strategy or specialist coordination is needed.
Seek urgent medical evaluation for a sudden worst headache, new weakness or numbness, facial droop, speech difficulty, vision loss, confusion, fainting, seizure, fever, stiff neck, head injury, cancer history, immune suppression, pregnancy or postpartum headache, new headache after age 50, or a major change in headache pattern.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If recurring pressure headaches, band-like head pain, neck tension, shoulder tightness, jaw clenching, or daily headaches are affecting your life, MPM can help evaluate what may be contributing. Our diagnosis-first approach considers tension-type headache, migraine, cervicogenic headache, TMJ dysfunction, muscle trigger points, medication overuse, stress physiology, sleep disruption, and chronic pain patterns. Request an appointment to discuss your symptoms and care options.
Tension headache is one of the most common headache patterns. It often causes pressure, tightness, aching, or a band-like sensation around the head. Some patients describe the feeling as a weight, squeezing, or pressure across the forehead, temples, back of the head, or base of the skull.
Tension headaches may be occasional or chronic. Occasional episodes may follow stress, poor sleep, prolonged computer work, jaw clenching, neck strain, dehydration, or fatigue. Chronic tension-type headaches may occur frequently and become more difficult to manage, especially when several contributors are active at the same time.
Many patients are told they have tension headaches because symptoms feel like pressure rather than throbbing migraine pain. Sometimes that diagnosis is accurate. Other times, pressure-type headache may overlap with migraine, cervicogenic headache, TMJ dysfunction, neck and shoulder myofascial pain, medication overuse, sleep disruption, or chronic pain sensitization.
This distinction matters because treatment depends on the true headache pattern. A patient with migraine overlap may need migraine-focused care. A patient with neck-related headache may need cervical and musculoskeletal evaluation. A patient with jaw clenching may need TMJ and orofacial pain assessment. A patient using frequent over-the-counter medication may need medication review to reduce the risk of medication overuse headache.
Tension headache often causes pressure or tightness, usually without the full migraine pattern of nausea, vomiting, light sensitivity, sound sensitivity, aura, or major worsening with routine activity. Migraine can also feel like pressure in some patients, so symptoms alone can be misleading.
Migraine is a neurological headache disorder. It may include throbbing pain, one-sided pain, nausea, light sensitivity, sound sensitivity, dizziness, aura, neck pain, and functional impairment. Some patients have both migraine and tension-type headache, which can make the pattern harder to recognize.
MPM reviews the headache frequency, quality, triggers, associated symptoms, medication response, and functional impact to help clarify whether symptoms are tension-type, migraine-related, mixed, or due to another condition.
Musculoskeletal factors can play an important role in tension-type headache. Tight or irritated muscles in the neck, shoulders, jaw, scalp, or upper back can refer pain into the head. Trigger points may cause local tenderness and referred pain patterns. Prolonged sitting, screen work, phone use, lifting, stress-related muscle guarding, or poor sleep can increase muscle load.
TMJ dysfunction and jaw clenching can also contribute. Some patients wake with headaches, jaw soreness, facial pressure, temple pain, or neck tension because of nighttime clenching or bruxism. Others notice headaches after chewing, stress, or long periods of jaw tension.
MPM evaluates the relationship between headache symptoms and neck mobility, shoulder tension, jaw function, trigger points, posture load, and activity patterns.
Stress can contribute to tension headaches, but that does not mean the pain is imagined. Stress physiology can affect muscle tension, sleep, breathing patterns, jaw clenching, autonomic arousal, pain sensitivity, and recovery. Over time, repeated headache episodes can also make the nervous system more sensitive.
This is where biofeedback and pain psychology may help selected patients. These tools can support nervous system regulation, stress response, sleep, coping, and headache-related fear or tension. They are not a substitute for medical evaluation, and they do not suggest that symptoms are “all in your head.”
Many patients with frequent headaches rely on over-the-counter medication. While these medications may help occasional headaches, frequent use can sometimes make headache patterns worse. Medication overuse headache can occur when acute headache medications are used too often.
MPM reviews how often patients use pain relievers, triptans, combination medications, caffeine-containing products, or other headache treatments. This review helps determine whether the treatment plan should focus on prevention, medication adjustment, non-medication strategies, or referral coordination.
MPM begins with a detailed headache history. The evaluation considers pain location, frequency, duration, severity, triggers, associated symptoms, neck and jaw involvement, sleep quality, medication use, stress patterns, prior diagnoses, imaging history, and prior treatment response.
The exam may include assessment of neck and shoulder mobility, muscle tenderness, trigger points, jaw-related symptoms, posture load, neurologic signs, and features that suggest another headache disorder. MPM also screens for red flags that may require urgent evaluation or additional specialty care.
The goal is to confirm whether symptoms fit tension-type headache, migraine, cervicogenic headache, TMJ-related headache, medication overuse headache, or another condition.
Treatment depends on the diagnosis and contributing factors. For some patients, care may involve medication management, lifestyle and trigger review, sleep support, hydration strategies, ergonomic changes, and activity pacing. For others, treatment may focus on neck and shoulder mechanics, TMJ coordination, movement-based care, acupuncture, biofeedback, pain psychology, or trigger point treatment.
Trigger point injections may be considered when specific myofascial pain generators are identified. These injections are not appropriate for every headache and should be used only when the muscle and referral pattern support that approach.
Botulinum toxin is not a standard treatment for ordinary tension headache. It may be relevant when migraine overlap, dystonia, TMJ dysfunction, or other specific muscle overactivity patterns are present. Ketamine therapy, infusions, trigeminal nerve blocks, and other advanced treatments should only be discussed when the clinical picture supports them.
Most tension headaches are not emergencies, but not every pressure-type headache is a tension headache. A new, severe, or unusual headache should be evaluated carefully.
Patients should seek urgent medical evaluation for a sudden worst headache, new weakness or numbness, facial droop, speech difficulty, vision loss, confusion, fainting, seizure, fever, stiff neck, head injury, cancer history, immune suppression, pregnancy or postpartum headache, new headache after age 50, or a major change in headache pattern.
MPM approaches tension headaches through a diagnosis-first, coordinated model. The goal is to identify whether the headache pattern is truly tension-type, whether migraine or another headache disorder is present, and whether neck, shoulder, jaw, stress, sleep, medication, or chronic pain factors are contributing.
For patients looking for tension headache treatment in NYC or Manhattan, MPM offers a careful headache and musculoskeletal pain perspective focused on diagnosis, function, medication review, and coordinated care.
The goal is to clarify the source of recurring headaches and guide appropriate next steps without overpromising outcomes.
