Pathophysiology of Tension-Type Headaches

So, why do we get tension-type headaches? What is the scientific explanation of how it happens? 

Don't worry! We'll explain in an easy way. We will also give a brief snippet of the research articles as 'too long didn't read' (TLDR)...

Tension-type headaches can seem very complicated because of how many biological factors might contribute. 

Currently, the exact cause of tension-type headaches are unknown. 

However, researchers believe pain sensitivity, pain perception and muscular mechanisms, brain chemicals, genetic factors and environmental factors all play a part in contributing to the physiology. 

Read more here: (Pan et al., 2025) - Hallmarks of primary headache: part 2– Tension-type headache

TLDR 

• A review detailing the pathophysiology, comorbidities, treatment options and psychosocial impact
• Main findings show peripheral mechanism, central sensitisation, genetic predisposition and psychological comorbidities such as anxiety and depression
• Pharmacological treatement but also non-pharmacological interventions - including cognitive behavioural therapy, neuromodulation techniques, physical therapy, mindfulness, lifestyle management and patient education highlighted to be valuable management points

Let's talk about the main ones! 

1. Muscular mechanisms:

Common muscular mechanisms can include tight and tender muscles around the neck and shoulder muscles, often linked to trigger points - this type of muscle tension may be caused by stress or anxiety and is suggested to be one of the main causes of tention-type headaches. 

Researchers have also found that neck muscles behave differently when people have neck pain with their tension type headaches. 

Read more here: (Do et al., 2018) - Myofascial trigger points in migraine and tension-type headache

TLDR

• Myofascial trigger points play important role
• Active trigger points prevalent in tension type headache
• Correlated with lower pain pressure thresholds = central sensitisation

2. Pain mechanisms:

Research suggests that pain is different in people with tension-type headaches. Their brain and their spine might be more sensitive to pain, touch and pressure which amplifies the pain experience. This is especially common when you're experiencing stress, anxiety or neck pain with your tension-type headache.

Read more here: (Klyne et al., 2026) - Understanding the relationship between sleep, psychological and musculoskeletal health from a neuroimmune perspective

TLDR

• Nervous and immune system interacts together
• Poor sleep, psychological disturbances and muscloskeletal system pathologies and pain are linked
• These influence systematic inflammation, causing the nervous system to become sensitive

The good news is that because there are so many factors that can be contributing to what is going on. There are so many different strategies for you to try to reduce and frequency and the intensity of your headache.