Our bodies have the ability to adjust our pain threshold to different situations. Our brain is busy all the time controlling how much pain information to let through. If the organism is exposed to prolonged stress, the brain adjusts the pain threshold, allowing us to tolerate the situation without being in constant pain.

Not all of the pain information reaching the brain is equally ‘valid.’ Whether or not a signal is perceived as pain depends on your body’s overall state and your pain regulation system’s current pain ‘setting’. One of the pain regulation system’s tasks is to ignore exaggerated signals. It usually works very smoothly in the background without us noticing.

There is no one fixed place in the nervous system in charge of pain regulation. Multiple central and more remote (peripheral) checkpoints interact in a neural network to maintain a delicate balance in how we perceive pain. Pain perception is like many other bodily functions in that respect. Depending on our physiological and psychological state in a given moment, the control system adjusts our pain threshold to stop us from experiencing pain all the time.

But in situations of major stress, physical tension or emotional emergency, we may notice signs that our pain regulation system is stretched to the limit. In moments like these, a tipping point may come where the system is unable to cope.

The brain’s pain regulation capacity is limited. If bombarded with signals for too long, the system goes into temporary meltdown.

A number of factors seem to be involved. One is the total number of pain signals streaming in from the neural network at a given moment. Stress and anxiety add to the load on the pain regulation system. So do seemingly forgotten pain events experienced in the past, which may intrude and demand additional attention in that moment.

Signal input duration is an additional drag on the system because every regulation process needs vast amounts of energy. With a few exceptions, the brain uses glucose to fuel its energy demand. Since there are no glucose stores in the brain, supplies may dry up sooner or later if the pain regulation system has been working full blast for a prolonged period – with disastrous results.

The system is unable to cope with all the pain signals coming in. The unstoppable flow of pain signals causes a headache.

Multiple factors come together to cause a tension-type headache. These factors differ greatly from one person to another. A multitude of signals and states – internal, natural or external – contribute to the overload and subsequent malfunction of the pain regulation system.

If there are too many pain signals, if they keep streaming in for too long a time, or if other (possibly psychological) factors add to the load, the system is no longer able to do its job properly. The battle-weary defense front cracks or collapses entirely. More and more pain signals flow in unfiltered and that headache sensation begins: pressing or tightening in quality, usually on both sides and sometimes spreading from the back of the neck.

Tension-type headaches can be episodic or chronic. It depends on whether your body’s natural pain control system breaks down only once in a while or on a regular basis. Relief comes only when a new supply of energy kick-starts the pain regulation system and restores the pain-free state we like to call ‘normal’.

Basically anything that imposes undue strain on the pain regulation system can trigger tension-type headaches, including:

› psychosocial stress, anxiety, depression

› muscular stress

› TMJ (temporomandibular joint/lower jaw) disorders

› sitting still at your desk for too long

› a poor sitting and working posture

› a poorly lit or noisy workplace

› not getting enough restful sleep

A tension-type headache takes more than 30 minutes to resolve. Untreated, it may last up to 7 days. The average duration is about 2 to 8 hours. More than half of sufferers experience two episodes per month. Tension-type headache that occurs on less than 180 days a year is called episodic. If it is more frequent, it is said to be chronic.

Tension-type headaches often start at the nape of the neck and spread across the back of the head to the forehead and eyes. It may feel like a heavy weight on top of your head, or a tight helmet squeezing your head.

› pressing or squeezing pain

› physical exertion and movement do not make it worse

› sensitivity to light or noise is not usually present

› no nausea

Tension-type headaches are usually mildly to moderately painful.