pc gamer with migrane

Tension-type headaches: a common struggle for gamers

Spending many hours in front of the screen can lead to headaches. Most commonly, gamers will suffer from tension-type headaches. These headaches result from poor posture, eye strain, stress, lack of sleep, fatigue, or poor diet.

What are tension-type headaches?

Tension-type headaches are considered secondary headaches. In other words, they are not truly pain in the head. Instead, muscles of the upper back, neck, head & face refer pain to different regions of the head.

Commonly, tension develops in the muscles of the upper back and neck when posture is poor. For gamers, this usually occurs when the head is leaning towards the monitor and the shoulders are rounded forward.

Pertinent anatomy

It’s important to understand the anatomy of the shoulders, head, and neck to better understand tension-type headaches.

Muscles that refer pain to the head

The most common muscles that refer pain to the head are as follows:

  • Occipitofrontalis
    • A muscle with two parts; one muscle belly is at the base of the skull in the back and one is on the forehead
    • This muscle will raise your eyebrows
  • Temporalis
    • Located above and in front of your ears
    • These muscles are primarily responsible for closing your jaw (biting down)
Tension-type headaches
  • Suboccipital muscles
    • There are four muscles collectively called the suboccipitals
    • These muscles are located at the back of the skull; they assist with extension and rotation of your head
  • Upper trapezius
    • These are the “shrug muscles,” at the top of your shoulders
    • They also extend, rotate, and laterally bend the neck and head
  • Sternocleidomastoid (SCM)
    • Located on each side of the neck, these muscles can be traced from behind the ear to the breast bone; they form the “V” shape along the front of the neck, responsible for rotation and flexion of the neck

Nerves involved in tension-type headaches

  • Greater occipital nerve
    • These nerves supply the back and top of the head
    • The suboccipital muscles lie on top of these nerves
  • Lesser occipital nerve
    • These nerves supply the lower and outer portions of the back of the skull/head
    • The suboccipital muscles lie on top of these nerves


The cause of pain in tension-type headaches is muscle tension or hypertonicity & trigger points. Muscular or “myofascial” pain tends to be dull, achy, and poorly localized.

Clinical understanding of tension-type headaches, paired with current treatment approaches (to be discussed below) suggest increased resting muscle tone (hypertonic or “tight” muscles) to be the most probable cause.

muscle tension headaches

Muscle hypertonicity & trigger points

Muscle tone is in reference to the muscle’s contraction at rest. Normal resting tone means the muscle is not contracting. A muscle at rest will feel loose and softer to the touch.

Increased resting tone means the muscle is engaged in contraction, regardless of conscious control. A hypertonic muscle will feel “tight” and feel firmer to the touch.

A spasm, on the other hand, is a full, unconscious muscle contraction. This is different than hypertonicity and will cause moderate-to-severe pain.

Trigger points are the term used for “knots” in the muscle. The name “trigger point” was given because, when stimulated (i.e. pressure, stretching, or contraction), it gives rise to pain elsewhere in the body—known as referred pain.

Signs & Symptoms

Some of the signs and symptoms have been stated above, but will be stated again as we go on as it is important to be able to differentiate from a migraine headache.

Tension-type headacheMigraine
Dull, aching head painYesNo
Tightness sensationYesNo
Tenderness of scalpYesPossible
Tenderness in muscles of head and neckYesPossible
Visual disturbancesNoPossible
Light and sound increase painUncommonYes
Pain usually on one side of headNoCommon
Pain wraps around head/foreheadYesNo
Nausea and VomitingUncommonYes
Relief with NSAIDsNoNo
Relief with heat therapyYesNo
illustration of migrane

Tension-type headaches will often feel more intense with movement of the head & neck due to stretching and contracting of the muscles and their trigger points.

Common mechanism(s) of injury

Previously, we discussed muscular involvement in tension-type headaches including hypertonicity & trigger points. But, what exactly does that mean?

When under stress, strain, improper or over use our muscles can develop knots or trigger points. These trigger points have the potential to refer pain. So, what does that mean?

This means that when stimulated—stretched or contracted—the pain will be felt in another area of your body. The most well-known example is the upper trapezius muscle.

Trigger points in the upper trapezius muscle will refer pain to the head; specifically, a dull, diffuse aching pain will be felt up the side of the neck and around the ear.

Postural & positional imbalance

A common cause of hypertonicity & trigger points is poor posture. Anterior head carriage and forward rounded shoulders—signs of upper crossed syndrome—will put muscles in a shortened position leading to increased tension.

Another exceptionally common mechanism of imbalance is your sleeping position. Your sleeping position can cause abnormal stress on the muscles and structures in your neck; for example, sleeping on your stomach will likely force you to turn your neck to one side or the other.

Holding this position for extended periods of time (i.e. one hour would be considered an extended period of time) will lead to hypertonicity and trigger points.

gaming posture

Hydration & mineral imbalance

Another common cause of hypertonicity and trigger points is hydration status and mineral (electrolyte) balance. The electrolyte minerals are sodium, potassium, calcium, and magnesium.

For most of us, lack of sodium is not an issue. Many diets, particularly the typical American diet, is high in sodium. For the other minerals—potassium, calcium, and magnesium—it is important to maintain sufficient levels.

  • Potassium
    • Important in maintaining the electrical activity of nerve cells
    • Nerve cells are noticeably affected when potassium levels fall, often leading to muscle spasm
  • Calcium
    • Important for the transmission of nerve impulses to the muscle fiber; calcium also facilitates the interaction between actin and myosin during contractions
  • Magnesium
    • Acts as a muscle relaxant; it competes with calcium for protein receptors to help calm and relax muscles

Last, but certainly not least, we have the water. The majority of our body is comprised of water, yet most of us barely drink it.

Water is necessary for normal body function, regardless of the tissue. For muscles, water helps maintain resting tone.

A simple way to understand hydrated versus dehydrated muscle is looking at a sponge. When a sponge is dry, it is not pliable; rather, it is rigid and feels firm to the touch. Once the sponge is hydrated, it easily manipulated and soft to the touch.

If you don’t consume enough water each day, your muscles will certainly be affected.

water pouring into glass

Prevention & treatment

One of the main causes of tension-type headaches is stress. Generally, those afflicted with headaches are experiencing stress in their daily lives. While it is easy to say “relax” or “chill out”, it’s not that simple.

Below are a few ways to help manage stress as well as address other issues that contribute to tension-type headaches, such as postural or muscular imbalances and to treat or manage hypertonicity trigger points.

  • Meditation
    • Guided meditation can be helpful with stress reduction, clarity and body awareness
    • Meditation guides may be as simple as a phone app, YouTube videos, or books about meditation
  • Yoga asanas
    • While it is often believed that yoga is mainly stretching, it is more aligned with teaching body awareness, muscle activation, alignment, mental clarity and balance
  • Chiropractic care
    • Chiropractic interventions aren’t just “cracking” joints; although adjustments can be incredibly beneficial to relieve tension-type headaches
  • Manual therapy & massage
    • Muscular release and relaxation will help to reduce the tension in muscles, which can decrease pain associated with TTH
  • Physical therapy
    • Aims to utilize muscular release, stretching and exercises to help reduce stress and strain on the muscles involved
  • Exercise
    • Specifically movements designed to improve posture, muscular balance, an efficient functional movement

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This information is for educational purposes only and is not intended to replace the advice of your doctor. Esports Healthcare disclaims any liability for the decisions you make based on this information.

The information contained on this website does not establish, nor does it imply, doctor-patient relationship. Esports Healthcare does not offer this information for diagnostic purposes. A diagnosis must not be assumed based on the information provided.

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