Tension-type headaches are the most common type of headache. The pain is typically described as dull, aching, or pressure-like rather than throbbing, and it may feel as though a tight band is wrapped around the head. Some people also experience tenderness in the muscles around the head, neck, or shoulders. Episodes can vary considerably, occurring occasionally in some people and frequently or even chronically in others. While tension-type headaches are generally not dangerous, frequent episodes can interfere with quality of life.

How healthcare providers approach these headaches continues to evolve as new evidence becomes available. In April 2026, a team of researchers published a comprehensive review of the literature—including 31 systematic reviews—to develop an updated consensus on nonpharmacological headache care. Their updated guidelines found sufficient evidence to support spinal manipulative therapy, a treatment commonly provided by chiropractors, as part of a multimodal approach to managing tension-type headaches.

Conservative multimodal management of tension-type headaches may combine spinal manipulation with exercise, soft tissue therapy, education, relaxation techniques, and mindfulness-based self-management strategies. Exercise may address strength, mobility, or endurance, while soft tissue techniques can target muscle tenderness or tension. Relaxation and mindfulness strategies may help patients manage stress and other factors that can contribute to headache symptoms. Education can also help people recognize patterns and develop practical strategies for managing recurring episodes.

Because each case is unique, treatment should be based on the patient’s history and physical examination, with additional diagnostic testing when appropriate. A doctor of chiropractic may consider the location and pattern of pain, how often headaches occur, accompanying symptoms, neck function, medical history, and other factors before recommending treatment. New, unusually severe, or otherwise concerning headaches may require additional medical evaluation rather than conservative musculoskeletal care.

For people with tension-type headaches who have not found adequate relief with previously recommended approaches, the updated guidelines offer another evidence-supported option to consider. The inclusion of spinal manipulation as part of multimodal care also gives medical providers additional evidence when considering whether a referral to a doctor of chiropractic may be appropriate for their patients.