Why Does Anxiety Cause Headaches? What Your Body Is Saying When You Can't
Illustration of a calming therapy office with an armchair and plants, representing therapy for Asian American women in Los Angeles. Miwa Emi, LCSW 26559
One of my clients keeps getting headaches. She saw her primary care doctor, who referred her to a neurologist just in case. The neurologist thinks the headaches come when she is stressed. She isn't sure that's it. Her dentist gave her a night guard last year because she had been grinding her teeth in her sleep.
Most of my clients come to me describing something physical. A stomach that never quite settles, a jaw that aches by the end of the day, headaches that arrive every afternoon around the same time. They have usually been dealing with it for months. The word anxiety often doesn't come up in the first session at all.
I wanted to explain what I see when someone tells me this.
When the Tests Come Back Normal
Normal results mean no disease was found. That isn't the same as nothing being wrong.
My clients describe two reactions to that appointment. Some feel relief for about a day, and then the confusion sets in, because the pain is still there and now there is no name for it. Others walk out feeling like they wasted the doctor's time. The pain was bad enough to make the appointment, and now they feel like they made too much of it.
Then someone says it's just stress. That word "just" does more damage than anything else in the sentence. It sounds like being told the pain isn't real, and it comes with nothing to do next.
I want to be clear about something before I go further. Headaches deserve a real medical workup, and if you haven't seen a doctor about yours, please do. Nothing in this post replaces that. Anxiety and a physical condition can also be happening at the same time, so ruling one out doesn't rule out the other. What I'm describing here is what I see in the women who have already been checked and are still in pain.
When a client tells me that, I tell her both things are true. Her tests are accurate, and her pain is real.
What a Body on Alert Actually Does
Anxiety doesn't stay in your thoughts. It shows up in the parts of you that hold still.
The women I work with spend most of the day braced. Not for anything specific. They are tracking what needs doing, what someone might be thinking, what could go wrong if they stopped paying attention for an hour. Their shoulders sit a little higher than they need to. Their jaw stays set. The muscles at the base of the skull stay tight.
Make a fist and hold it. After a minute, your hand starts to hurt. Nothing is wrong with your hand. You are just asking it to stay tight.
That is what their shoulders and jaw do all day. By three in the afternoon, those muscles have been holding since the alarm went off, and they ache for the same reason your hand would.
The stomach does its own version of this. Digestion slows down when a body thinks it might need to run, so my clients describe nausea, or a stomach that turns over before a meeting, or an appetite that disappears on the hardest weeks.
Sleep is part of the same picture, and I've written separately about why waking at 3 am and trying harder to sleep makes it worse.
None of this means you are weak or sick. This is what a body does after a long time on alert.
Why the Headache Comes Before the Meeting and Leaves After It
One of my clients told me about a headache bad enough that she had to lie down. It came on before a meeting she had been dreading. Once the meeting time passed, she was fine.
That timing is the clue, and it's also the part that makes my clients feel worse. They notice the pattern themselves. The headaches come on Sunday night and Monday morning. They come the week her mother visits. They lift on Friday afternoon. Once they see it, they start to wonder if they made the whole thing up.
They didn't. Her body responded to something it read as a threat. The threat was social rather than physical, but a nervous system doesn't sort threats into categories. It responds to what feels dangerous, and for a woman who has spent her life managing how she is seen, a meeting where she might be judged is dangerous.
The pain lifting on its own is confusing for the same reason. Nothing was treated. No medication worked. It just stopped, which looks like proof that nothing was ever wrong. What it actually shows is that the thing her body was bracing for had passed.
What Counts as a Good Enough Reason to Stop
One of my clients told me about middle school. She was having trouble with her friend group and couldn't tell her mother, because she didn't want her mother to worry about her. Just thinking about going to school gave her a terrible stomachache. She told her mother about the stomachache. Her mother let her stay home.
She learned something that day that she is still living by. There has to be a reason to miss school. A body reason counts. Being unhappy does not.
Grown women run on the same rule. You can call in sick with a headache, and nobody asks a follow-up question. You cannot call in and say you are dreading the meeting. One of those is allowed, and the other isn't, and every woman I work with knows exactly which is which without ever being told directly.
There is a second layer underneath it. Saying "I'm struggling" hands someone else a problem to carry. My clients grew up not wanting to be that. Saying "my head hurts" asks nothing of anyone. It explains why you're quiet at dinner, and it doesn't make anyone worry about you.
So the distress goes where it is allowed to go.
This is the same pattern I described in why so many Asian American women wait years to try therapy. They don't ask for help until there is a reason that will be accepted. A headache is a reason. Being tired of holding everything together is not, at least not yet.
Why Managing the Symptom Doesn't End It
My clients are not sitting still about this. By the time they reach me, they have tried a long list of sensible things.
They cut caffeine. They drink more water. They raise the monitor at their desk and buy the better pillow. They wear the night guard, like the client I opened with, and they still wake up with their jaw sore. Some of them track triggers in an app for months, looking for the food or the weather pattern that explains it.
Some of it helps a little, for a while, and that partial relief is the confusing part, because it looks like progress. Then the headaches come back the week of a deadline. Or they stop, and the stomach starts.
The routines aren't wrong. I'm not going to tell anyone to stop doing yoga. But these women are already exhausted from managing everything, and a list of things they have to do correctly becomes one more place to fail. When the headache comes back anyway, they don't take it as information. They take it as proof they haven't tried hard enough yet.
What Changes in Therapy
I want to be honest about what improvement looks like, because it isn't the headaches disappearing next month.
We work on both halves. Some of it is cognitive, looking at the thoughts that show up before the meeting and why they carry the weight they do. We use Cognitive Behavioral Therapy for that part. The other half is the body, and what it's doing all day before the pain ever arrives.
A lot of the work is building language that was never built. My clients can tell me in detail what needs doing this week. Ask them what they're feeling, and there is usually a long pause. So we start smaller than feelings. They begin noticing the shoulders climbing, or the jaw setting, an hour before it becomes a headache.
What changes first is usually not the pain. It's that she can say what's happening without needing the pain to make it legitimate.
One client told me she left a meeting, noticed her jaw was aching, and said to herself that she had been dreading that meeting all week. Nothing about her day changed. She just didn't need a headache to know it.
This work sits alongside medical care rather than replacing it. If you're working with a doctor about your headaches, keep doing that. This is the piece that gets left out. Working with an anxiety therapist in Los Angeles who looks at what your body is carrying, not only what you are thinking, is often what's missing.
What Therapy With Me Looks Like
I'm Miwa Emi, a bilingual anxiety therapist in Los Angeles, California. I work with Asian women, many of them Japanese and Japanese American, who are exhausted by the distance between how capable they look and how they actually feel.
You don't need to arrive at a first session with an explanation of what's wrong. Most of my clients start out describing a headache. Sessions are available in English and Japanese by telehealth throughout California, and you're welcome to move between the two languages in the same conversation.
You've been managing this on your own for a long time. Please contact me for a free 15-minute consultation.
Frequently Asked Questions
Can anxiety really cause headaches?
Yes. When your body stays on alert, the muscles in your jaw, neck, shoulders, and the base of your skull hold tension for hours at a time. Muscles held that way ache. This is why so many people notice their headaches arriving in the afternoon rather than first thing in the morning. The bracing has been going on all day by then.
Why did my tests come back normal if the pain is this bad?
Normal results mean no disease was found. They don't mean the pain isn't real. Pain caused by sustained muscle tension and a nervous system running on alert doesn't show up on bloodwork or a scan, because there's no damaged tissue to find. The test was looking for something else.
Why does my headache go away once the thing I was dreading is over?
Because your body was responding to the anticipation, not to the event. Once the meeting or the phone call or the family dinner has passed, the bracing stops and the muscles let go. This doesn't mean you invented the pain. It means the pain was tracking something real.
Can I have anxiety without feeling anxious?
Often, yes. Many of the women I work with don't describe themselves as anxious at all. They describe themselves as busy, or responsible, or tired. The anxiety shows up in the body first and in the vocabulary last, especially for women who learned early that naming a feeling wasn't useful.
My headaches only happen on work days. Does that mean it's in my head?
No. A pattern that tracks with your week is information, not proof you're making it up. Your body is responding to the days that require the most from you. That's worth paying attention to rather than dismissing.
Do I need to stop seeing my doctor if I start therapy?
No, and please don't. Keep working with your doctor about the physical side. Anxiety work sits alongside medical care. If a doctor has checked things and the headaches are still there, that's usually when the anxiety piece is the part still left to treat.
Miwa Emi, LCSW is a bilingual (English/Japanese) anxiety therapist in Los Angeles, CA, who uses a somatic approach. She offers online therapy to women throughout California, with a focus on Asian women navigating anxiety, stress, overwhelm, and life transitions. Her work helps women reconnect with their bodies when pressure, responsibilities, and guilt begin to manifest as exhaustion, tension, and an inability to stop.
Learn more about Miwa’s background, approach, and services here.
