Headache

26 November 2011

Tension headaches

This is, by far, the most common type of headache in adults and teens. A tension headache is the dull, aching, pressure headache which often develops after a stressful day

Summary

  • It is the most common type of headache in adults and teens.
  • It is not a serious risk to health.

Description 

This is, by far, the most common type of headache in adults and teens. A tension headache is the dull, aching, pressure headache which often develops after a stressful day at work or school or during times of emotional upheaval - particularly when overtired, rushed and anxious.

These types of headaches are said to occur in "uptight" people with "uptight" muscles. They can also stem from eyestrain or sitting for prolonged periods in one position such as at computer or behind a steering wheel. Typically, the headache is worse towards the end of the day.

Tension-type headaches are sometimes, but not always, associated with tension or spasm in the muscles of the head, neck, face, or jaw. This may be accompanied by other symptoms of tension, palpitations, sweating and depression.

Unlike some migraine headaches, visual and nervous system symptoms (such as flashing lights, distorted vision, tingling or numbness in the face or hands) do not occur prior to the onset of the headaches.

Many people have occasional or episodic tension-type headaches (less than 15 per month). If you have 15 or more headaches per month for at least 6 months, you have a chronic tension-type headache problem.

Cause

Physical or emotional stress may trigger tension-type headaches.

Stress may result from:

  • Anxiety or depression
  • Problems with family, work, school, or other stress-provoking situations.
  • Lack of sleep or relaxation.
  • Excessive glare.
  • Neck strain from poor posture, work environment, or injury.
  • Strain in the chewing muscles of the jaw from grinding or clenching the teeth.

Symptoms

The location, duration and frequency vary widely. A typical tension-type headache has the following features:

  • Steady, dull headache that slowly becomes worse. It is usually associated with a feeling of fullness, tightness, or pressure. Some people claim that it feels as if their head is being squeezed in a vice or that there is a tight band around the head. The pain may vary throughout the day.
  • The pain usually occurs on both sides of the head, including the neck and temple area. In rare episodes it may be on one side of the head or in one small, well-defined area of the head.
  • The headache may last from one hour to a full day or may be present for many days. It often starts soon after a person gets up in the morning, although it seldom wakes the person or disturbs his/her sleep. Headaches which disturb sleep may be related to anxiety or depression.

Other symptoms that may occur with tension-type headaches include:

  • Tenderness of the scalp
  • Pain, stiffness, or tightness in the neck, upper back, or shoulder muscles
  • Fatigue, tiredness, dizziness
  • Sensitivity to light or sound. This is more typical of migraine headache and is usually milder in a person with a tension-type headache.
  • Nausea or loss of appetite if the headache is severe. Vomiting may be more likely if a person has a mixed tension-type and migraine headache.
  • Depression is common in chronic tension-type headaches. Some doctors think that depression may be the result of a chronic headache pain rather its cause. Anxiety is common in people who have recently started experiencing tension-type headaches.

Diagnosis

The history and physical exam are all that is needed to diagnose tension headaches. Additional tests are only needed to help diagnose other conditions which may cause similar symptoms. See Diagnosis under Headaches.

Treatment

Most people can manage mild tension-type headaches themselves and do not need to see a doctor for help. Mild tension-type headaches usually respond well to home treatment or go away on their own.

Medication

Two general types of medications are used:

  • Pain relievers taken to relieve headache pain or stop the headache while it is still in the early stages
  • Antidepressants and other medications taken continuously to prevent headaches

Occasional mild or moderate tension headaches can often be controlled with nonprescription (OTC) pain relievers and home treatment. Painkillers such as aspirin, paracetamol or ibuprofen usually treat a tension headache adequately. Medicine to prevent the condition should be considered if tension headaches occur more than twice a week or for more than two days. A tricyclic antidepressant is the drug of choice for prophylaxis of tension headaches.

Chronic tension headaches are often best managed with a combination of home treatment, antidepressants and pain relievers. Although muscle relaxants may be helpful, they are not generally satisfactory for long-term use. You may need to take a trial-and-error approach in finding a drug therapy that works.

If one drug or drug combination doesn't work or has too many side effects, another will be tried until you and your doctor establish one that works for you.

Other

Don’t only rely on medication to treat headaches. These measures will also help to relieve pain:

  • At the first sign of a headache, try to go to a quiet, dark place and relax.
  • Apply heat to the painful area with a heating pad, warm shower, or hot water bottle.
  • Have someone gently massage your neck and shoulder muscles, or give yourself a massage.
  • Practice a relaxation exercise such as progressive muscle relaxation or roll breathing.
  • Take a break from whatever is causing a tension headache. Take a 5-minute walk or a stretch break, or find a place to lie down and take some deep breaths.

It is important to keep a headache diary which will identify possible triggers.

If the headache is caused by poor posture which puts unnecessary strain on muscles, a chiropractor could remove this strain through spinal manipulation and treatment.

Biofeedback can be very effective if you are very interested in controlling the problem and motivated to learn and continue using the technique.

Other treatments, such as cognitive therapy (a type of psychotherapy or counseling), may also determine how often tension-type headaches occur and how long they last. The type of cognitive therapy most often used teaches one to recognize negative thoughts and reactions to situations that lead to stress and tension and to respond in ways that produce less stress. This method of teaching 'coping strategies' may work especially well in teenagers.

Transcutaneous electrical nerve stimulation (TENS) is an investigational treatment for headache which may or may not be effective. TENS involves the stimulation of some of the nerves in the head.

Reviewed by Dr Andrew Rose-Innes, MD, Department of Neurology, Yale University School of Medicine, New Haven.

 

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Headache expert

Dr Elliot Shevel - Founder and Medical Director - The Headache Clinic, (Johannesburg, Durban, Cape Town) South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon.

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