Tension type headache: what is it, symptoms and treatment

Introduction

Headache is a very common pain or discomfort in the head or neck area.

Headaches can be:

1. primarythat are not caused by the underlying condition. For example, they can be a symptom of stress, strabismus, or poor posture. Examples of primary headaches are tension headaches, cluster headaches, and migraines;
2. secondary headaches that are caused by an underlying medical condition such as meningitis or a brain tumor.

This page focuses on tension headache, which is the most common type of primary headache.

What is tension headache?

Tension headaches are felt as constant pain that affects both sides of the head. There is also a constriction of the neck muscles and a feeling of pressure behind the eyes. The pain usually lasts 1 to 6 hours, but some people may have more persistent conditions lasting for several days.

How common are they?

Many people experience one or two tension headaches once a month. They sometimes develop more frequently, usually during times of stress.

In about 3% of people, tension headaches occur on most days. When this happens, they are called chronic tension headaches.

Tension headaches are more common in women than in men.

Symptoms of tension headaches

Tension-type headache pain:

• usually mild to moderate
• Feels like pressure on both sides of the head
• constant;
• not aggravated by normal physical activity;
• not associated with nausea or vomiting;
• sometimes associated with light sensitivity (photophobia) or tinnitus.

There may also be a feeling of pressure behind the eyes and stiff neck muscles.

Tension headache usually occurs during the day and may gradually worsen. In most cases, it lasts several hours and does not interfere with your daily activities.

Chronic (persistent) tension headache occurs more than 15 days a month and lasts more than three months.

Causes of tension headaches

The cause of tension headaches is not clear. However, they are believed to be caused by certain situations, such as:

• stress, emotional stress, depression, or anxiety;
• Poor posture that tightens the muscles in the head and neck
• read squinting, which makes the muscles of the head tense;
• certain foods;
• bright sunlight;
• fatigue;
• noise;
• caffeine;
• certain smells;
• menstrual periods;
• weather changes;
• daily use of pain relievers (the body becomes accustomed to pain relievers and a persistent headache may occur if pain relievers are not taken every day).

Diagnostics

Generally, there is no need to visit your GP if only occasional headaches are observed. However, see your GP if:

• headaches are frequent or severe;
• headaches start suddenly and are unlike anything you have had before;
• headaches are accompanied by severe neck stiffness, fever, nausea, vomiting, and confusion;
• headaches followed an accident, especially if it was a blow to your head;
• also experience weakness, numbness, slurred speech, or confusion.

Diagnostic signs

Your healthcare provider will ask about family history, diet and lifestyle. They will also ask how long the headaches last, how frequent and severe they are, where they are and when they occur.

Your healthcare professional can diagnose tension headache if the following apply:

• Headaches last from 30 minutes to seven days.
• Headaches have at least two of the following characteristics:
  • pain affects both sides of the head;
  • pain presses;
  • mild or moderate pain;
  • pain does not worsen with normal physical activity, such as walking.
• No nausea or vomiting.
• The headache is not caused by other health conditions.

The frequency of tension headaches varies from person to person.

Directions

Most tension headaches (and other headaches not caused by an underlying medical condition) can be managed by a healthcare professional and research is rarely needed.

However, you may be referred to a neurologist (nervous system specialist) if symptoms are difficult to control or if your doctor thinks there is something serious behind the pain.

Treatment

Tension headaches can usually be relieved by using relaxation techniques or over-the-counter pain relievers taken during the headache.

More persistent or repetitive tension headaches can be treated amitriptyline (cm. below). If it does not help, you should contact a neurologist (specialist in diseases of the nervous system) or a pain clinic.

Pain relievers

Taking a pain reliever such as paracetamolusually helps relieve tension-type headaches. It is best to take the full dose as soon as the pain begins. A second dose can be taken 4 hours later if needed.

Reception ibuprofen (anti-inflammatory pain reliever) is an alternative. Anti-inflammatory drugs may be more effective than acetaminophen for some people.

Codeine should be used with caution due to the increased likelihood of drug overdose, headache, and dependence. The short course can be used for severe headaches.

As with all medicines, always follow the directions in the package.

Long-term use painkillers will eventually lead to withdrawal headaches, so they should not be taken for more than a few days at a time and should not be taken to prevent headaches, but rather taken during the start headache. Overuse of pain relievers is a common cause of chronic daily headaches (headache from overuse of drugs).

Amitriptyline

Amitriptyline may be prescribed to treat chronic (persistent) tension headaches. Evidence has shown that this drug significantly reduces their duration and frequency.

Occipital nerve stimulation

Occipital nerve stimulation is a treatment for tension-type headaches that are difficult to treat and cannot be treated with medication.

Occipital nerve stimulation includes implanting electrodes, a pulse generator, and connecting wires under the skin. The electrodes are implanted around occipital nerve at the base of the head, and the pulse generator is implanted somewhere in the body. The patient uses a remote control to deliver electrical impulses to the occipital nerve to relieve pain.

Relaxation techniques

Tension headaches can be alleviated by:

• applying hot flannel to the forehead or neck;
• exercise, yoga, or relaxation techniques;
• massaging the shoulders and neck.

Drug abuse

If a tension headache is caused by overuse of the medication, the medication should be discontinued. This will initially make the headache worse, but improvement will be noticed after a few weeks.

Prophylaxis

Breathing and relaxing exercises in stressful situations can help prevent headaches.

Also, regular exercise often relieves stress and tension, and can reduce the frequency of headaches.

Forecast

Tension headaches, like most primary headaches, are not life threatening and are usually relieved by medication or lifestyle changes.