Headaches/Migraines

Tension headaches, often referred to as stress headaches, are characterized by a dull pain, tightness, or pressure sensation akin to a clamp squeezing your skull. They are the most common type experienced by adults, with two main categories:

1. Episodic tension headaches: These occur fewer than 15 days per month.
2. Chronic tension headaches: These happen more frequently, exceeding 15 days a month.

These headaches typically last from 30 minutes to a few days. Episodic tension headaches tend to initiate slowly, often manifesting in the middle of the day. Conversely, chronic tension headaches persist over an extended period, with the pain fluctuating in intensity throughout the day but consistently present.

Despite causing discomfort, tension headaches generally do not impede daily activities or affect vision, balance, or strength.

Symptoms and Location

Tension headaches can exhibit the following characteristics:

• They may start in one area of the head and then spread.
• They often manifest as a band of dull pressure or squeezing pain encircling the entire head.
• The pain typically affects both sides of the head equally.
• They can lead to tightness and soreness in the muscles of the neck, shoulders, and jaw.

Common Symptoms

Typical symptoms include:

• Mild to moderate pain or pressure in the front, top, or sides of the head.
• Onset of headaches later in the day.
• Profound fatigue.
• Irritability.
• Difficulty concentrating.
• Mild sensitivity to light or noise.
• Muscle aches.

Unlike migraine headaches, tension headaches do not produce additional nerve symptoms such as muscle weakness or blurred vision. Furthermore, they rarely cause severe sensitivity to light or noise, stomach discomfort, nausea, or vomiting.

Causes of Tension headaches

The exact cause of tension headaches remains elusive, and they do not seem to have a hereditary component. However, some individuals experience them due to tight muscles in the neck and scalp regions.

Triggers

Tension headaches are often triggered by stress stemming from various sources, such as work, school, family dynamics, or relationships. Episodic headaches may result from a single stressful event or cumulative stress buildup, whereas chronic tension headaches can be linked to daily stressors.

Common triggers include:

• Inadequate rest.
• Poor posture.
• Emotional or mental stress, including depression and anxiety.
• Fatigue.
• Hunger.
• Low iron levels.
• Alcohol consumption.
• Jaw or dental issues.
• Eye strain.
• Dehydration.
• Skipping meals.
• Smoking.
• Respiratory infections like colds, flu, or sinusitis.

Understanding these triggers and employing strategies to manage stress can help alleviate tension headaches and improve overall well-being.

Tension Headache Risk Factors

• Up to 80% of adults in the United States experience tension headaches intermittently, while approximately 3% suffer from chronic daily tension headaches.
• Women are twice as likely as men to develop tension headaches.
• Episodic tension headaches typically occur once or twice a month but can happen more frequently.
• Many individuals with chronic tension headaches have been dealing with them for over 60 to 90 days.

When to Consult a Doctor

• Seek medical advice if you experience frequent or severe headaches, especially if they disrupt your daily activities.
• Contact emergency services (911) if you have a sudden and severe headache accompanied by facial drooping, weakness or numbness, or difficulties in speech, vision, or cognition.

Tension Headaches Diagnosis

Your doctor may diagnose tension headaches based on your symptoms, inquiring about:

• The location and nature of the pain.
• Timing and duration of headaches.
• Impact on daily life and sleep patterns.
• Levels of stress.
• History of head injuries.
• Changes in behavior or personality.

They may also conduct tests to rule out other conditions, including:

• Blood tests.
• Imaging tests such as X-rays, CT scans, or MRI exams to visualize the inside of your head.

Tension Headache Treatment

Addressing tension headaches promptly upon onset when the symptoms are mild is advisable. The primary objective is to alleviate pain and prevent its recurrence.

Medications

• Over-the-counter (OTC) painkillers serve as initial treatment for a tension headache However, chronic sufferers should use these cautiously to avoid medication overuse or rebound headaches.
• Common OTC options include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen.
• If OTC medications prove ineffective, stronger prescriptions such as indomethacin, ketoprofen, ketorolac, or naproxen may be recommended.
• Muscle relaxants like cyclobenzaprine or methocarbamol may also be prescribed.
• Some medications, such as tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), or anti-seizure drugs, may be taken daily to prevent a tension headache.

Note: Medications provide relief but do not cure headaches. Prolonged use may diminish effectiveness and have side effects. Consult your doctor to weigh the benefits and drawbacks.

Supplements

• Certain dietary supplements, including butterbur, feverfew, riboflavin, and coenzyme Q10, have shown efficacy in managing migraine headaches and may also aid in preventing a tension headache. Consult your doctor before incorporating supplements into your regimen.

Tension Headaches Prevention

Implement the following strategies to mitigate the severity and frequency of this type of headache:

Stress Management:

• Practice relaxation techniques such as biofeedback, cognitive behavioral therapy, acupuncture, massage therapy, physical therapy, deep breathing, meditation, yoga, or hypnotherapy.

Lifestyle Modifications:

• Reduce stress through organization, planning, and relaxation activities like massage or meditation.
• Pace yourself, take breaks, engage in enjoyable activities, and practice mindfulness to stay present and alleviate worry and fear.
• Foster a supportive network by spending time with loved ones or seeking therapy to address anxiety or depression.
• Incorporate regular exercise, at least 30 minutes five times a week, to reduce stress and maintain fitness. Pay attention to stretching, especially in the jaw, neck, and shoulders.
• Ensure adequate sleep, as rest facilitates stress management.
• Improve posture to prevent muscle tension by maintaining proper alignment while standing and sitting.
• Stay hydrated by consuming plenty of water and water-rich foods to reduce the risk of dehydration-induced headaches.
• Maintain regular, balanced meals to avoid skipping meals, which can trigger headaches. Emphasize fruits, vegetables, and whole grains in your diet.
• Limit caffeine and alcohol consumption, as they can trigger headaches.
• Minimize pain-relief medication usage, utilizing the smallest effective dose and limiting intake to one or two times per week.
• Cultivate a sense of humor to reduce tension.
• Keep a headache diary to identify triggers and aid in treatment planning by recording details such as date, time, symptoms, pain intensity, activities, medications, and dietary intake during headache episodes.

Tension Headaches vs. Migraines: How to Tell Them Apart

Tension Headaches:

• Description: A tension headache typically presents as steady, mild-to-moderate pain without throbbing. The intensity may fluctuate during the headache’s duration.
• Location: Pain can be felt throughout the head, often as a band around the forehead, base of the skull, or neck. It doesn’t worsen with activity. Tenderness may be experienced in the jaw, shoulders, neck, and head.
• Additional Symptoms: Unlike migraines, a tension headache doesn’t accompany nausea, vomiting, light sensitivity, or an aura.
• Pre-Headache Symptoms: Stress or tension might precede the onset.
• Affected Population: Mainly adults.
• Frequency: Varied.
• Duration: Lasts from thirty minutes to 7 days.

Migraines:

• Description: Migraines develop slowly and escalate into intense pain, ranging from moderate to severe. The pain often throbs or pulses and exacerbates with physical activity.
• Location: Typically affects one side of the head, potentially extending to the eye, temple, or base of the skull.
• Additional Symptoms: Some individuals experience visual disturbances called auras before the headache, heightened sensitivity to light and sound during, the headache nausea, vomiting, and mobility or speech difficulties.
• Affected Population: Prevalent in both genders, with boys experiencing more before puberty, but women outnumber men afterward.
• Frequency: Varies.
• Duration: Lasts between 4 and 72 hours.

Sources:

1. National Institute of Neurological Disorders and Stroke: “Headache: Hope Through Research.”
2. National Headache Foundation: “Tension-Type Headache.”
3. MedlinePlus Medical Encyclopedia: “Tension headache.”
4. American Headache Society: “Types of Headaches.”
5. Mayo Clinic: “Tension headache,” “Tension-type headaches: Self-care measures for relief.”
6. Pain research and treatment: “Is There a Relation between Tension-Type Headache, Temporomandibular Disorders and Sleep?”
7. Johns Hopkins Medicine: “Tension Headaches.”
8. Cleveland Clinic: “Tension-Type Headaches,” “Rebound Headaches.”
9. American Family Physician: “Tension-Type Headache.”
10. American Migraine Foundation: “Tension-type headache.””
11. National Stroke Association: “Act FAST.”