What are tension headaches. How do they differ from migraines. What causes tension headaches. How long do tension headaches typically last. Are tension headaches dangerous. How are tension headaches diagnosed. What are the best treatments for tension headaches.

What Are Tension Headaches and How Common Are They?

Tension headaches are the most prevalent type of headache, affecting a significant portion of the population. These headaches typically cause mild to moderate pain around the head, face, or neck, without accompanying symptoms like nausea or vomiting. Healthcare providers generally consider tension headaches to be non-dangerous, although they can significantly impact quality of life.

Research estimates suggest that up to two-thirds of adults in the United States experience tension headaches. Women are more prone to these headaches compared to men. While episodic tension headaches are more common, chronic tension headaches affect approximately 3% of adults.

Types of Tension Headaches

Tension headaches are classified into two main categories based on frequency:

• Episodic tension-type headaches: These occur less than 15 days per month. If headaches happen once a month or less, they’re considered “infrequent.”
• Chronic tension-type headaches: These occur 15 or more days per month for over three months consecutively. In this case, headache days outnumber headache-free days.

Understanding the Symptoms and Causes of Tension Headaches

The exact cause of tension headaches remains unclear, and they are not considered hereditary. Some healthcare providers theorize that tightened muscles in the back of the head or neck may trigger these headaches. Various factors can increase the likelihood of experiencing tension headaches.

Common Triggers for Tension Headaches

• Eye strain, often from prolonged screen time
• Pain in other parts of the head and neck, such as temporomandibular disorders
• Sleep problems, including insomnia
• Stress related to family, work, or life challenges

Characteristic Symptoms of Tension Headaches

Tension headache symptoms can vary among individuals, but common descriptions include:

• A feeling of pressure or tightness around the head, often described as a band-like sensation
• Constant, non-throbbing pain
• Mild to moderate intensity
• Pain affecting both sides of the head
• Relief after taking over-the-counter pain medications

Distinguishing Tension Headaches from Migraines

While both tension headaches and migraines are common, they present distinct symptom profiles. Understanding these differences is crucial for proper diagnosis and treatment.

Key Differences Between Tension Headaches and Migraines

Migraines are more likely to cause:

• Severe, throbbing, or pounding pain
• Symptoms focused on one side of the head
• Increased sensitivity to bright lights and loud sounds
• Nausea or vomiting

In contrast, tension headaches typically produce milder, more constant pain affecting both sides of the head, without the additional symptoms associated with migraines.

Duration and Severity of Tension Headaches

The duration of tension headaches can vary significantly, ranging from 30 minutes to several months in rare cases. Episodic tension headaches tend to develop gradually and resolve more quickly, often occurring midday and lasting less than a week.

Chronic tension headaches, while less common, can persist for months, maintaining a consistent level of discomfort for days at a time. These prolonged headaches can significantly impact an individual’s quality of life.

Are Tension Headaches Dangerous?

Medical experts generally do not consider tension headaches to be dangerous. While chronic tension headaches can disrupt daily life, they typically do not lead to serious health issues. However, it’s important to note that in some cases, tension-type headaches may be a symptom of an underlying condition.

When to Seek Medical Attention

Certain situations warrant a medical evaluation:

• New onset headaches in individuals over 50 years old
• Headaches that may be indicative of thyroid disease, tumors, or other primary headache disorders
• Chronic headaches that significantly impact daily functioning

Diagnosing Tension Headaches: The Process and Challenges

Diagnosing tension headaches can be challenging as there is no definitive test for this condition. Healthcare providers rely on a comprehensive approach to reach a diagnosis.

Steps in Diagnosing Tension Headaches

1. Medical history review: Your healthcare provider will start by examining your medical background and headache patterns.
2. Physical examination: This may include checking for signs of underlying conditions that could be causing the headaches.
3. Neurological examination: To rule out other potential causes of headaches.
4. Diagnostic criteria assessment: Healthcare providers use established criteria to diagnose tension-type headaches.

In some cases, additional tests may be ordered to exclude other conditions, especially if the headache pattern is unusual or if there are concerning symptoms.

Effective Treatments and Management Strategies for Tension Headaches

While tension headaches can be bothersome, various treatment options and management strategies can help alleviate symptoms and reduce frequency.

Medication Options for Tension Headaches

Over-the-counter pain relievers are often effective for managing tension headaches:

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin IB)
• Naproxen (Aleve)
• Aspirin

For chronic tension headaches, healthcare providers may prescribe preventive medications such as tricyclic antidepressants or muscle relaxants. It’s crucial to use medications as directed to avoid rebound headaches from overuse.

Non-Medication Approaches to Managing Tension Headaches

Several non-pharmacological strategies can be effective in managing tension headaches:

• Stress management techniques (e.g., meditation, deep breathing exercises)
• Regular exercise and physical activity
• Proper sleep hygiene
• Maintaining good posture
• Staying hydrated
• Cognitive behavioral therapy
• Biofeedback
• Acupuncture
• Massage therapy

Preventing Tension Headaches: Lifestyle Modifications and Strategies

Prevention is key in managing tension headaches. By identifying and addressing triggers, individuals can reduce the frequency and severity of their headaches.

Effective Prevention Strategies

1. Identify and avoid personal triggers: Keep a headache diary to track potential triggers.
2. Practice stress reduction techniques: Regular relaxation exercises can help manage stress-related headaches.
3. Maintain a consistent sleep schedule: Aim for 7-9 hours of quality sleep each night.
4. Stay physically active: Regular exercise can help reduce tension and stress.
5. Practice good posture: Especially when working at a desk or using electronic devices.
6. Take regular breaks: When engaging in activities that may strain your eyes or neck muscles.
7. Stay hydrated: Drink plenty of water throughout the day.
8. Limit caffeine and alcohol intake: These can contribute to dehydration and trigger headaches in some individuals.

By implementing these preventive measures and working closely with healthcare providers, many individuals can effectively manage their tension headaches and improve their overall quality of life.

When to Consult a Healthcare Provider for Tension Headaches

While tension headaches are generally not dangerous, certain situations warrant medical attention. It’s important to recognize when professional help is needed to ensure proper management and rule out more serious conditions.

Signs That Indicate the Need for Medical Evaluation

• Headaches that occur more than 15 days per month
• Headaches that consistently interfere with daily activities
• A sudden change in headache pattern or intensity
• Headaches that worsen or don’t improve with over-the-counter medications
• New onset headaches in individuals over 50 years old
• Headaches accompanied by other symptoms like fever, stiff neck, or neurological changes
• Headaches following a head injury

Healthcare providers can offer personalized treatment plans, prescribe appropriate medications, and help identify and manage underlying causes of chronic headaches.

What to Expect During a Medical Consultation

When consulting a healthcare provider about tension headaches, you can expect:

1. A detailed discussion of your headache history and symptoms
2. Questions about your lifestyle, stress levels, and potential triggers
3. A physical examination, including a neurological check
4. Possible recommendations for keeping a headache diary
5. Discussion of treatment options, both medicinal and non-medicinal
6. Potential referral to a specialist if needed

Remember, early intervention and proper management can significantly improve outcomes for individuals suffering from chronic tension headaches.

Tension Headaches: Symptoms, Causes, & Treatments

Overview

What are headaches?

Headaches are a common health problem. Almost everyone experiences one at some point in life. But they’re not all the same. Medical experts group headaches into more than 100 types.

For most people, headaches lead to minor aches or pains and happen occasionally (every once in a while). Less commonly, more severe headaches (such as migraines) can cause throbbing pain. Some headaches may make routine tasks difficult or near impossible.

Rarely, severe, sudden head pain can be a sign of a serious health problem, such as a brain tumor.

What are tension-type headaches?

Tension headaches are the most common type of headache. These headaches often cause mild-to-moderate pain around the head, face or neck. They usually don’t cause other symptoms (like nausea or vomiting). Healthcare providers generally don’t consider tension headaches to be dangerous.

Your healthcare provider may call your tension headache, “tension-type headache. This is what this headache is called by the official medical publication that classifies all headache disorders.

What are the types of tension-type headaches?

Healthcare providers break down tension headaches into two main types. They base the type on how many headaches you have and how often:

• Episodic tension-type headaches happen less often (fewer than 15 days a month). Your provider may call them “infrequent” if you have one or fewer headaches each month.
• Chronic tension-type describe when your headache days outnumber headache-free days. Chronic tension headaches happen 15 or more days each month for more than three months in a row.

How common are tension headaches?

People don’t always see their doctor for a tension headache, which makes exact numbers hard to predict. Researchers estimate that as many as 2 in 3 adults in the U.S. get tension headaches.

Chronic tension headaches are much less common. They affect an estimated 3% of adults. Women get tension headaches more often than men.

Symptoms and Causes

What causes tension headaches?

Researchers haven’t identified one single cause for tension headaches. This headache type is not hereditary (run in families).

Some healthcare providers believe tightened muscles in the back of your head or neck may trigger (bring on) tension headaches.

What are some triggers that may bring on tension-type headaches?

You may be more likely to have tension headaches if you have:

• Eye strain, such as from staring at a computer screen for a long time.
• Pain in other parts of your head and neck caused by problems such as temporomandibular disorders.
• Problems sleeping, such as insomnia.
• Stress related to family, work or life challenges, such as starting or losing a job or juggling too many commitments.

How does a tension-type headache feel?

People experience tension headache symptoms differently. Some people describe tension headache pain as feeling like someone (or something) is squeezing both sides of their head together or a band around their head.

You may have pain that’s:

• Constant (but not throbbing).
• Mild or moderate (not severe).
• On both sides of the head.
• Better after you take over-the-counter pain relievers.

How is a tension-type headache different from a migraine?

Migraines are another common headache type. Migraines and tension headaches tend to cause different symptoms.

A migraine is more likely to cause:

• More severe pain.
• Throbbing or pounding pains.
• Symptoms focused on one side of the head.
• Pain that gets worse when you’re near bright lights or loud sounds.
• Nausea or vomiting.

How long does a tension-type headache last?

That depends. A tension-type headache may last for 30 minutes or (less commonly) months. In general, episodic tension headache symptoms tend to come on slowly and end sooner. They often happen in the middle of the day. Episodic headaches usually don’t last longer than a week.

People with chronic tension-type headaches can have symptoms that last for months at a time. Pain may stay at the same level of discomfort for days. While uncommon, these headaches can take a toll on your quality of life.

Is a tension-type headache dangerous?

Not according to medical experts. While chronic tension-type headaches can disrupt your life, tension headaches don’t tend cause serious health issues.

Sometimes tension-type headaches may be a sign of an underlying disorder such as thyroid disease or an underlying tumor or a primary headache disorder, such as chronic migraine or new daily persistent headache. Anyone over age 50 with a new onset headache should see their doctor for an evaluation .

Diagnosis and Tests

How are tension-type headaches diagnosed?

No test exists to definitively diagnose tension headaches. Your healthcare provider will start by reviewing your medical history. They will then examine you to evaluate your symptoms.

Your provider may ask you a lot of questions to learn more about your symptoms, such as:

• Do your symptoms feel worse at certain times of the day?
• Do your symptoms feel worse after eating certain foods?
• Do over-the-counter pain relievers help you feel better?
• How often do you have symptoms?
• How would you describe your stress levels?

A headache specialist will use a diagnostic manual called the International Classification of Headache Disorders-3 to make sure that you fulfill criteria for tension-type headache.

In some cases, your provider may order an imaging scan, such as an MRI. Imaging tests can help rule out less common but potentially serious causes of your symptoms. Learn more about headache diagnosis and tests.

Management and Treatment

How are tension-type headaches treated?

If you get a tension headache every so often, over-the-counter pain relievers may effectively treat your pain. Your provider may recommend you first try one of these options to relieve your symptoms:

• Acetaminophen (Tylenol®).
• Aspirin.
• Ibuprofen (Advil®, Motrin®).
• Naproxen sodium (Aleve®).

Are there any other tension headache medication options?

If over-the-counter pain relievers don’t help, your provider may prescribe medication. Certain medications reduce how often your headaches happen or how much they hurt. The antidepressant amitriptyline (Elavil®) has helped some people with chronic tension headaches. Opioids should not be used.

Are there any risks to taking medication to treat tension headaches?

Over-the-counter pain relievers are generally safe. But overusing pain relievers can cause other problems. Make sure to follow the instructions on the bottle carefully. Always check in with your provider if you feel the need to use pain relievers more than twice a week.

Take these medications only when you need them. Use the smallest dose that relieves your pain.

In general, overusing pain medications may cause:

• Headaches: Taking pain relievers too often can actually cause a headache (called rebound headaches) when you stop taking the medicine. This effect is similar to withdrawal.
• Other side effects: All drugs have side effects. Avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, too often. Overuse may cause stomach pain, bleeding or ulcers. If you take any medication regularly, discuss the risks and benefits with your doctor.
• Reduced benefits over time: Your body can build up a tolerance (get used to) any medication. You may notice that a medication you’ve used regularly doesn’t work as well as it once did.
• Dependence: Some medications can become addictive. They may pose more risks than benefits. For that reason, healthcare providers usually recommend against prescribing benzodiazepines and narcotics (such as codeine and oxycodone) to treat tension headaches.

Can medication cure tension-type headaches?

No treatment (medication or otherwise) can cure tension headaches. Medicines help you manage and get relief from your symptoms so that you can enjoy more of life.

Can I treat a tension-type headache without medication?

Absolutely. While medication may be helpful, it’s not a substitute for coping with stressors that may cause your headaches.

Other tension-type headache treatment options include:

• Home remedies, like placing a hot or cold compress where it hurts, may help you feel better.
• Counseling can help you identify what’s causing your headaches and learn useful coping methods.
• Relaxation training includes deep breathing exercises and listening to soothing music. These methods can relax your muscles and relieve pain.
• Meditation.
• Biofeedback uses sensors connected to your body to monitor and then counteract your body’s physical functions. It teaches you ways to manage stress by identifying and then reducing muscle tension. Biofeedback may relieve or prevent headaches.

Prevention

How can I prevent tension headaches?

Researchers have yet to uncover how to prevent all headaches. If you experience chronic tension-type headaches or frequent tension-type headaches certain medications may stop some headaches before they start. These are antidepressants such as amitriptyline or venlafaxine or duloxetine. These work on the pain centers in the brain.

Overall, lifestyle changes and reducing your response to stress is the best way to prevent tension headaches. The most effective stress management tool is the one that fits into your life and you feel good using. You may want to try:

• Massage therapy.
• Exercising regularly.
• Staying hydrated.
• Getting regular, restful sleep.

Outlook / Prognosis

What should I expect if I have tension-type headache?

Tension headaches can be annoying. In severe cases, they can disrupt your personal life or career in big ways. But most cases cause minor symptoms. Medication and other therapies help many people overcome their symptoms with minimal interruptions to their life.

Living With

When should I call the doctor?

Most headaches aren’t dangerous. Rarely, headache pain can be a sign of a serious medical problem. You should seek immediate medical care if you have:

• Stiff neck.
• Sudden, severe headache that gets worse quickly.
• Fever that doesn’t go away.
• Headache after concussion (head injury).
• Confused thoughts or slurred speech or weakness.
• New onset headache over the age of 50.
• Sudden change in your headache pattern.
• New onset headache in someone with cancer or autoimmune disease.

A note from Cleveland Clinic

Almost everyone experiences tension headaches. But that doesn’t mean you need to live with the pain. Over-the-counter pain relievers may be enough to relieve minor symptoms. If you have a headache more days than not, reach out to your provider for guidance. Medication and stress management help many people reduce the impact of tension headaches on their life. Massage, meditation, exercise or talking to someone you trust are just some of your options. The best stress-management therapy is the one that works for your lifestyle and feels right to you.

Tension Headaches: Symptoms, Causes, & Treatments

Overview

What are headaches?

Headaches are a common health problem. Almost everyone experiences one at some point in life. But they’re not all the same. Medical experts group headaches into more than 100 types.

For most people, headaches lead to minor aches or pains and happen occasionally (every once in a while). Less commonly, more severe headaches (such as migraines) can cause throbbing pain. Some headaches may make routine tasks difficult or near impossible.

Rarely, severe, sudden head pain can be a sign of a serious health problem, such as a brain tumor.

What are tension-type headaches?

Tension headaches are the most common type of headache. These headaches often cause mild-to-moderate pain around the head, face or neck. They usually don’t cause other symptoms (like nausea or vomiting). Healthcare providers generally don’t consider tension headaches to be dangerous.

Your healthcare provider may call your tension headache, “tension-type headache. This is what this headache is called by the official medical publication that classifies all headache disorders.

What are the types of tension-type headaches?

Healthcare providers break down tension headaches into two main types. They base the type on how many headaches you have and how often:

• Episodic tension-type headaches happen less often (fewer than 15 days a month). Your provider may call them “infrequent” if you have one or fewer headaches each month.
• Chronic tension-type describe when your headache days outnumber headache-free days. Chronic tension headaches happen 15 or more days each month for more than three months in a row.

How common are tension headaches?

People don’t always see their doctor for a tension headache, which makes exact numbers hard to predict. Researchers estimate that as many as 2 in 3 adults in the U.S. get tension headaches.

Chronic tension headaches are much less common. They affect an estimated 3% of adults. Women get tension headaches more often than men.

Symptoms and Causes

What causes tension headaches?

Researchers haven’t identified one single cause for tension headaches. This headache type is not hereditary (run in families).

Some healthcare providers believe tightened muscles in the back of your head or neck may trigger (bring on) tension headaches.

What are some triggers that may bring on tension-type headaches?

You may be more likely to have tension headaches if you have:

• Eye strain, such as from staring at a computer screen for a long time.
• Pain in other parts of your head and neck caused by problems such as temporomandibular disorders.
• Problems sleeping, such as insomnia.
• Stress related to family, work or life challenges, such as starting or losing a job or juggling too many commitments.

How does a tension-type headache feel?

People experience tension headache symptoms differently. Some people describe tension headache pain as feeling like someone (or something) is squeezing both sides of their head together or a band around their head.

You may have pain that’s:

• Constant (but not throbbing).
• Mild or moderate (not severe).
• On both sides of the head.
• Better after you take over-the-counter pain relievers.

How is a tension-type headache different from a migraine?

Migraines are another common headache type. Migraines and tension headaches tend to cause different symptoms.

A migraine is more likely to cause:

• More severe pain.
• Throbbing or pounding pains.
• Symptoms focused on one side of the head.
• Pain that gets worse when you’re near bright lights or loud sounds.
• Nausea or vomiting.

How long does a tension-type headache last?

That depends. A tension-type headache may last for 30 minutes or (less commonly) months. In general, episodic tension headache symptoms tend to come on slowly and end sooner. They often happen in the middle of the day. Episodic headaches usually don’t last longer than a week.

People with chronic tension-type headaches can have symptoms that last for months at a time. Pain may stay at the same level of discomfort for days. While uncommon, these headaches can take a toll on your quality of life.

Is a tension-type headache dangerous?

Not according to medical experts. While chronic tension-type headaches can disrupt your life, tension headaches don’t tend cause serious health issues.

Sometimes tension-type headaches may be a sign of an underlying disorder such as thyroid disease or an underlying tumor or a primary headache disorder, such as chronic migraine or new daily persistent headache. Anyone over age 50 with a new onset headache should see their doctor for an evaluation .

Diagnosis and Tests

How are tension-type headaches diagnosed?

No test exists to definitively diagnose tension headaches. Your healthcare provider will start by reviewing your medical history. They will then examine you to evaluate your symptoms.

Your provider may ask you a lot of questions to learn more about your symptoms, such as:

• Do your symptoms feel worse at certain times of the day?
• Do your symptoms feel worse after eating certain foods?
• Do over-the-counter pain relievers help you feel better?
• How often do you have symptoms?
• How would you describe your stress levels?

A headache specialist will use a diagnostic manual called the International Classification of Headache Disorders-3 to make sure that you fulfill criteria for tension-type headache.

In some cases, your provider may order an imaging scan, such as an MRI. Imaging tests can help rule out less common but potentially serious causes of your symptoms. Learn more about headache diagnosis and tests.

Management and Treatment

How are tension-type headaches treated?

If you get a tension headache every so often, over-the-counter pain relievers may effectively treat your pain. Your provider may recommend you first try one of these options to relieve your symptoms:

• Acetaminophen (Tylenol®).
• Aspirin.
• Ibuprofen (Advil®, Motrin®).
• Naproxen sodium (Aleve®).

Are there any other tension headache medication options?

If over-the-counter pain relievers don’t help, your provider may prescribe medication. Certain medications reduce how often your headaches happen or how much they hurt. The antidepressant amitriptyline (Elavil®) has helped some people with chronic tension headaches. Opioids should not be used.

Are there any risks to taking medication to treat tension headaches?

Over-the-counter pain relievers are generally safe. But overusing pain relievers can cause other problems. Make sure to follow the instructions on the bottle carefully. Always check in with your provider if you feel the need to use pain relievers more than twice a week.

Take these medications only when you need them. Use the smallest dose that relieves your pain.

In general, overusing pain medications may cause:

• Headaches: Taking pain relievers too often can actually cause a headache (called rebound headaches) when you stop taking the medicine. This effect is similar to withdrawal.
• Other side effects: All drugs have side effects. Avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, too often. Overuse may cause stomach pain, bleeding or ulcers. If you take any medication regularly, discuss the risks and benefits with your doctor.
• Reduced benefits over time: Your body can build up a tolerance (get used to) any medication. You may notice that a medication you’ve used regularly doesn’t work as well as it once did.
• Dependence: Some medications can become addictive. They may pose more risks than benefits. For that reason, healthcare providers usually recommend against prescribing benzodiazepines and narcotics (such as codeine and oxycodone) to treat tension headaches.

Can medication cure tension-type headaches?

No treatment (medication or otherwise) can cure tension headaches. Medicines help you manage and get relief from your symptoms so that you can enjoy more of life.

Can I treat a tension-type headache without medication?

Absolutely. While medication may be helpful, it’s not a substitute for coping with stressors that may cause your headaches.

Other tension-type headache treatment options include:

• Home remedies, like placing a hot or cold compress where it hurts, may help you feel better.
• Counseling can help you identify what’s causing your headaches and learn useful coping methods.
• Relaxation training includes deep breathing exercises and listening to soothing music. These methods can relax your muscles and relieve pain.
• Meditation.
• Biofeedback uses sensors connected to your body to monitor and then counteract your body’s physical functions. It teaches you ways to manage stress by identifying and then reducing muscle tension. Biofeedback may relieve or prevent headaches.

Prevention

How can I prevent tension headaches?

Researchers have yet to uncover how to prevent all headaches. If you experience chronic tension-type headaches or frequent tension-type headaches certain medications may stop some headaches before they start. These are antidepressants such as amitriptyline or venlafaxine or duloxetine. These work on the pain centers in the brain.

Overall, lifestyle changes and reducing your response to stress is the best way to prevent tension headaches. The most effective stress management tool is the one that fits into your life and you feel good using. You may want to try:

• Massage therapy.
• Exercising regularly.
• Staying hydrated.
• Getting regular, restful sleep.

Outlook / Prognosis

What should I expect if I have tension-type headache?

Tension headaches can be annoying. In severe cases, they can disrupt your personal life or career in big ways. But most cases cause minor symptoms. Medication and other therapies help many people overcome their symptoms with minimal interruptions to their life.

Living With

When should I call the doctor?

Most headaches aren’t dangerous. Rarely, headache pain can be a sign of a serious medical problem. You should seek immediate medical care if you have:

• Stiff neck.
• Sudden, severe headache that gets worse quickly.
• Fever that doesn’t go away.
• Headache after concussion (head injury).
• Confused thoughts or slurred speech or weakness.
• New onset headache over the age of 50.
• Sudden change in your headache pattern.
• New onset headache in someone with cancer or autoimmune disease.

A note from Cleveland Clinic

Almost everyone experiences tension headaches. But that doesn’t mean you need to live with the pain. Over-the-counter pain relievers may be enough to relieve minor symptoms. If you have a headache more days than not, reach out to your provider for guidance. Medication and stress management help many people reduce the impact of tension headaches on their life. Massage, meditation, exercise or talking to someone you trust are just some of your options. The best stress-management therapy is the one that works for your lifestyle and feels right to you.

Tension Headaches: Symptoms, Causes, & Treatments

Overview

What are headaches?

Headaches are a common health problem. Almost everyone experiences one at some point in life. But they’re not all the same. Medical experts group headaches into more than 100 types.

For most people, headaches lead to minor aches or pains and happen occasionally (every once in a while). Less commonly, more severe headaches (such as migraines) can cause throbbing pain. Some headaches may make routine tasks difficult or near impossible.

Rarely, severe, sudden head pain can be a sign of a serious health problem, such as a brain tumor.

What are tension-type headaches?

Tension headaches are the most common type of headache. These headaches often cause mild-to-moderate pain around the head, face or neck. They usually don’t cause other symptoms (like nausea or vomiting). Healthcare providers generally don’t consider tension headaches to be dangerous.

Your healthcare provider may call your tension headache, “tension-type headache. This is what this headache is called by the official medical publication that classifies all headache disorders.

What are the types of tension-type headaches?

Healthcare providers break down tension headaches into two main types. They base the type on how many headaches you have and how often:

• Episodic tension-type headaches happen less often (fewer than 15 days a month). Your provider may call them “infrequent” if you have one or fewer headaches each month.
• Chronic tension-type describe when your headache days outnumber headache-free days. Chronic tension headaches happen 15 or more days each month for more than three months in a row.

How common are tension headaches?

People don’t always see their doctor for a tension headache, which makes exact numbers hard to predict. Researchers estimate that as many as 2 in 3 adults in the U.S. get tension headaches.

Chronic tension headaches are much less common. They affect an estimated 3% of adults. Women get tension headaches more often than men.

Symptoms and Causes

What causes tension headaches?

Researchers haven’t identified one single cause for tension headaches. This headache type is not hereditary (run in families).

Some healthcare providers believe tightened muscles in the back of your head or neck may trigger (bring on) tension headaches.

What are some triggers that may bring on tension-type headaches?

You may be more likely to have tension headaches if you have:

• Eye strain, such as from staring at a computer screen for a long time.
• Pain in other parts of your head and neck caused by problems such as temporomandibular disorders.
• Problems sleeping, such as insomnia.
• Stress related to family, work or life challenges, such as starting or losing a job or juggling too many commitments.

How does a tension-type headache feel?

People experience tension headache symptoms differently. Some people describe tension headache pain as feeling like someone (or something) is squeezing both sides of their head together or a band around their head.

You may have pain that’s:

• Constant (but not throbbing).
• Mild or moderate (not severe).
• On both sides of the head.
• Better after you take over-the-counter pain relievers.

How is a tension-type headache different from a migraine?

Migraines are another common headache type. Migraines and tension headaches tend to cause different symptoms.

A migraine is more likely to cause:

• More severe pain.
• Throbbing or pounding pains.
• Symptoms focused on one side of the head.
• Pain that gets worse when you’re near bright lights or loud sounds.
• Nausea or vomiting.

How long does a tension-type headache last?

That depends. A tension-type headache may last for 30 minutes or (less commonly) months. In general, episodic tension headache symptoms tend to come on slowly and end sooner. They often happen in the middle of the day. Episodic headaches usually don’t last longer than a week.

People with chronic tension-type headaches can have symptoms that last for months at a time. Pain may stay at the same level of discomfort for days. While uncommon, these headaches can take a toll on your quality of life.

Is a tension-type headache dangerous?

Not according to medical experts. While chronic tension-type headaches can disrupt your life, tension headaches don’t tend cause serious health issues.

Sometimes tension-type headaches may be a sign of an underlying disorder such as thyroid disease or an underlying tumor or a primary headache disorder, such as chronic migraine or new daily persistent headache. Anyone over age 50 with a new onset headache should see their doctor for an evaluation .

Diagnosis and Tests

How are tension-type headaches diagnosed?

No test exists to definitively diagnose tension headaches. Your healthcare provider will start by reviewing your medical history. They will then examine you to evaluate your symptoms.

Your provider may ask you a lot of questions to learn more about your symptoms, such as:

• Do your symptoms feel worse at certain times of the day?
• Do your symptoms feel worse after eating certain foods?
• Do over-the-counter pain relievers help you feel better?
• How often do you have symptoms?
• How would you describe your stress levels?

A headache specialist will use a diagnostic manual called the International Classification of Headache Disorders-3 to make sure that you fulfill criteria for tension-type headache.

In some cases, your provider may order an imaging scan, such as an MRI. Imaging tests can help rule out less common but potentially serious causes of your symptoms. Learn more about headache diagnosis and tests.

Management and Treatment

How are tension-type headaches treated?

If you get a tension headache every so often, over-the-counter pain relievers may effectively treat your pain. Your provider may recommend you first try one of these options to relieve your symptoms:

• Acetaminophen (Tylenol®).
• Aspirin.
• Ibuprofen (Advil®, Motrin®).
• Naproxen sodium (Aleve®).

Are there any other tension headache medication options?

If over-the-counter pain relievers don’t help, your provider may prescribe medication. Certain medications reduce how often your headaches happen or how much they hurt. The antidepressant amitriptyline (Elavil®) has helped some people with chronic tension headaches. Opioids should not be used.

Are there any risks to taking medication to treat tension headaches?

Over-the-counter pain relievers are generally safe. But overusing pain relievers can cause other problems. Make sure to follow the instructions on the bottle carefully. Always check in with your provider if you feel the need to use pain relievers more than twice a week.

Take these medications only when you need them. Use the smallest dose that relieves your pain.

In general, overusing pain medications may cause:

• Headaches: Taking pain relievers too often can actually cause a headache (called rebound headaches) when you stop taking the medicine. This effect is similar to withdrawal.
• Other side effects: All drugs have side effects. Avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, too often. Overuse may cause stomach pain, bleeding or ulcers. If you take any medication regularly, discuss the risks and benefits with your doctor.
• Reduced benefits over time: Your body can build up a tolerance (get used to) any medication. You may notice that a medication you’ve used regularly doesn’t work as well as it once did.
• Dependence: Some medications can become addictive. They may pose more risks than benefits. For that reason, healthcare providers usually recommend against prescribing benzodiazepines and narcotics (such as codeine and oxycodone) to treat tension headaches.

Can medication cure tension-type headaches?

No treatment (medication or otherwise) can cure tension headaches. Medicines help you manage and get relief from your symptoms so that you can enjoy more of life.

Can I treat a tension-type headache without medication?

Absolutely. While medication may be helpful, it’s not a substitute for coping with stressors that may cause your headaches.

Other tension-type headache treatment options include:

• Home remedies, like placing a hot or cold compress where it hurts, may help you feel better.
• Counseling can help you identify what’s causing your headaches and learn useful coping methods.
• Relaxation training includes deep breathing exercises and listening to soothing music. These methods can relax your muscles and relieve pain.
• Meditation.
• Biofeedback uses sensors connected to your body to monitor and then counteract your body’s physical functions. It teaches you ways to manage stress by identifying and then reducing muscle tension. Biofeedback may relieve or prevent headaches.

Prevention

How can I prevent tension headaches?

Researchers have yet to uncover how to prevent all headaches. If you experience chronic tension-type headaches or frequent tension-type headaches certain medications may stop some headaches before they start. These are antidepressants such as amitriptyline or venlafaxine or duloxetine. These work on the pain centers in the brain.

Overall, lifestyle changes and reducing your response to stress is the best way to prevent tension headaches. The most effective stress management tool is the one that fits into your life and you feel good using. You may want to try:

• Massage therapy.
• Exercising regularly.
• Staying hydrated.
• Getting regular, restful sleep.

Outlook / Prognosis

What should I expect if I have tension-type headache?

Tension headaches can be annoying. In severe cases, they can disrupt your personal life or career in big ways. But most cases cause minor symptoms. Medication and other therapies help many people overcome their symptoms with minimal interruptions to their life.

Living With

When should I call the doctor?

Most headaches aren’t dangerous. Rarely, headache pain can be a sign of a serious medical problem. You should seek immediate medical care if you have:

• Stiff neck.
• Sudden, severe headache that gets worse quickly.
• Fever that doesn’t go away.
• Headache after concussion (head injury).
• Confused thoughts or slurred speech or weakness.
• New onset headache over the age of 50.
• Sudden change in your headache pattern.
• New onset headache in someone with cancer or autoimmune disease.

A note from Cleveland Clinic

Almost everyone experiences tension headaches. But that doesn’t mean you need to live with the pain. Over-the-counter pain relievers may be enough to relieve minor symptoms. If you have a headache more days than not, reach out to your provider for guidance. Medication and stress management help many people reduce the impact of tension headaches on their life. Massage, meditation, exercise or talking to someone you trust are just some of your options. The best stress-management therapy is the one that works for your lifestyle and feels right to you.

Symptoms, Causes, Treatment, and Prevention

SOURCES:

National Institute of Neurological Disorders and Stroke: “Headache: Hope Through Research. “

National Headache Foundation: “Tension-Type Headache.”

MedlinePlus Medical Encyclopedia: “Tension headache.”

American Headache Society: “Types of Headaches.”

University Health Services, University of California, Berkeley: “Tension Headache Fact Sheet,” “Headaches.”

National Center for Complementary and Integrative Health: “Headaches: In Depth.”

Mayo Clinic: “Tension headache,” “Tension-type headaches: Self-care measures for relief.”

Pain research and treatment: “Is There a Relation between Tension-Type Headache, Temporomandibular Disorders and Sleep?”

PennState Hershey: “Tension headache.”

Wayne State University Physician Group: “Tension Headache.”

Harvard Health Publishing: “What type of headache do you have?” “Tension Headache,” “4 ways to tame tension headaches.”

UpToDate: “Evaluation of headache in adults,” “Patient education: Headache causes and diagnosis in adults (Beyond the Basics),” “Tension-type headache in adults: Preventive treatment. “

National Health Service: “Tension-type headaches.”

Temple Health: “Tension Headache.”

Johns Hopkins Medicine: “Tension Headaches.”

Medscape: “Tension Headache.”

Minneapolis Clinic of Neurology: “Headaches/Migraine.”

Cleveland Clinic: “Tension-Type Headaches,” “Rebound Headaches.”

American Family Physician: “Tension-Type Headache.”

American Migraine Foundation: “Tension-type headache.”

Mount Sinai Hospital: “Headache Triggers and Tips,” “Tension Headache.”

University of Michigan Health System: “Tension Headaches,” “When Should You See a Doctor for Headache or Migraines?”

President’s Council on Fitness, Sports & Nutrition.

University of Wisconsin Hospitals and Clinics Authority: “Headaches: Should I Take Prescription Medicine for Tension Headaches?”

National Stroke Association: “Act FAST.”

TENSION HEADACHE – Student Health and Wellness Services

WHAT IS IT?

A tension headache is head pain that results from muscle tightening (contraction) in the neck and head. The muscle contraction leads to a slight decrease in blood flow to the surrounding areas and an irritation of pain fibers in the skin, muscles, and blood vessel walls.

WHAT CAUSES IT?

The causes are unknown. Anxiety, depression, and emotional conflicts are often associated with tension headaches. Headaches may also result from muscle strain associated with injury to the neck muscles. An abnormality in the bones at the back of the neck (cervical vertebrae) or in the area where the mouth opens and closes (temporomandibular joint) may also put tension on the surrounding muscles and lead to a tension headache. On occasion, a child who has been incorrectly fitted with glasses may suffer from a tension headache due to eye muscle strain.

WHAT ARE ITS COMMON SYMPTOMS?

More than 90 percent of tension headaches are on both sides of the head. The headache is often described as a pressure or band-like sensation around the head. The dull, steady pain builds gradually and is often intense at the end of the day. In some individuals, the headache continues day and night. Even after sleep, the headache may still be present.

IS IT CONTAGIOUS?

No.

HOW LONG WILL IT LAST?

Tension headaches may last a few hours, several days, weeks, or even months.

HOW IS IT TREATED?

Treatment for this problem consists of two important parts: (1) what you can do, and (2) what your health care provider can do.

1. Some people get relief by applying heat to the area of the head or neck where the pain is most severe. Apply heat in the form of a dry towel warmed in the oven, or use a heating pad on a low setting for brief time periods. Other people gain relief by applying an ice bag wrapped in a towel to the painful area.
2. A gentle fingertip massage over the area just in front of and above the ears (temporal area) may reduce the pain.
3. Lying down and relaxing may also help to decrease the pain. Many people find concentrating on a soothing thought or image while taking slow, deep breaths helps them relax.
4. Record on a calendar the date of the headache, the time it started and ended, the amount of medication you took. Remember to brink this record with you on follow-up visits to your health care provider. It will help in your treatment.

WHAT CAN YOUR HEALTH CARE PROVIDER DO?

If the cause of the tension headache is a cervical vertebrae or temporomandibular joint problem, medical correction of the condition will be necessary. Incorrectly fitted eyeglasses must be refitted if they are the cause of tension headaches. A neck injury that is contributing to a tension headache can be helped with supportive collar, which allows the muscles in the neck to rest and relax.

Medications are needed for some individuals. Your health care provider may prescribe one or more of the following medications.

• Analgesics — These medicines reduce the pain of a tension headache.
• Muscle relaxants — These medications aid in relaxation by causing sedation and decreasing anxiety. They have little or no direct effect on relaxing the muscles of the head and neck that contribute to the headache. Some of these medications can become addictive.

CAN YOU PREVENT IT?

Because tension headaches recur in some individuals for years and because continual use of medication can lead to serious side effects, prevention is a key aspect in the management of tension headaches.

Tension headaches are often a response to stress, anxiety, and emotional conflict in a person’s life. It is important to find ways to reduce these conflicts. Regular exercise (e.g., walking, biking, swimming) and relaxation techniques (e.g., yoga, meditation) may help you. Exercise and relaxation not only reduce stress but also decrease the severity of head pain. A trained counselor can help provide assistance to identify the stresses in your life and make suggestions to resolve the problems.

COMMON MYTHS

It is a myth that tension headaches are inherited. However, people tend to imitate the stress reduction and responses of those around them. They may develop a tension headache as a result of ineffective stress management.

FOLLOW-UP

It is important to return for your follow-up care as advised.

RESOURCES

Call your local community center, YMCA, YWCA, or adult education program for information about classes in yoga, meditation, aerobic dance, or other exercise classes. A community mental health center can assist in an evaluation for stress and make a referral to a counselor for you.

REMEMBER

Notify your health care provider if you have any of the following:

• Changes in vision
• Difficulty speaking
• Numbness or tingling in your arms or legs
• Marked change in severity of your headache
• Sudden onset of a fever with a headache
• Difficulty walking
• Questions concerning the symptoms you are experiencing

Information provided by University of Illinois Health Resource Center

Tension Headaches | Johns Hopkins Medicine

What is a tension headache?

Tension headaches are the most common type of headache. Stress and muscle tension are often factors in these headaches. Tension headaches typically don’t cause nausea, vomiting, or sensitivity to light. They do cause a steady ache, rather than a throbbing one, and tend to affect both sides of the head. Tension headaches may be chronic, occurring often, or every day.

What causes a tension headache?

The exact mechanism that causes a tension headache is not known. Several factors, such as genetics and environment, are thought to be involved. Muscle contractions in the head and neck are considered a major factor in the development of a tension headache. Some people get tension headaches in response to stressful events or hectic days.

What are the symptoms of a tension headache?

These are common symptoms of a tension headache:

• Slow onset of the headache
• Head usually hurts on both sides
• Pain is dull or feels like a band or vice around the head
• Pain may involve the back part of the head or neck
• Pain is usually mild to moderate, but not severe

The symptoms of tension headaches may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How are tension headaches diagnosed?

Tension headaches are mainly diagnosed based on the symptoms you report. A thorough medical exam, which may include other tests or procedures, may be used to rule out underlying diseases or conditions.

Tracking and sharing information about your headache with your healthcare provider helps make an accurate diagnosis.

Questions commonly asked during the exam may include:

• When do headaches occur?
• What is the location of the headache?
• What do the headaches feel like?
• How long do the headaches last?
• Have there been changes in behavior or personality?
• Do changes in position or sitting up cause the headache?
• Do you have trouble sleeping?
• Do you have a history of stress?
• Have you had a head injury?

If the history suggests tension headaches and the neurological exam is normal, no further testing may be needed. But, if the headache is not found to be the main problem, then other tests may be needed to determine the cause such as:

• Blood tests. Various blood and other lab tests may be run to check for underlying conditions.
• Sinus X-rays. An imaging test to check for congestion, infection, or other problems that may be corrected.
• Magnetic resonance imaging (MRI). A procedure that uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in the body.
• Computed tomography scan (also called a CT or CAT scan). An imaging procedure that uses X-rays and a computer to make horizontal images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.

How are tension headaches treated?

The goal of treatment is to stop headaches from occurring. Good headache management depends on reducing stress and tension. Some suggestions include:

• Going to sleep and waking at the same time each day
• Exercising regularly each day for at least 30 minutes
• Eating regular meals without skipping any, especially breakfast
• Avoiding headache triggers, such as certain foods and lack of sleep
• Resting in a quiet, dark environment as needed
• Stress management (yoga, massage, or other relaxation exercises)
• Medicine, as recommended by your healthcare provider

Can tension headaches be prevented?

Identifying and avoiding headache triggers may prevent a tension headache. Maintaining a regular sleep, exercise, and meal schedule is also helpful. If tension headaches occur regularly or frequently, therapies such as cognitive-behavioral therapy, relaxation therapy, or biofeedback may reduce or eliminate headaches. Talk to your healthcare provider about medicines to prevent tension headaches.

When should I call my healthcare provider?

A severe headache that is the “worst headache ever” requires immediate attention.

Key points about tension headaches

• Tension headaches are the most common type of headache.
• Tension headaches typically do not cause nausea, vomiting, or sensitivity to light.
• Tension headaches affect both sides of the head, come on slowly, and are described as a tight band or vice around the head.
• Lifestyle changes including regular sleep, exercise, and meal schedules can reduce or prevent headaches.
• Discuss medicines to treat or prevent tension headaches with your healthcare provider.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Tension-type headache

BMJ. 2008 Jan 12; 336(7635): 88–92.

, chief¹ and , director ²

Elizabeth Loder

¹Division of Headache and Pain, Department of Neurology, Brigham and Women’s/Faulkner Hospitals, Harvard Medical School, Boston, MA, USA

Paul Rizzoli

²Graham Headache Center, Faulkner Hospital, Boston, MA, USA

¹Division of Headache and Pain, Department of Neurology, Brigham and Women’s/Faulkner Hospitals, Harvard Medical School, Boston, MA, USA

²Graham Headache Center, Faulkner Hospital, Boston, MA, USA

Correspondence to: Dr E Loder, 1153 Centre Street, #4970, Boston, MA 02130, USA gro. srentrap@redoleThis article has been cited by other articles in PMC.

Summary points

• Episodic tension-type headache is the most common cause of headache in the general population and is usually self managed

• Chronic tension-type headache may be highly disabling and often prompts medical consultation

• Diagnosis is clinical, based on widely accepted and validated criteria

• Peripheral factors are implicated in episodic tension-type headache, whereas central factors probably underlie chronic tension-type headache

• Simple analgesics, especially aspirin, are used for acute treatment

• Amitriptyline and biofeedback assisted relaxation training have the best evidence of effectiveness for headache prevention

Tension-type headache is a neurological disorder characterised by a predisposition to attacks of mild to moderate headache with few associated symptoms. The diagnosis is based on the history and examination. Over the past few decades research on headache has centred on migraine, and much of the best quality evidence for the treatment of tension-type headache is decades old. Some consensus based treatment guidelines are available (see Additional Educational Resources box towards the end of this article). Treatment has changed little over the past two decades. Many patients self treat acute attacks and seek advice when attacks become frequent or chronic. This review focuses on how to identify and manage patients who require medical advice about acute attacks and preventive treatment to minimise further attacks.

What is tension-type headache?

Box 1 summarises the criteria for tension-type headache outlined in the second revision of the international classification of headache disorders, in which such headache is classified according to whether it is episodic or chronic and whether muscle tenderness is present.¹

Box 1 Diagnostic criteria for tension-type headache*

• (A) At least 10 episodes fulfilling the criteria B-D:

• (B) Headache lasting from 30 minutes to 7 days

• (C) Headache has at least two of the following characteristics:

• • Bilateral location

  • Pressing/tightening (non-pulsating) quality

  • Mild or moderate intensity

  • Not aggravated by routine physical activity such as walking or climbing stairs

Infrequent episodic tension-type headache

Frequent episodic tension-type headache

Chronic tension-type headache

*Adapted from the second revision of the international classification of headache disorders¹

What causes tension-type headache?

The underlying cause of tension-type headache is uncertain. Activation of hyperexcitable peripheral afferent neurons from head and neck muscles is the most likely explanation for episodes of infrequent tension-type headache.² Muscle tenderness and psychological tension are associated with and aggravate tension-type headache but are not clearly its cause.² Abnormalities in central pain processing and generalised increased pain sensitivity are present in some patients with tension-type headache.³ Susceptibility to tension-type headache is influenced by genetic factors.⁴

Who is at risk of tension-type headache?

The mean lifetime prevalence of tension-type headache in adults, based on pooled results from five population based studies, is 46% (range 12-78%).⁵ Children are often affected, but prevalence peaks at age 40-49 years in both sexes.⁶ The female to male ratio is about 5:4 and increases as headaches become more chronic. The prevalence of episodic tension-type headache increases with educational level. ⁷

Chronic tension-type headache is less common, affecting about 3% of the general population but accounting for over half of those who have headache more than 180 days a year.⁸ A substantial minority with tension-type headaches lost work time or had reduced productivity as a result of headache, leading to a considerable public health burden.⁹

How does tension-type headache present?

People with infrequent episodic tension-type headache are unlikely to seek medical advice. As the frequency of tension-type headache increases so commonly does the severity of the pain and the likelihood that the patient will present for treatment; younger patients are also more likely to consult.¹⁰ Usually patients report a mild to moderate, bilateral sensation of muscle tightness or pressure lasting hours to days and not associated with constitutional or neurological symptoms. Patients may simultaneously describe and indicate the location of the pain (the “band around the head”) (figure).

Patient with tension-type headache indicating location of his headache pain

Patients with chronic tension-type headache are more likely than those with the episodic type to seek medical care. Often the patient has a history of episodic headache, but consultation is delayed until frequency and disability are high. In one study, two thirds of patients who presented with chronic tension-type headache had had daily or near daily headache for an average of seven years before consultation. Most continued to function at work or school, but performance was substantially impaired. Almost half had severe anxiety or depression, and affective distress predicted functional impairment.¹⁰

It can be difficult to distinguish tension-type headache from other causes of headache, especially migraine or headache disorders due to neck problems. Both migraine and tension-type headache have chronic forms, and, as headaches become more frequent, the characteristic features of migraine disappear and severity tends to decrease. The muscle tenderness of tension-type headache may involve the neck, leading patients and physicians to assume that some sort of disorder of the neck is the cause of the headache. Medication overuse headache also may present as a chronic daily or near daily pattern of relatively non-descript headache. The amount, type, duration, and frequency of medication use needed to cause overuse headache is not clearly established, and probably varies among individuals. The diagnosis should be considered in patients taking opioid or combination analgesics for an average of 10 or more days a month, or simple analgesics for an average of 15 or more days a month.¹¹¹

What examinations, tests, or imaging studies are useful?

If a patient meets the criteria for tension-type headache and has a normal result on neurological examination, further diagnostic testing generally is not helpful. Manual palpation of pericranial muscles is a valuable but underused physical examination technique: pericranial muscle tenderness on palpation is the most common abnormal finding in tension-type headache, although its absence does not rule out tension-type headache (box 2). ¹ Careful funduscopic examination for papilloedema or other abnormalities is important for evaluating whether secondary headaches are present. Appropriate testing depends on the suspected diagnosis; a history of a “normal head scan” does not exclude all serious causes of headache. Box 3 lists some situations in which neuroimaging should be considered for non-acute headaches.

Box 2 How to evaluate muscle tenderness in tension-type headache*

Pericranial tenderness is easily recorded by manual palpation by small rotating movements and a firm pressure (preferably aided by use of a palpometer) with the second and third finger on the frontal, temporal, masseter, pterygoid, sternocleidomastoid, splenius, and trapezius muscles. A local tenderness score from 0-3 on each muscle can be summated to yield a total tenderness score for each individual. It has been shown that, by using a pressure sensitive device that allows palpation with a controlled pressure, this clinical examination becomes more valid and reproducible. However, such equipment is not generally available to clinicians, and clinicians are advised to simply perform the manual palpation as a traditional clinical examination.

Palpation is a useful guide for the treatment strategy. It also adds value and credibility to the explanations given to the patient.

*Taken from the second revision of the international classification of headache disorders¹

Box 3 Recommendations for neuroimaging

According to guidelines issued by the European Federation of Neurological Societies, neuroimaging for non-acute headache is warranted in the situations (evidence from observational studies or methodologically weak randomised trials) listed below.

• Atypical pattern of headaches

• History of seizures

• Neurological signs or symptoms

• Symptomatic illness such as acquired immunodeficiency syndrome, tumours, or neurofibromatosis

Who should be treated?

People with infrequent headache and good results from occasional use of non-prescription drugs do not need medical treatment, although some may want reassurance that this approach is reasonable. In general, medicine for acute headache should be used no more than two to three days a week; this is to minimise the chance that medication overuse or “rebound” headache will develop.¹¹¹ Medical treatment is indicated for patients whose intake of non-prescription drugs regularly exceeds this level because of the chance that medication overuse headache or other complications will develop.¹¹ Patients who are disabled by headache or whose frequency or severity of headache steadily escalates also need medical supervision. Whether treatment prevents or delays the transition from episodic to chronic tension-type headache is not known.

How should tension-type headache be treated?

Treatment for tension-type headache includes acute therapy for individual attacks and preventive treatment to minimise the number of attacks that occur. Acute and preventive treatment can be used together.

Individual headache attacks

Acute attacks of tension-type headache are usually treated with simple analgesics. Oral aspirin 500-1000 mg has the best evidence of effectiveness in randomised controlled trials. In one study, 75% of participants reported relief of headache two hours after aspirin and success was not affected by pain intensity at the time of treatment.¹² Other non-steroidal anti-inflammatory drugs also are effective, suggesting a class effect. Gastric irritation and occasionally ulceration may complicate treatment with aspirin or other non-steroidal anti-inflammatory drugs, even when they are used intermittently. Evidence for paracetamol (acetaminophen) from randomised controlled trials is mixed. It is probably more effective than placebo, but inferior to non-steroidal anti-inflammatory drugs.¹²¹³

Randomised controlled trials show that combination drugs containing simple analgesics and caffeine are also effective for acute treatment of tension-type headache.^14,15,16 Many drugs used for acute treatment of tension-type headache are available to patients without a prescription, making it difficult for the doctor to monitor use.

Opioids or sedative hypnotics should not be used routinely to treat tension-type headache because they impair alertness and are common causes of overuse and dependence syndromes.¹⁷ Evidence from case-control and cohort studies shows that opioids increase the risk of chronic headache.^18,19,20 Once established, all forms of medication overuse are difficult to treat, and recidivism is common.¹¹ Clinical vigilance to prevent medication overuse is among the most important responsibilities of the doctor caring for a patient with headache.

Preventive treatment

Daily preventive treatment should be considered for patients with frequent headaches or who respond poorly to abortive treatment (pain reducing treatment) alone. The risk of developing more frequent headaches over time is confined principally to patients with at least two headaches a month, and the risk increases exponentially once headaches are weekly, suggesting that preventive treatment should be considered at or before this point. ²⁰ Clinical experience and evidence from case series and cohort studies suggest that the benefit of preventive treatment is diminished when patients are simultaneously overusing abortive treatments. In most cases, withdrawal of medication is advisable before starting preventive treatment.

The best evidence of effectiveness from randomised controlled trials is for amitriptyline, usually in doses of 75-150 mg a day. In addition to its effects on pain, amitriptyline decreases muscle tenderness.²¹ Its effect is augmented by the addition of relaxation or tizanidine.²²²³ Amitriptyline also is effective for migraine prophylaxis, making it a good choice for patients who have both forms of headache.²⁴ Common side effects of amitriptyline include dry mouth, sedation, constipation, and blurred vision. Weight gain is the most common side effect that limits treatment, occurring in up to a quarter of patients.

The headache benefits of amitriptyline are unlikely to stem from its antidepressant actions as the effective dose is generally lower than the dose needed to treat depression. Additionally, other drugs effective against depression, such as selective serotonin reuptake inhibitors, are not effective for tension-type headache.

Compared with amitriptyline, other preventive treatments for tension-type headache have far less rigorous evidence of benefit. There is modest evidence from randomised controlled trials that tizanidine, an α agonist, is helpful for chronic tension-type headache in doses up to 18 mg a day. Side effects include sedation and dry mouth.²⁵ One trial showed benefit for mirtazapine 15-30 mg a day.²⁶ Randomised controlled trials consistently show no benefit for botulinum toxin type A injections into the pericranial muscles.²⁷

Clinical experience suggests that side effects are minimised and compliance increased when preventive treatment is started at a low dose and gradually increased until the target dose is reached. A common practice is to increase the dose at weekly intervals. Headaches naturally wax and wane, so two or three months of preventive treatment at the target dose is recommended before outcomes can be judged. A headache diary provides objective confirmation of treatment effects.

The usual goals of treatment are a reduction in the frequency and intensity of headache and improved response to abortive treatment. The optimal duration of preventive treatment is unknown. In the absence of evidence, a reasonable practice is to continue a successful preventive regimen for six months and then slowly reduce the dose while observing headache frequency. Treatment can be resumed if headaches recur.

Education, lifestyle advice, and non-pharmacological treatment

Little evidence exists to support or refute most dietary or lifestyle recommendations made for tension-type headache, so suggestions to alter lifestyle should be made cautiously.

A systematic review found positive effects for participants receiving biofeedback compared with controls in at least three studies for “tension headache/migraine.”²⁸ A systematic review of manual therapies for tension-type headache concluded that no rigorous evidence existed for such therapies having a positive effect in reducing pain or influencing the natural course of tension-type headache. ²⁹ The preponderance of evidence for acupuncture suggests that beneficial effects of this treatment in tension-type headache are small and probably non-specific.

When is referral to a specialist warranted?

Referral to a specialist should be considered for patients whose headache diagnosis is unclear or who do not respond as expected to treatment. Patients whose headaches are complicated by medication overuse may need the close supervision of withdrawal regimens afforded by specialist care.¹¹ Admission to hospital is rarely necessary. Treatment outcomes are probably improved if patients are referred before medication overuse, daily headache, and expectations of treatment failure have become entrenched.

Specialist headache clinics or treatment units exist in most developed countries, but are difficult to find in less developed areas. Clinicians with a special interest in headache can be found throughout the world, although their training, experience, and medical specialties vary. In the United States, headache medicine is a recognised neurology subspecialty, with certification of practitioners and accreditation of training programmes.

What is the prognosis for tension-type headache?

The prognosis for tension-type headache in the general population is favourable: 45% of adults with frequent or chronic tension-type headache at baseline were in remission when examined three years later, although 39% still had frequent headaches, and 16% had chronic tension-type headache. Poor outcome was associated with the presence of chronic tension-type headache at baseline, coexisting migraine, not being married, and sleep problems. Predictive factors for remission were older age and absence of chronic tension-type headache at baseline.³⁰ The prognosis for patients who need medical intervention or specialist headache care is presumably not so favourable but is difficult to determine because case mix varies considerably from clinic to clinic and country to country.

Methods

We searched PubMed using the terms tension-type headache plus randomised controlled trials (173 hits), systematic reviews (17), meta-analyses (14), and Cochrane database (4). We also searched using the term tension-type headache plus pathophysiology (503) and using the terms risk factors plus tension-type headache and systematic reviews (3) or meta-analyses (0). We searched the “epub ahead of print” sections of the specialist journals Headache and Cephalalgia. The overall quality of evidence varied considerably. It was highest for studies of pathophysiological mechanisms of headache. It was of mixed quality for treatment trials of recently introduced drugs and of low quality for many older drugs and for non-pharmacological treatments (with the exception of biofeedback and some acupuncture studies). Very little evidence of any sort exists on appropriate evaluation, testing strategies, or examination techniques.

Ongoing research

• Few new treatments for tension-type headache are in development. Primary headache disorders have received comparatively little attention from pharmaceutical and academic researchers relative to their prevalence and the disability they cause. The situation is perhaps worst of all for tension-type headache

• Nitric oxide synthase inhibitors are in clinical trials for migraine treatment and may eventually be tested in tension-type headache as well

Unanswered questions

• How do emotional triggers such as such as psychological stress activate the mechanisms of head pain?

• What is different about people who never experience headache?

• What are the specific effects of commonly used non-drug treatments for headache, such as physiotherapy, massage, and exercise?

• When is the optimal time to intervene with preventive treatment for headache?

• What are the mechanisms of medication overuse headache?

Tips for non-specialists

• Most patients in general care who present with headache have either migraine or tension-type headache

• The history of headache features is most important in making a diagnosis; with the exception of pericranial muscle tenderness to manual palpation, physical and neurological examinations should yield normal results in patients with tension-type headache or any abnormalities should be explained by other conditions

• If worrisome examination or historical features are present, secondary headache should be excluded with appropriate testing

• If the distinction between migraine, tension-type headache, and other primary headache is not clear, a headache diary can help to clarify the diagnosis

• Some patients with occasional headaches do not need medical treatment. Others need only simple analgesics for acute headaches. Preventive treatment should be considered when acute treatment is ineffective or overused or if headache occurs more than four times a month

• An important responsibility of the physician is to monitor medication intake to prevent overuse

• Patients who regularly use acute medication for headache more than two to three days a week or whose headaches respond poorly to treatment should be referred to a specialist

Additional educational resources

Educational materials and information about tension-type headache are available to health professionals and patients from the organisations listed below.

Resources on bmj.com

• Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, et al. Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ 2005;331:376-82; doi: 10.1136/bmj.38512.405440.8F

• Fuller G, Kaye C. Headaches. BMJ 2007;334:254-6; doi: 10.1136/bmj.39090.652847.DE

• Østergaard S, Russell MB, Bendtsen L, Olesen J. Comparison of first degree relatives and spouses of people with chronic tension headache. BMJ 1997;314:1092

• Goadsby PJ. To scan or not to scan in headache. BMJ 2004;329:469-70; doi: 10.1136/bmj.329.7464.469

*Organisations that have issued consensus guidelines of relevance to tension-type headache

Notes

We thank Dhirendra Bana and his patient for permission to use the photographs.

Contributors: PR wrote the first draft of manuscript and participated in revising it for intellectual content. EL did the literature search, located articles, and wrote subsequent drafts of the manuscript. Both authors read and approved the final manuscript. EL is the guarantor.

Competing interests: EL is a part time clinical editor for the BMJ. In the past three years, she has received research support, consulting, or speaking fees from Allergan, AstraZeneca, Endo, GlaxoSmithKline, Merck, NMT, OrthoMcNeil, Pfizer, the National Headache Foundation, the American Headache Society, the American College of Physicians, the American Academy of Neurology, and the United Council for Neurologic Subspecialties. PR has received speaking fees from Pfizer.

Provenance and peer review: Commissioned; externally peer reviewed.

References

1. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia 2004;24(suppl 1):9-160. [PubMed] [Google Scholar]2. Ashina M. Neurobiology of chronic tension-type headache. Cephalalgia 2004;24:161-72. [PubMed] [Google Scholar]3. Jensen R, Olesen J. Initiating mechanisms of experimentally induced tension-type headache. Cephalalgia 1996;16:175-82. [PubMed] [Google Scholar]4. Russell MB, Saltyte-Benth J, Levi N. Are infrequent episodic, frequent episodic and chronic tension-type headache inherited? J Headache Pain 2006;7:119-26. [PMC free article] [PubMed] [Google Scholar]5. Stovener LJ, Hagen K, Jensen R, Katsarava Z, Lipton RB, Scher AI, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27:193-210. [PubMed] [Google Scholar]6. Laurell K, Larsson B, Eeg-Olofsson O. Prevalence of headache in Swedish schoolchildren, with a focus on tension-type headache. Cephalalgia 2004;24:380-8. [PubMed] [Google Scholar]7. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA 1998;279:381-3. [PubMed] [Google Scholar]8. Scher AI, Stewart WF, Liberman J, Lipton RB. Prevalence of frequent headache in a population sample. Headache 1998;38:497-506. [PubMed] [Google Scholar]9. Schwartz BS, Stewart WF, Lipton RB. Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occup Environ Med 1997;39:320-7. [PubMed] [Google Scholar]10. Holroyd KA, Stensland M, Lipchik GL, Hill KR, O’Donnell FS, Cordingley G. Psychosocial correlates and impact of chronic tension-type headaches. Headache 2000;40:3-16. [PMC free article] [PubMed] [Google Scholar]11. Dodick, D, Freitag F. Evidence-based understanding of medication-overuse headache: clinical implications. Headache 2006;46(suppl 4):S202-11. [PubMed] [Google Scholar]12. Steiner TJ, Lange R, Voelker M. Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalalgia 2003;23:59-66. [PubMed] [Google Scholar]13. Steiner TJ, Lange R. Ketoprofen (25 mg) in the symptomatic treatment of episodic tension-type headache: double-blind placebo-controlled comparison with acetaminophen (1000 mg) Cephalalgia 1998;18:38-42. [PubMed] [Google Scholar]14. Diener HC, Pfaffenrath V, Pageler L, Peil H, Aicher B. The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Cephalalgia 2005;25:776-87. [PubMed] [Google Scholar]15. Diamond S, Freitag FG. The use of ibuprofen plus caffeine to treat tension-type headache. Curr Pain Headache Rep 2001;5:472-8. [PubMed] [Google Scholar]16. Migliardi JR, Armellino JJ, Friedman M, Gillings DB, Beaver WT. Caffeine as an analgesic adjuvant in tension headache. Clin Pharmacol Ther 1994;56:576-86. [PubMed] [Google Scholar]17. Silberstein SD, McCrory DC. Butalbital in the treatment of headache: history, pharmacology, and efficacy. Headache 2001;41:953-67. [PubMed] [Google Scholar]18. Scher AI, Lipton RB, Stewart W. Risk factors for chronic daily headache. Curr Pain Headache Rep 2002;6:486-91. [PubMed] [Google Scholar]19. Bigal ME, Sheftell FD, Rapoport AM, Tepper SJ, Lipton RB. Chronic daily headache: identification of factors associated with induction and transformation. Headache 2002;42:575-81. [PubMed] [Google Scholar]20. Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 2003;106:81-9. [PubMed] [Google Scholar]21. Bendtsen L, Jensen R. Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia 2000;20:603-10. [PubMed] [Google Scholar]22. Bettucci D, Testa L, Calzoni S, Mantegazza P, Viana M, Monaco F. Combination of tizanidine and amitriptyline in the prophylaxis of chronic tension-type headache: evaluation of efficacy and impact on quality of life. J Headache Pain 2006;7:34-6. [PMC free article] [PubMed] [Google Scholar]23. Holroyd KA, O’Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA 2001;285:2208-15. [PMC free article] [PubMed] [Google Scholar]24. Mathew NT. Prophylaxis of migraine and mixed headache. A randomized controlled study. Headache 1981;21:105-9. [PubMed] [Google Scholar]25. Fogelholm R, Murros K. Tizanidine in chronic tension-type headache: a placebo controlled double-blind cross-over study. Headache 1992;32:509-13. [PubMed] [Google Scholar]26. Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology 2004;62:1706-11. [PubMed] [Google Scholar]27. Schulte-Mattler WJ, Krack P, BoNTTH Study Group. Treatment of chronic tension-type headache with botulinum toxin A: a randomized, double-blind, placebo-controlled multicenter study. Pain 2004;109:110-4. [PubMed] [Google Scholar]28. Stetter F, Kupper S. Autogenic training: a meta-analysis of clinical outcome studies. Appl Psychophysiol Biofeedback 2002;27(1):45-98. [PubMed] [Google Scholar]29. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA. Are manual therapies effective in reducing pain from tension-type headache? A systematic review. Clin J Pain 2006;22:278-85. [PubMed] [Google Scholar]30. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R. Prognosis of migraine and tension-type headache: a population-based follow-up study. Neurology 2005;65:580-5. [PubMed] [Google Scholar]90,000 Chronic migraine

What is chronic migraine?

Chronic migraine – a disease in which the head hurts 15 days a month or more. At the same time, attacks typical for migraine occur at least eight times a month . This is the description given by the III International Classification of Headaches.

How does chronic migraine occur ?

As a rule, before a person develops a chronic migraine, he suffers from more rare attacks (episodic migraine).When the disease becomes chronic, the headache may lose its migraine features. It can become bilateral, compressive rather than pulsating. The accompanying symptoms become weaker – vomiting, phobia and sound. Nevertheless, although chronic migraine is less similar to the classic one, it is also sensitive to specific anti-migraine drugs – triptans.

What is the problem with chronic migraine treatment?

Up to 3-4% of people worldwide suffer from chronic daily or almost daily headache.The main reason for which is chronic migraine. However, it is usually difficult for doctors to diagnose. They take it for a chronic tension headache, believe that the pain is caused by osteochondrosis or insufficient blood supply to the brain (which does not at all correspond to modern scientific ideas about the nature of migraine).

What Really Causes Chronic Migraine?

Large studies were carried out, which revealed that the development of chronic migraine is influenced by:

1. Excessive use of drugs for relieving headaches (pain relievers),
2. overweight,
3. depression, stress and / or increased anxiety,
4. hypothyroidism,
5. increased frequency of episodic migraine attacks.

One of the significant factors in the transition of migraine to chronic migraine is also considered the previous, even for many years, physical or emotional abuse.

However, whether this is all a cause or a consequence of chronic migraine is still under discussion. What is scientifically proven: at the initial stage of the development of chronic migraine, when rare attacks become more frequent, certain biochemical changes occur in the brain. The brain learns pain. If preventive treatment is started at this stage, chronic migraines can be prevented.If more than 6 months have passed since the onset of chronic migraine, the chances of success decrease. Therefore, it is important not to delay treatment.

What if you suspect that migraine attacks are more frequent?

1. Start keeping a headache diary. For example @ Migrebot in Telegram. You need to consider how many days a month you “fall out of life” due to migraines, what medications, including over-the-counter ones, and how much you take, what events preceded the increased frequency of attacks (head injury, started taking a new medication, etc.).etc.). Try to remember how many times a month you had a headache before
2. Contact a specialist. Chronic migraines are much easier to prevent than to cure. Don’t wait until it becomes daily!
3. If you take painkillers with opiates / opioids (codeine, hydrocodone, meperidine, tramadol, oxycodone) and drugs containing butalbital, you will need to stop or reduce their intake.

If the headache has already become chronic

• Do not tolerate headaches, relieve attacks quickly and aggressively (take a sufficient dose of the drug at the beginning of the attack).At the same time, avoid taking the drug of the same class too often. Ask your doctor to advise you on several drugs of different pharmacological groups;
• actively use non-drug methods of treatment;
• if you are overweight, try to get rid of it;
• Ask a specialist for help in the treatment of comorbidities, if any. It is necessary to treat depression, anxiety, sleep disorders.

In the treatment of chronic migraine, openness and honesty between doctor and patient is especially important.Thanks to partnerships, early treatment of developing chronic migraine can give remarkable results.

Literature:

1. “International classification of headaches, 2nd edition (full Russian version)” , 2006, 380 p.
2. Nikitin S.S., Artemenko A.R., Kurenkov A.L. “Treatment of chronic migraine.” // Journal of Neurology and Psychiatry named after S.S. Korsakov. – 2011. – N 5. – S. 85-89.
3. Tabeeva G.R., Yakhno N.N. “Migraine”. // GEOTAR-media. – 2011 .– 624s.
4. Barbanti P., Aurilia C., Egeo G., Fofi L. “Migraine prophylaxis: what is new and what we need?” // Neurol Sci. – 2011. – v.32. – Suppl 1. – S111-115
5. Manack A.N., Buse D.C., Lipton R.B. Chronic migraine: epidemiology and disease burden. // Curr Pain Headache Rep. – 2011. – v. 15. – p.70-78.
6. Rothrock J.F. Migraine “chronification”. // Headache. – 2008. – v.48. – p.181-182
7. Rothrock J.F. “Migraine” chronification “: what can you do”. // Headache. – 2009. – v.49. – p. 155-156

Tension headache – treatment, symptoms, causes, diagnosis

Tension headache is usually diffuse, mild to moderate in intensity, and is often described as a “tight band” sensation around the head. Tension headache (HDN) is the most common type of headache, and yet the causes of this type of headache are still not well understood.

Treatment of tension headache is quite effective. Management of tension headache is often a balance between living a healthy lifestyle, using non-drug therapies, and prescribing adequate medical treatment.

Symptoms

Symptoms of tension headache include:

• Dull, aching headache
• Tightness or pressure in the forehead or sides of the head and back of the head
• Soreness of the scalp, neck and shoulder muscles

Tension headaches are divided into two main categories – episodic and chronic.

Episodic tension headaches

Episodic tension headaches can last from 30 minutes to a week. Episodic tension headaches occur on less than 15 days a month for at least three months. Frequent episodic tension headaches can become chronic.

Chronic tension headaches

This type of tension headache lasts several hours and may be continuous.If headaches occur 15 days or more per month for at least three months, they are considered chronic.

Tension headaches and migraines

Tension headaches are sometimes difficult to distinguish from migraines. In addition, if the patient has frequent episodic tension headaches, then they may also have a migraine.

Unlike some forms of migraine, tension headache is usually not accompanied by visual impairment, nausea or vomiting.And if with a migraine physical activity increases the intensity of the headache, then with a headache, stress loads do not have such an effect. Hypersensitivity to any light or sound can sometimes occur with tension headaches, but these symptoms are uncommon.

Reasons

The causes of tension headaches are not known. Medical experts believed that tension headaches are caused by problems in the muscles of the face, neck and scalp, which in turn are caused by strong emotions, excessive exertion or stress.But research shows that muscle spasm is not the cause of this type of headache.

The most widespread theories hold the theory that people who have tension headaches and possibly have an increased sensitivity to stress have hypersensitivity to pain. Increased muscle soreness, which is a common symptom of tension headache, may be the result of increased overall pain sensitivity.

Triggers

Stress is the most common trigger that causes tension headaches.

Risk factors

Risk factors for tension headache include:

• Gender. Women are more likely to get this type of headache. One study found that nearly 90 percent of women and 70 percent of men experience tension headaches during their lifetime.
• Average age of the patient. The frequency of tension headaches peaks by age 40, although this headache can develop at any age.

Complications

Due to the fact that headaches can bother quite often, it can significantly affect productivity and quality of life in general, especially if they become chronic.Frequent pain can disrupt the usual way of life and overall performance.

Diagnostics

The diagnosis of tension headache is primarily based on medical history and symptoms and neurological examination findings.

Physicians may be interested in answers to the following questions:

• When did the symptoms start?
• Has the patient noticed any triggers such as stress or hunger?
• Were the symptoms continuous or episodic?
• How severe are the symptoms?
• How often do headaches occur?
• How long did you have a headache for the last time?
• What does the patient think reduces symptoms and what makes symptoms worse?

In addition, the doctor is also interested in the following details:

• Characteristics of pain.Is the pain pulsating in nature? Is the pain dull, constant, or sharp?
• Intensity of pain. A good indicator of the severity of a headache is the time the patient can work during a headache attack. Can the patient work? Are there episodes where the headache has led to awakening from sleep or sleep disturbance?
• Localization of pain. Does the patient feel pain all over the head, only on one side of the head, or simply in the forehead or eye socket?

Instrumental examination methods

If the patient has unusual or intense headaches, the doctor may order additional tests to rule out more serious causes of the headaches.

The most commonly used two diagnostic methods are CT (computed tomography) and MRI, which allow visualization of organs and tissues and detect morphological changes.

Treatment

Some patients with tension headaches do not go to the doctor and try to treat the pain on their own. Unfortunately, repeated self-reliance on pain relievers can itself cause severe headaches.

Drug treatment

There is a wide variety of medications, including over-the-counter, pain relief medications, including:

• Pain relievers.Simple over-the-counter pain relievers are usually the first line of treatment for headaches. These include aspirin, ibuprofen (Advil, Motrin IB, others), and naproxen (Aleve). Prescription medications include naproxen (Naprosyn), indomethacin (Indocin), and ketorolac (ketorolac tromethamine).
• Combined preparations. Aspirin or acetaminophen, or both, often combined with caffeine or a sedative in the same medication. Combination drugs may be more effective than drugs with a single active ingredient.
• Triptans and drugs. For people who have both migraines and tension headaches, triptans can effectively relieve headaches. Opiates or drugs are rarely used because of their side effects and high risk of addiction.

Preventive drugs

In order to reduce the frequency and severity of attacks, especially if the patient has frequent or chronic headaches that are not relieved by pain medication, other drugs may be prescribed.

Preventive medications may include:

• Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and nortriptyline (Pamelor), are the most commonly used drugs to prevent tension headaches. Side effects of these drugs may include weight gain, drowsiness, and dry mouth.
• Other antidepressants. There is evidence for the use of antidepressants such as venlafaxine (Effexor XR) and mirtazapine (Remeron) in patients who also do not have depression.
• Anticonvulsants and muscle relaxants. Other drugs that can prevent tension headaches are anticonvulsants such as topiramate (Topamax) and muscle relaxants.

Lifestyle adjustments and home remedies

Rest, ice packs, or prolonged, hot showers can often reduce the intensity of headaches.

Drug-free treatment

• Acupuncture.Acupuncture can provide temporary relief from chronic tension headache.
• Massage. Massage can help reduce stress and relieve tension. It is especially effective in relieving muscle spasms in the back of the head, neck and shoulders.
• Deep breathing, biofeedback and behavioral therapy. A variety of relaxing treatments are very helpful in treating tension headaches, including deep breathing and biofeedback.

Headache, headache, migraine treatment in the medical center

Probably every person has a headache at least once in his life.If the head hurts rarely and not much, then the problem is solved by taking a regular pain reliever, which is dispensed in a pharmacy without a prescription. However, in 10-15% of people, headache can seriously complicate life. Such people cannot fully work, rest, enjoy life. Relationships at work, in the family are broken. Social isolation is on the rise. Along with the increase in the frequency of headaches, the consumption of analgesics increases. It has now been proven that regular, frequent use of pain relievers in itself leads to a new persistent headache.2-3% of the population suffers from daily or almost daily headaches. Chronic headache is very often accompanied by anxiety and depressive disorders.

It was for the purpose of a more detailed study of headaches in the Medical Center “Spine Team” that the Headache Department was created, which specifically deals with the diagnosis and treatment of headaches.

The Department is headed by Yuri Mikhailovich Nemchenko, a neurologist, headache specialist.Yuri Mikhailovich is a member of the Russian, international and American societies for the study of headache. He has been leading patients with headache since 1999.

In the overwhelming majority of cases, the headache is benign, that is, it is not a manifestation of a life-threatening disease … However, it is important not to miss a really dangerous headache.

Signs of a dangerous headache:

1. Increasing intensity of headache.If the pain gets worse over the course of several months, weeks, or days.
2. Onset of a new, unusual, severe headache. A sharp, sudden, severe headache that lasts a few minutes or seconds. Patients often describe it as the worst headache in their life.
3. Headache that occurs during physical exertion, coughing or sexual activity.
4. Changing the habitual headache stereotype. For example, if you have periodically had throbbing pain in your temples throughout your life, and suddenly there was pressing pain in the back of your head.
5. Onset of headache for the first time after age 50.
6. If the headache is accompanied by high pressure, temperature, visual disturbances.
7. Weakness in the limbs, speech disorders, numbness in any part of the body.
8. With headaches, drowsiness, lethargy, confusion are observed.

The Spine Teams Headache Unit focuses on the diagnosis and treatment of headaches. There are more than 10,000 patients in the database of our medical center.The overwhelming majority of them managed to help get rid of headaches or significantly reduce its frequency and intensity. The peculiarity of the treatment at the center is the combination of various approaches to the treatment of pain.

Indications for referral to the Headache Department

All types of headaches, including:

• migraine;

90,033 tension headache;

• cluster headache;

90,033 headaches associated with diseases of the cervical spine;

90,033 pain associated with drug abuse;

90,033 pains of muscle origin;

• post-traumatic headaches.

Headache treatment

Drug treatment meets the requirements of evidence-based medicine, that is, only those drugs are prescribed, the effectiveness of which has been proven in serious clinical studies, and which are included in modern European and American protocols.

In the Headache Department, prescription of drugs is combined with non-drug treatment . So, for example, more than half of the patients on examination reveal painful seals in the muscles of the neck and face, the so-called trigger points .Our center has developed and successfully applied a unique and effective method of treating headaches of muscle origin – therapeutic muscle relaxation.

Posture disorders are directly related to headaches. Scoliosis, tilting the head forward, causes constant tension in certain muscles in the neck and face, leading to headaches. Our center uses posture correction methods to stabilize the spine and relax the muscles.

When headache is combined with anxiety and depressive disorder, antidepressants are prescribed, sometimes a psychotherapist is involved in the treatment of such patients.

In conclusion, I would like to wish you never to experience a headache. But if a headache spoils your life, do not delay, do not drive the pain into an intractable stage. Contact the Headache Department of the Spine Team Medical Center. We guarantee high quality services, optimal prices, excellent equipment and everything you need to make you forget what a pain in your head is. We know everything about her, and we successfully rid our patients of her!

How to contact?

To make an appointment with the specialists of the Headache Department of the Medical Center “Spine Team” in Yekaterinburg, as well as to clarify the full cost of any service, you can always contact our administrator by phone: +7 (343) 300-19-77, 286-80-24 or 286-80-20.

Abuse headache | TN Clinic

Abuse headaches. An ordinary classic tension headache can be complicated by a second drug-induced headache if a person takes painkillers more than twice a week for more than 2 pcs. In this case, it is necessary to treat already two headaches.

Abuse headache. Causes and symptoms

A classic tension headache or a classic migraine may be complicated by a drug-induced headache that develops when 2 or more tablets of any analgesic are taken daily for at least 2 months.This is an abusal headache, manifested by various symptoms – dull pressing pains all over the head, most intense in the morning, a feeling of nausea, fatigue, sleep disturbances and associated distraction, irritability, and a significant decrease in working capacity. Abuse headache in most cases develops when taking combined painkillers, special anti-migraine drugs (triptans), to a lesser extent when using the simplest analgesic drugs – aspirin, analgin, paracetamol and other conventional over-the-counter medicines.

A persistent (chronic) headache in itself can cause disruptions in the physical condition and psychoemotional sphere, therefore, its elimination is very important for maintaining overall health. Abuse headache is characterized by high intensity, characterized by patients as “exhausting and hopeless,” therefore it often leads to the development of depressive conditions, increased anxiety, and a tendency to panic attacks.

Abuse headache.Treatment

Treatment of abusal headache is multi-stage, the first step is the complete and abrupt withdrawal of the drug that caused the headache. Since in this case the patient may have a psychological dependence on taking the pills, the doctor individually selects a substitute drug, as a rule, from another group of analgesics. In addition, other drugs with anti-inflammatory, detoxification, and sedative effects are included in the complex treatment regimen.Abuse headache recedes gradually, and with strict adherence to the rules for taking any, first of all, painkillers, improvement has been observed for several weeks.

Abuse headache is a form of drug dependence that aggravates existing tension headaches or migraines. Treatment consists not only in the abolition of the drug that causes drug-induced headaches, but in the elimination of the primary type of pain, due to which the patient began to use analgesics.

In the probable development of an abusal headache, the following symptoms may speak:

• a person experiences headaches for more than 15 days a month,

• taking painkillers does not bring relief, and often leads to increased pain,

• the number of pills taken per day is increasing.

Abuse headache is combined with an already existing headache and disrupts the usual routine of a person’s life.In order for the condition not to worsen, it is necessary to consult a neurologist who uses not only medical means in treatment, but also auxiliary methods that help to more easily endure the complete cancellation of the usual drug.

Treatment of abusal headache in TN-Clinic

Unlike the methods of treating other types of headaches, in the treatment of abusal headache, the behavior of the patient himself and his attitude to taking medications, primarily analgesics, are of great importance.Therefore, treatment begins with taking anamnesis, finding out the number and frequency of drugs taken, identifying the primary form of headache. Doctors of TN-Clinic have extensive successful experience in treating patients with this kind of addiction, which underlies the appearance of abusal headache.

A treatment program is selected individually for each patient, which is carried out in several stages. First, it is necessary to neutralize the effects of the drug that caused the addiction, then to identify and eliminate the root cause – the headache, for which the person began to take analgesics, and then get rid of the habit of taking painkillers.Thanks to the professionalism of the doctors and the individual approach to each patient at TN-Clinic, the prognosis with proper treatment is always favorable.

Questions left

You can always make an appointment and get detailed information from the specialists of our advisory department by phone:

+7 (495) 210-02-48 +7 (495) 799-02-06

Make an appointment
90,000 “Tension headache: what to do?”

Everyone has experienced a tension headache at least once.It is a tedious, constant pain, pressing or squeezing the head like a hoop, which can last for days or even weeks, reducing the quality of a person’s life. One of the main reasons for this headache is stress and prolonged work at the computer. Most often, knowledge workers suffer from it. How to stop feeling the “iron hat” on your head? Doctor-osteopath Alexander Ivanov told about this in a new article for “BUSINESS Online”.

“Headache is a common complaint when visiting an osteopathic neurologist.”
Photo: pixabay.com

MOST COMMON HEADACHE

Headache is a common complaint when visiting an osteopathic neurologist. Lately, parents often come to me with school-age children who have a headache. Drug treatment of such pains does not suit anyone, because there are many side effects, as they say, one we treat, the other we cripple. Therefore, people are looking for effective and non-drug ways to get rid of headaches. Earlier in my publications, I have already talked in general terms about tension headaches.Today I will give practical guidelines and exercises for getting rid of headaches.

A person experiences pain all over his head, as if it were squeezed with a hoop or a helmet was put on it. The pain appears more often in the afternoon, in the late afternoon, after work or school. The trigger for pain is stress and muscle tension. Occasionally, it is accompanied by nausea. This pain lasts from several hours to a day. The intensity is usually low and the attack is relieved with pain relievers.

CAUSES OF VOLTAGE HEADACHE

Reason # 1. Stress during the day. Psychoemotional stress during the day leads to a malfunction of the anti-pain system, and ordinary nerve impulses from receptors turn into a source of pain. In addition, stress leads to excessive tension in the muscles in the neck and head, which also leads to pain.

Reason number 2. Violation of ergonomics of work. For example, an uncomfortable posture for work, a high table or a low chair will strain the muscles of the shoulder girdle and neck.

Reason number 3. Abuse of gadgets and long work at the computer. This is a common cause of headaches in office workers, students and schoolchildren. Earlier I already had an article about the dangers of using gadgets.

Reason # 4. Uncomfortable pillow and wrong sleeping position. Overextension of the neck muscles during sleep can give tension pain. She usually appears in the morning after waking up. Earlier I also wrote about how to choose a pillow and what position is best to sleep in.

Reason number 5.Physical inactivity, or lack of movement. Impaired blood circulation with lack of movement during the day can also cause tension headaches. This often occurs in office workers during prolonged sitting. Therefore, it is important to do industrial gymnastics and break away from work every 40 minutes.

PREVENTION AND TREATMENT OF VOLTAGE HEADACHE

Prevention of headache follows from the analysis of its causes. Think about what is most likely the cause of your headache.You need to eliminate the cause first. Next, work goes with the muscles of the neck and head – this is the elimination of trigger (starting) muscles. Mild manual therapy (osteopathy) and physiotherapy exercises are important in this work.

However, to identify the cause and make a diagnosis, in any case, you need to see a doctor. This could be a neurologist or an osteopathic neurologist. For the treatment of tension headaches, it is advisable to use non-drug methods: osteopathy, therapeutic massage, acupuncture, physiotherapy exercises.

GYMNASTICS FOR VOLTAGE HEADACHES ACCORDING TO IVANOV

1. Place both hands on the sides of the scalp (temples, crown). The fingers are spread out like a rake. Make light shaking movements of your head back and forth so that your hands slide over your head and massage the scalp. Exercise relaxes the frontal-occipital aponeurosis. We carry out one minute.

Photo courtesy of Alexander Ivanov

2.You can use a wooden comb to massage your head. Comb your hair in all directions with a comb. This will improve blood flow and relax the aponeurosis of the head. We carry out one minute.

Photo courtesy of Alexander Ivanov

3. Exercise “slider”. Place one hand on your forehead and the other on the back of your head. Move your hands first in different directions up and down, and then in one direction up or down. We carry out one minute.

Photo courtesy of Alexander Ivanov

4. Grasp your head with your hands tightly from the sides. Further, “sticking” to the scalp, make it shift in different directions to the left and right, back and forth, clockwise and counterclockwise, along an oblique line. We carry out one minute.

Photo courtesy of Alexander Ivanov

5. Tapping the head.With the phalanges of the fingers, we lightly tap the head along the sagittal seam (strictly in the middle), then along the entire head from the forehead to the back of the head. We carry out one minute.

Photo courtesy of Alexander Ivanov

Exercise may have contraindications. Check with your doctor before performing.

Be healthy!

Sincerely yours,

Ivanov Alexander Alexandrovich – Candidate of Medical Sciences, osteopath, neurologist, naturopath, member of the Russian osteopathic association, popularizer of a healthy lifestyle and a conscious approach to health.

The opinion of the author may not coincide with the position of the editorial office

Photo on the announcement provided by Alexander Ivanov

The opinion of the authors of blogs does not necessarily reflect the opinion of the editorial staff

Types and causes of headaches – About health

Headaches

Headaches are not as simple as they might seem at first glance. Their different types have their own characteristics, evolve with their own unique mechanisms and have their own treatment.

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The most common types of headaches.

There are more than 150 types of headaches, but the main ones are:

1. Tension headache.

👉🏻 The most common type of pain among adolescents and adults. More common in women, mild to moderate intensity, and can last from a few minutes to several days. Patients describe it as being compressed by a hoop or tight cap.

2. Migraine.

👉🏻 Often described as stabbing, throbbing, one-sided pain. It can last from 4 hours to 3 days and usually occurs 1 to 4 times a month. Is quite intense. Along with pain, many patients may have a so-called aura, which manifests itself as increased sensitivity to light, noise, odors, nausea or vomiting, loss of appetite, discomfort or abdominal pain. Prevention of these types of pain usually requires medication.

3. Cluster headaches.

👉🏻 This type of headache is the most severe. The pains are characterized as intense burning and piercing, often around the eye. The intensity can be so pronounced that during the attack, the patient cannot find a place for himself. On the side of the pain, there may be lacrimation, redness of the eye, constriction of the pupil. There may be nasal congestion on one side and a runny nose. During exacerbations, attacks can occur several times a day, and the acute period itself lasts from 2 weeks to 3 months.Each attack lasts from 15 minutes to 3 hours. Patients may wake up at night when an attack occurs. The pain can disappear completely (doctors call it remission) for months or even years. Men are 4 times more likely to develop this type of pain than women.

Other causes of headaches can be:

🔸 colds

🔸 trauma

🔸 diseases of the ear, throat, nose

🔸 stress

🔸 excessive alcohol consumption

🔸 uncomfortable sleeping position

🔸 improper and irregular power supply

🔸 insufficient fluid intake (dehydration)

🔸 abuse of anesthetic (!) Drugs

🔸 headaches associated with the female cycle or menopause

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In some cases, headaches are a symptom of quite serious and sometimes dangerous diseases, both from the spine, brain and internal organs.