Published in Panorama
Tackling Tension Headaches
About 75% to 90% of frequent or chronic headache sufferers are plagued by tension headache, the most common type of headache, second only to migraine. These headaches are not caused by disease, and are often considered to be "normal" headaches. Tension headaches may occur at any age, though they are commoner in adolescents and adults and affect women more than men. If a headache occurs twice or more in a week for several months or longer, it is deemed to be chronic.
While tension headaches might mimic migraine symptoms in some respects, they also display certain distinct characteristics that set them apart from migraine or any other types of headaches. In fact, certain studies reveal that the more severe migraine headaches may actually transform to the less severe but more frequent tension headache, says Dr.Sasikumar.K., Specialist Neurologist, Al Musalla Medical Centre, Dubai.
It is not longer accepted that that tension headaches are due, entirely to over-contraction of the muscles covering the scalp and back of the neck. Because all types of chronic headache may give rise to increased muscle tension and individuals with tension headaches often describe the continuous squeezing discomfort even when completely relaxed. However, this continues to be a very common cause of tension headaches - the contraction of neck and scalp muscles. This contraction is itself a response to anxiety, depression and stress, reveals Dr.Sasikumar. Also, any activity which involves the head being held in one position for a long period of time without moving, as while working on the computer, can bring on this type of headache.
Abnormally craning the neck while sleeping, can also bring on a bout of tension headache. It is also believed that these headaches probably occur due to changes in brain chemicals which trigger pain from nerves and blood vessels surrounding the brain. This mechanism is similar to the one that causes migraines.
While tension headaches may be a response by the body to emotional and mental strains and pressures, Colds, nasal congestion, flu, sinus infection, abuse of caffeine, excessive smoking and drinking, significant amounts of eye strain and fatigue can be other factors triggering tension headache, explains Dr.Sasikumar.
Symptoms of tension headache include dull, pressure-like pain, worse in the scalp, temples and back of the neck, generally with pains all over the head, worsened by stress, fatigue, glare, noise and other triggers. Dr.Sasikumar elaborates, “The patients will have a tight band like feeling around the head which will be there throughout the day but more in the evening. These individuals are usually fresh in the morning and by evening they get the headache. They are then unable to work properly and they may be having the problem everyday! It may be present everywhere in the head but more prominently in the vertex area. This is a characteristic feature of tension headache. The patient will have difficult in falling asleep, feel chronic fatigue and will complain of general aches and pains. However, nausea and vomiting are not features of tension headaches, usually. On very rare occasions, some individuals with tension headache, may have the throbbing, pulsating headache usually associated with migraine.”
Some people may exhibit symptoms of both tension and migraine headaches, reveals Dr.Sasikumar. For instance, the headache may be worsened by bright light or loud noise, typically associated with migraine. On the other hand, the patient might also have a persistent, nagging headache, typical of the tension type.
How does one differentiate before tension headaches and migraine? Dr.Sasikumar explains, “Tension headaches normally affect both sides of the head, in a diffuse manner. The pain is dull, aching, with a feeling of being squeezed or of a sensation of something tight across the head. The onset of tension headaches is more gradual than in migraine. Very often the sufferers may experience the pain almost everyday though at varied intensity in the case of tension headaches.”
An acute tension headache may last for between a few hours to a day or two. But chronic tension headaches persist for part or all of the day for most days of the week. The intensity of the pain may however, fluctuate during this period.
Diagnosis of tension headache is primarily done from clinical examination and history taking, explains Dr.Sasikumar. Such an examination would often reveal muscular tenderness in the areas of the next, base of the skull, on the scalp, forehead, jaw, shoulders and upper arm.
If the headache is mild or moderate and is not associated with any other symptoms and responds well to simple medication or home remedy within a few hours, does not require any further examination. On the other hand, if the headache is severe, persistent, recurrent and associated with other abnormal symptoms, then it needs to be investigated further to exclude other serious medical problems that may be producing headaches as a secondary symptom. In such an event CT Scan, MRI or EEG may be ordered before concluding that the headache is truly the tension type, emphasizes Dr.Sasikumar.
These additional investigative measures may also be required to allay the fears of patients, reveals Dr.Sasikumar. “Since tension headaches can be severe and last for a long time, this often arouses the suspicion in the patients that something more sinister like a brain tumour could be at the root of the problem. However, this is extremely rare and fewer than two patients in every 1000 with tension headache will be found to have a brain tumour. But we have the patients investigated if we feel we can provide them psychological respite and even help them in bringing their tension and anxiety levels down”
The objective of treatment is to relieve the symptoms and more importantly, prevent these headaches from occurring at all in the first place, emphasizes Dr.Sasikumar. A holistic approach to the problem is therefore required and this includess Stress management strategies, yoga and meditation, opines Dr.Sasikumar. While pain relievers may be taken occasionally, it does not provide a real solution to the problem of tension headaches. On the contrary, frequent use of painkillers may actually result in rebound headaches on days when the medications are not taken! So such over-the-counter analgesics and painkillers are best avoided, advices Dr.Sasikumar.
Other therapeutic measures include keeping appropriate pillow while sleeping, giving sufficient exercise to the head and neck regions while working on the computer or such other activity that may require the individuals to maintain a fixed posture for prolonged periods of time, getting adequate rest and sleep and abstaining from trigger-inducing factors as excessive smoking, drinking or taking caffeine containing bevereges. Chronic headache sufferers may have to modify lifestyle habits and allow sufficient time for exercising and relaxing. Headache sufferers may also benefit from psychotherapy as a means of learning how to cope with stress and tension.