Tension headaches

Is stress causing you that headache? If so and left untreated, it can occur again and again leading to anxiety and depression.

Tension headaches

What is a tension headache?

A tension headache is a constant dull pain felt all over the head in response to stress or an untoward situation. This is the commonest type of headache seen and affects people globally. It can occur again and again, leading to anxiety and depression if left untreated.

Causes for tension headache

Stressful situations, hunger, muscle strain, fatigue and depression can trigger this type of headache.

But, experts are unsure about what exactly leads to a tension headache. Nevertheless, they blame it on changes in brain chemicals.

Symptoms and signs of tension headache

  • The onset is slow or sudden. The pain is dull, not throbbing and felt all over the head, more so at the temples or the back of the head and neck. Sufferers describe the pressure as a vise-like grip on the head.
  • Generally, the pain is not severe and one can function at work or a social situation, however, for some the pain is bad and lasts for a long time.
  • A tension headache can last from 30 minutes to 7 days.

Classification of tension headaches

It is categorised on the basis of frequency of headaches.

  • Infrequent episodic: This is when you get a headache in less than once a month or fewer than 12 headaches a year. The pain is mild to moderate and there may be sensitivity to light and sounds, but not both and the pain does not get worse after physical activity.
  • Frequent episodic: Here the pain is present more than once a month but fewer than 14 days a month. Other symptoms are the same as mentioned above.
  • Chronic: In this case, you have pain for more than 15 days a month or more than 180 days a year. It may be accompanied by nausea but not vomiting. It is frequently seen in patients suffering from anxiety or depression. It may be confused with a migraine.

Diagnosing tension headaches

Based on the description of the headache and a general examination, your doctor can diagnose a tension headache. A headache diary detailing the date, time, type and duration of pain and your actions and moods is of assistance when arriving at the diagnosis.

To rule out serious conditions like brain haemorrhage, a CT scan or MRI may be advised. In some cases, EEG or a lumbar puncture (in case of suspected meningitis) is needed.

Treatment for tension headaches

i) Drug therapy: Common over-the-counter drugs (OTC’s) like Aspirin, Ibuprofen, Naproxen and Acetaminophen can aid pain relief in the case of tension headaches. Combinations of some drugs for e.g. Aspirin, Acetaminophen and caffeine are popular. Limit taking these drugs to three times a week, as taking them more often can result in rebound headaches when the affect of the drug wears off.

Prescription drugs are used when the OTC’s fail to act or cause side effects like rebound headaches when taken too often. They include

  • Antidepressants – Amitriptyline
  • Anti-anxiety drugs – Buspirone
  • Seizure drugs – Topiramate
  • Muscle relaxants – Tizanidine

ii) Cognitive behavioural therapy is another useful method to tackle tension headaches.

iii) Biofeedback (the process of becoming aware of various physiological functions) is advised as an alternative or supplement to medication.

Written by Dr Nisreen Nakhoda, general physician

Photograph via sxc.hu