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Symptoms of Tension-Type Headache
The Diagnosis of Tension-Type Headache
The Causes of Tension-Type Headache
Treatments for Tension-Type Headache - Drug Therapy
Treatments for Tension-Type Headache - Non Drug Therapy
Tension-Type Headache Websites
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pain on both sides of the head |
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pressing/tightening quality ("like a tight belt
around my head") |
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perhaps a mild degree of photophobia (sensitivity
to light) or phonophobia (sensitivity to sound) |
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tight and tender neck shoulder muscles |
The diagnosis of a tension-type headache is only based upon
the patient's description of the headache along with a normal neurological
examination. The International Headache Society (IHS) criteria include:
- At least 10 previous attacks that fulfill Items 2 - 4 below
- Headache attacks last 30 minutes to 7 days (untreated or unsuccessfully
treated)
- At least two of the following:
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bilateral (both sides of the head) |
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pressing/tightening quality |
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mild or moderate intensity (may inhibit but does
not prohibit activities) |
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not made worse by walking stairs or similar routine
physical activity |
- During headache, both of the following:
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no nausea or vomiting |
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photophobia (sensitivity to light) and phonophobia
(sensitivity to sound) are absent, or one but not the other
is present |
- History, physical and neurologic examination do not suggest a brain
tumor, infection, or blood vessel abnormality (very rare)
Although neurological examination is normal, the majority of patients
with tension-type headache have tight muscles in their temples, neck and
shoulders. Some have poor movement of the neck.
The causes of tension-type headache are controversial. Prior to 1998,
when the International Headache Society's (IHS) new classification schema
was developed, this headache syndrome was called muscle contraction headache
because most experts believed that the underlying cause of this headache
was tight and spastic muscles in the shoulders, neck, and head. Today
some experts continue to believe that muscle spasm causes the pain, but
others believe that brain chemicals and stress/psychological problems
may also play a role. Importantly, the name tension-type headache does
not imply that the headache is thought to be due to primarily a psychological
problem.
Tension-type headache is much more common than migraine headache. It is
thought that up to 60-70% of people suffer from a tension-type headache
every year.
All tests are normal in tension-type headache. Like migraine, there is
no reason to have a brain MRI or CT scan if the history and examination
are consistent with uncomplicated tension-type headache.
Drug therapy is often recommended for tension-type headache. Drugs for
headache are divided into two types:
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abortive/symptomatic medications |
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prophylactic medications |
Unlike migraine headache, however, many patients with tension-type headache
do not experience excellent pain relief from drugs. For these patients,
non-drug therapy may be more important.
Abortive/symptomatic medications
are those drugs that are taken at the onset or during a headache attack
in the hopes of stopping the headache from occurring or decreasing associated
symptoms. When prescribing abortive/symptomatic medications, it is very
important to remember the following points:
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Each patient is different; it is not possible to predict
whether a particular person will respond favorably to a drug. |
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If abortive/symptomatic medication is used excessively,
the development of
Rebound Headache Syndrome can result. (Rebound
headache means headache that is actually worsened by the overuse
of short-acting abortive medication). Some authorities recommend
that a patient take no more than 10 doses of abortive/symptomatic
headache medication per month. Others allow more but become very
concerned when abortive/symptomatic drugs are needed more than a
few times each week. |
Abortive/symptomatic headache medications include:
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over-the-counter analgesics (such as aspirin, acetaminophen, ibuprofen, naproxen, etc.) |
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prescription nonsteroidal anti-inflammatory drugs
(such as diclofenac, ketorolac, etc.) |
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barbiturates (such as butalbital) |
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ergots (such as ergotamine or dihydroergotamine) |
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antiemetics (such as prochlorperazine) |
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"muscle relaxants" (such as Flexeril, Soma,
etc.). (Note that these drugs do not actually relax skeletal muscles
directly, but rather are analgesic [pain-relieving] drugs that act
on a patient's brain.) |
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opioids (such as meperidine, morphine, etc.) |
Prophylactic headache medications
are those drugs that are taken every day, regardless of whether a headache
is being experienced, in the hopes of preventing headache attacks. These
daily medications should only be prescribed when patients have frequent
headaches (e.g., three or more times per month) that are significantly
interfering with quality of life.
When prescribing prophylactic headache medication, it is very important
to remember the following points:
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every tension-type headache patient is different;
response to a drug cannot be predicted |
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only one drug should be prescribed at a time |
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most drugs should have careful dose adjustment. The
first dose is relatively low, and the dose is gradually increased
if a headache occurs and if no intolerable side effects are experienced
by the patient.. |
Prophylactic medications for tension-type headache include:
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antidepressants (such as amitriptyline, nortriptyline,
desipramine, doxepin, venlafaxine, etc.) These drugs act on headache
independent of their effects on depression. They typically work
for headache at lower doses than are needed to treat affective disorders;
the tricyclic antidepressant drugs also may improve sleep, which
is often disturbed in headache patients. |
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alpha-2 adrenergic agonists (such as tizanidine) |
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opioids |
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some physicians try gabapentin for these headaches |
Biofeedback
Many studies have shown biofeedback to be very effective treatment for
tension-type headache.
Acupuncture
Some patients may obtain benefit from acupuncture.
Physical Therapy
Studies have shown that aerobic conditioning (getting in shape) can reduce
the amount and intensity of tension-type headaches. Also, some patients
find that techniques that may reduce the degree of muscle tension in the
neck and shoulder musculature can reduce the frequency of headache; methods
include trained stretching exercises, osteopathic manipulation, and craniosacral
manipulation.
TENS (Transcutaneous Electrical Nerve Stimulation)
Some patients report that applying a transcutaneous nerve stimulation
device on their neck and shoulder muscles helps with tension-type headache.
Stress Management
Many studies have found that stress is a common trigger for tension-type
headache (in over 60% of patients). Techniques that help relieve stress,
such as relaxation, imagery, and even yoga, have been shown in studies
to be very effective.
Trigger Point Injections
Some patients report benefit from trigger point injections. A needle is
inserted directly into a specific tender site within a muscle. A variety
of trigger point injection techniques are used; some doctors just insert
a needle, others inject local anesthetic (like Novocaine), and others
inject a safe form of botulinum toxin.
Headache/Pain Clinic Treatment
Most often, tension-type headache patients can be successfully managed
by one physician, without the need for a comprehensive pain clinic treatment.
However, some patients with severe headaches that fail to respond to routine
measures may need a multidisciplinary approach involving several headache
specialists, which may be provided in headache and pain clinics.
American Family Physician [Journal]: Tension-Type Headache
Mayo Clinic: Tension-Type Headache
National Headache Foundation: Headache Types - Tension-type
National Institutes of Health: Headache
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