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Tension Headaches

It is estimated that 75% to 90% of all persons who complain of chronic or frequent headaches suffer from tension headaches. They are the most common type of primary headache, and while they share some characteristics with the more serious migraine, they also display certain distinct differences that set them apart.

Some experts believe that tension headaches and migraines represent two ends of a common spectrum, and that migraines, which are severe but irregular in occurrence, sometimes progress or transform to the less severe, but more frequent, tension-variety headache.

Physical Findings
When a patient is examined by the physician, there are often findings of muscular tenderness. This is often present in the areas of the neck, at the base of the skull, shoulders, upper arms, and the jaw and face. Some people may show signs of clenching the teeth. The scalp and forhead may also be painful when palpated. The neurological examination is usually normal.

Causes

Like migraines, tension headaches seem to be more common in women than in men. Unlike migraines, which often make their initial appearance during adolescence, tension headaches usually begin in middle age. As such, their onset often is equated with the development of adult stresses, anxieties and depression that can characterize mid-life. The name "tension headache" therefore can be said to describe a response by the body to emotional strains and pressures, rather than to excessive muscular tightness and resultant constriction of the scalp arteries, as was once widely presumed. In many such cases, researchers have found that patients complaining of frequent headaches, which are generally not migraines, also exhibit varying degrees of depression, anxiety and worry.

Despite these findings, many physicians and researchers still believe strongly that stress-induced muscular tension in the head, neck and shoulders can bring on tension headaches. This is supported by evidence of muscular tenderness in areas of the neck, the base of the skull, scalp, forehead, face, jaw, shoulders or upper arms in many tension-type headache sufferers. Others show signs of pronounced clenching of the teeth, suggesting that problems related to the temporomandibular joint (TMJ) are causative factors, along with cervical disorders, such as arthritis or degenerative disease of the neck and/or spine, leading to chronic muscular contraction.

Signs and Symptoms

The typical tension headache is one that produces a dull, steady, achy pain on both sides of the head. This contrasts which the classic symptom of migraine, which is severe, throbbing or pulsating pain, usually on one side of the head.

However, a small proportion of tension-headache patients report that their pain, when at its worst, does at times develop a pulsating quality, a phenomena which physicians sometimes call a tension-vascular headache. This represents one more area where the distinction between tension headaches and migraines becomes somewhat blurred, and tends to support the theory that the two headache types are not actually separate conditions, but opposite ends of common spectrum of primary headache activity.

Many tension headache sufferers describe their pain as producing a sensation of pressure or tightness around the head, as though a band were pulled tightly around it; others compare the feeling to having their head clamped in an ever-tightening vise. The pain usually begins gradually and increases steadily over a period of hours, but while severe and distracting, it rarely becomes overwhelming and physically debilitating, as in a migraine.

Diagnosis

Physicians typically diagnose tension-type headache on the basis of observed differences between its symptoms and those that characterize migraines, cluster headaches and other kinds of chronic craniofacial pain. With all patients who complain of abnormally frequent head pain, however, the physician usually will perform a thorough physical examination, including a medical history and one or more diagnostic procedures, to rule out any underlying serious medical problems that may be producing the headaches as a secondary symptom.

Treatment

Many patients with tension headaches do not seek medical attention or advice, instead choosing to treat themselves with nonprescription analgesics and over-the-counter pain medications.

While this works for some people, others, whose tension headaches are severe enough or sufficiently frequent to compel them to seek professional treatment, obtain relief through a course of doctor-prescribed antidepressant or anxiety-reducing medications, such as amitriptyline, nortriptyline or desipramine.

When headaches are severe, symptomatic treatment with aspirin, acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful. In such cases, care must be taken to avoid medication overuse, as this can lead to "rebound headaches." Due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.

Some patients report beneficial results from secondary treatments that help reduce the effects of stress and tension on the body, such as massage, meditation and the use of biofeedback techniques. In some cases, patients also may benefit from the effects of psychotherapy as a means of learning how to cope with stress and tension.

Headache, Tension Headache, Causes, Signs and Symptoms, Diagnosis, Treatment reprinted with permission from neurologychannel.com
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