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Tension headaches, also known as stress headaches, are pain, pressure, or discomfort felt in and around the head, scalp, or neck. The mild to moderate pain is characterized by tightness in these areas and it’s often described as a clamp squeezing the skull or a tight band around the head. Tension headaches are the regarded as the most common types in adults and older teens.
Tension headaches causes are not well-understood but they may occur when neck and scalp muscles become tense, or contract. This tension or contraction may be due to stress, depression, head injury, or anxiety. Activities that cause the head to held in place for a long time without moving can cause a tension headache. Such activities include typing or other computer work, delicate work with the hands that requires concentration, and using a microscope for a long time. Also, sleeping with the neck in an abnormal position may also trigger a tension headache. Other triggers of tension headaches are inadequate rest, physical or emotional stress, binge drinking, eye strain, caffeine (too much or withdrawal), dental problems, excessive smoking, and fatigue or overexertion.
It is reported that up to 80% of adults in the U.S. have them from time to time. About 3% get chronic daily tension headaches. Women are twice as likely to develop them as men.
Signs and symptoms of tension headaches include the following:
There are two main types of tension headaches. They are the episodic and chronic types.
Episodic tension headaches occur less than 15 days a month for at least 3 months and it can last from 30 minutes to one week. Episodic tension headaches usually begin gradually, often in the middle of the day. Frequent episodic tension headaches may become chronic.
Chronic tension headaches occur more than 15 days a month for at least 3 months and it can last for hours and may be continuous. They are considered chronic.
Though one’s head is hurtful, tension headaches don’t usually prevent one from one’s daily activities, and they don’t affect one’s sight, balance, or strength.
If a patient has chronic headaches, physical and neurological tests may be carried out by a doctor to try and identify the type and cause of the headache using the following approaches:
Pain description: providing an adequate description of the pain can help a doctor to accurately diagnose the headache. So, an adequate description of the pain given by the patient should include the following details:
Characteristics. Is the pain constant and dull? Sharp or throbbing? Pulsating or not?
Severity. Is the pain mild, moderate or severe? Does it keep you from working? Do the headaches prevent you from sleeping or wake you from sleep?
Location. Is the pain widespread all over the head, on one side only, or just on the forehead or behind the eyes?
Imaging tests: A doctor may order imaging tests to be carried out in the case of unusual or complicated headaches. This is done so as to rule out serious causes of head pain, such as brain tumor. The imaging tests carried out are:
Computerized tomography (CT): also called CT scan, uses a beam of computer-focused X-rays to provide a comprehensive and detailed view of the brain.
Magnetic resonance imaging (MRI): employs radio waves, a magnetic field and a computer to produce well-defined images of structures within the body.
Sinus X-rays: may also be performed to evaluate for congestion, blockage or other problems that may require corrections.
Other tests include blood tests to analyze blood chemistry and laboratory tests to check for any underlying conditions.
Tension headaches are best treated when the pain is still mild. So as soon as you experience any unusual pain in your head, you should visit a doctor. Some people try to treat the pain on their own using over-the-counter pain relievers, which eventually complicate the pain due to repeated use, and can actually cause another type of headache called overuse or rebound headaches.
Also learning to manage tension headaches at home is important as it can help to improve on the treatment plan and can also help provide additional information to the doctor during medical check-ups for better treatment plan. Ways of managing tension headaches at home include:
There are various medications, prescriptions and over the counter (OTC) drugs, that can be taken to reduce the pain of tension headaches. These are called acute medications and they include:
Pain relievers: The first line of treatment for reducing the headache pain is simple over-the- counter, OTC, pain relievers. Examples are ibuprofen, aspirin and naproxen. Prescription medications that can be taken include indomethacin, ketorolac, and naproxen.
Combination medications: Caffeine or a sedative drug is usually combined with aspirin or acetaminophen or both in a single combination therapy. Combination drugs may prove to be more effective than a medication containing only one drug component.
Triptans and narcotics: a triptan is capable of effectively relieving both migraines and episodic tension headaches for people who have both. Narcotics, because of them being addictive and their side effects, are rarely being used.
Doctors may also prescribe medications to help reduce the occurrence and intensity of attacks, particularly if one has chronic headaches that are not alleviated by simple medications and other therapies. These medications are called preventive medications and they include:
Anticonvulsants and muscle relaxants: these can help prevent tension headaches. Example is topiramate (Topamax).
Tricyclic antidepressants: these are the most commonly used medications to prevent tension headaches. Examples include amitriptyline and protriptyline. They have side effects such as constipation, drowsiness and dry mouth.
Other antidepressants: Evidence have been reported that antidepressants such as venlafaxine (Effexor XR) and mirtazapine (Remeron) are also effective preventive medications.
Preventive medications may take time to exert their effects, usually several weeks or more. This is specifically emphasized, so the patient doesn’t get frustrated if after they begin the drugs and don’t see any immediate improvements. The doctor monitors the progress of the treatment to see how the preventive medication works. During this period, continued use of pain relievers may interfere with the actions of the preventive medications.
Other alternative ways that may help provide relief from tension headaches include nontraditional therapies such as acupuncture- the use of extremely thin, disposable needles that cause little pain to bring about temporary relief from chronic headache pain. Massage can also be a helpful way to alleviate stress and relieve tension. Particularly effective for relieving tight, tensed up muscles in the neck, shoulders and back of the head, it may relieve one from headache pain. Deep breathing, behavior therapies and biofeedback can also help cope with tension headaches.
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Brian J. Hall; John C. Hall. “Infectious diseases in the skin”. Sauer’s Manual of Skin Diseases. Lippincott Williams & Wilkins, 2010. p. 232.
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