Tension Headache

tension-type headache

What is Headache?

Headache is a general description for a common disorder. In addition to several distinct types of headache (tension headache, migraine headache, cluster headache), it can be a symptom of a variety of other disorders (such as infections in the sinuses, meninges, or brain), severe high blood pressure, bleeding or tumor in the brain, alcohol overuse, or it may occur without any known cause. Most people have experienced a headache at one time or another caused by muscular tension. These tension headaches may result from acute stress, or they may be associated with chronic anxiety or depression. Vascular headaches are thought to be caused by dilation of blood vessels in the brain and/or scalp. Migraine is the most common type of vascular headache. Cluster headaches also are thought to be vascular in origin.

Many disorders involving structures of the head and face can cause headaches or facial pain. Among these are sinusitis, otitis media (middle-ear infection), mastoiditis, dental disorders, and temporomandibular joint (TMJ) syndrome. Headaches also may result from eyestrain or may be a symptom of an eye disease such as iritis or glaucoma. Facial pain can be caused by nerve disorders such as tic douloureux or herpes zoster.

Headache may be a symptom of central nervous system (CNS) disease. CNS infections (meningitis, encephalitis) and space occupying lesions (cerebral hemorrhage, subdural hematoma, brain cancer, brain abscess) may be accompanied by headache. So may systemic (system-wide) diseases affecting the central nervous system (severe hypertension, systemic lupus erythematosus). A head injury (concussion or cerebral contusion) may be followed by posttraumatic headaches. Headache also may occur after a lumbar puncture (spinal tap).

Pain may be referred to the head from other areas of the body, particularly the neck, shoulders, or back. Disorders of the spine (intervertebral disc disorders) or the brachial plexus (thoracic outlet syndrome) may produce headaches. Headaches also may arise from disorders of muscle and fascia (neck or back strains, myofascial pain syndrome, fibromyalgia). Headaches may be of toxic origin (in alcoholism, lead poisoning, and renal failure). Caffeine withdrawal is often overlooked as a cause of headaches. Also, headache may be an adverse effect of certain medications, such as nitrates (used to treat angina pectoris). In addition, fever from any cause may be accompanied by headache.

How is it diagnosed?

Tension Headache signs and symptoms

Any of the following:

  • Moderate pain in the front or back of the head, accompanied by tight muscles in the neck or scalp.
  • Constant pain over the temples, accompanied by the feeling that a vise is over the back of the head.
  • Throbbing pain all over the head.
  • Often present when you wake up.
  • Insomnia.

History provides most of the important diagnostic information. It should include the location and character of the pain, when it is noticed, what brings it on, any associated symptoms, and its relation to psychological stresses in the person's life.

Physical exam is usually normal. But there might be signs of severe hypertension seen in the eyes, tenderness to pressure over the sinuses or teeth, muscle tension in the neck, or a large and pulsating temporal artery.

Tests: If sinusitis is suspected as the cause of headache, sinus x-rays may confirm it. If bleeding or a brain tumor is suspected, a CT scan or MRI of the head can be diagnostic.

How is it treated?

Treatment and prognosis depend on the specific diagnosis.

Medications for tension headaches

  • You may take acetaminophen or aspirin to relieve pain.
  • Nonsteroidal anti-inflammatory medications may be prescribed.
  • Antidepressants may be prescribed for chronic tension headaches.
Information Brand Generic Label Rating
Lioresal Lioresal Baclofen Off-Label
Buy Venlafaxine Effexor Venlafaxine Off-Label
Ibuprofen Motrin Ibuprofen On-Label

Naprosyn (Naproxen), Prozac (Fluoxetine), Ultram (Tramadol), Soma (Carisoprodol), Ativan (Lorazepam)

Activity

  • Rest in a quiet room while you have the headache.
  • Participate in a regular physical fitness program. Focus on exercises that help muscles in the back, shoulders and neck.

Diet

  • Most persons feel better if they don't eat, unless the headache is from low blood sugar.
  • Don't drink alcohol.

What might complicate it?

Dependence on pain medicines can become a distinct problem, both in the treatment of the headache (creating rebound headaches), and in and of itself.

Predicted outcome

Prognosis depends on the identified cause.

Alternatives

Headache is apparent as a symptom. History and the physical exam will determine the particular diagnosis.

Appropriate specialists

Neurologist and internist.

Seek Medical Attention

You or a family member has a headache and any of the following occur:

  • Fever.
  • Recent head injury.
  • Drowsiness.
  • Nausea or vomiting.
  • Pain in one eye.
  • Blurred vision.
  • High blood pressure.
  • Pain and tenderness around the eyes and cheekbones that worsens when you lean forward.
  • Vision disturbances and vomiting prior to the headache.
  • Persistent headache pain for longer than 24 hours without other symptoms.
  • You suspect a prescription or non-prescription drug caused the headache.

Last updated 16 December 2011


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