Tension Headache

Cause

The cause of tension headache is not fully known. The condition was formerly particularly attributed to an increased tension in the muscles of the neck, shoulders and face. The increased muscle tension is caused by psychological and physical factors.
With psychological factors, one can think of tension and stress at home, at work or at school. Sometimes, people suffer just in weekends from headache, when the weekday stress disappears. Anxiety and depression can also cause tension headache.
Physical causes of the increased muscle tension are a wrong body posture, making the same movement repeatedly and great effort. Lack of sleep can also trigger the headache.
The role of muscle tone in the development of tension headache is, however, more often being questioned. The original thought is more and more replaced by the idea that stretching the membranes under the skull by the tendons of the muscles causes the condition.
Heredity probably also plays a role in the development of tension headache.

Symptoms

The signs and symptoms of tension headache are as follows:

• The pain is located at both sides of the head, around the head or in the neck.
• The pain is pressing, pinching or feels like a tight band around the head.
• The pain is mild to moderate.
• The muscles of the shoulders, neck and skull are often extra sensitive.
• The patient can also suffer from bright light or loud noise.
• Perhaps the patient has less appetite, but he or she is not sick.
• During effort, such as climbing stairs, the pain is not getting worse.
• The pain lasts a few minutes to many days.
• In case of tension headache, a person can usually manage to continue with his or her activities.

By distraction or relaxation, the pain may reduce. It often passes when sleeping.

Diagnosis

The diagnosis of tension headache is made on the basis of the story of the patient and when the headache doesn’t comply with other diagnoses of headache, such as migraine and cluster headache. Additional examination, such as blood tests or imaging studies to demonstrate other causes of the headache, are usually not necessary.

Treatment

If a person suffers from tension headache, he or she can initially try to eliminate the pain by some adjustments of lifestyle. Getting enough sleep, doing regular stretching exercises at work and trying to find relaxation in physical exercises and massages can, for example, be very effective. Keeping a headache diary can be a useful way to gain understanding in the pain pattern in order to tailor the treatment together with the general practitioner.
In case lifestyle changes don’t benefit, then one can try to ease the pain with paracetamol or an anti-inflammatory painkiller, such as ibuprofen. However, these drugs should not be used too often or for too long, because the patient can suffer from side effects then, including more headaches.

Prognosis

No prediction can be made about the course of tension headache and how the headache develops further. Avoiding triggering factors can increase the control over the headache. Long-lasting tension headache can lead to depression.

Considerations

• Avoid caffeinated beverages, such as coffee, ice-tea and energy drinks.
• Provide adequate lighting when reading. Purchase, if necessary, good (reading) glasses and actually wear these while reading, driving, etc. This prevents excessive eye effort.
• Don’t overload the chewing muscles by, for example, frequently chewing gum.
• Try to reduce and/or prevent stress.
• Pay attention to posture. An incorrect posture or sleeping position results in neck and shoulder problems, which can cause tension headache.
• Get sufficient exercise. Just going for a stroll and taking a break from the activities, can reduce headache.
• Try to avoid fatigue as much as possible. This may cause headache.
• Get plenty of fresh air. A room with not enough fresh air and thus oxygen can cause headache.
• Get sufficient relaxation by doing fun things, possibly in combination with relaxation exercises and/or massage.
• Using an infrared lamp for neck and/or shoulders can relax the muscles by the heat that is released.

Facts

• The prevalence of tension headache is 38%.