Clinical presentation (with complications)
Tension headaches possess the following characteristics:
Frequency – episodic or chronic
Intensity – moderate to severe
Duration – a few minutes to several days
Location of pain – forehead, temples, back of head and neck
Type of pain – sensation of pressure or tightness; a typical band-like sensation may be present
In addition, people with tension headache may be irritable and fatigued all the time, especially those with chronic tension headache. They may not be able to concentrate on the task at hand and are extremely sensitive to any kind of noise or music. They may not be able to sleep well and suffer from muscle aches.
All patients suspected with tension headache must be differentiated from migraine headache. The absence of one-sided pain and nausea/vomiting in these patients is usually adequate to eliminate migraine. Other causes of headache must be considered such as sinusitis or headache caused due to eye troubles (ophthalmologic).
Causative & risk factors
Tension headaches can be caused due to physical or mental stress.
Physical stress may occur due to fatigue, lack of rest, improper posture, not eating on time and overexerting yourself.
Mental stress can occur as a result of situations arising at home, school or workplace. Lack of social life, obesity, going on a holiday and becoming a new parent can also trigger tension headaches.
Investigations
The patient’s medical history and symptomatic assessment are adequate to make a diagnosis of tension headache. No additional testing is necessary. If your doctor suspects any other underlying disease, you may be required to undergo certain blood tests and imaging tests.
Treatment
The goal of treatment in tension headaches is to relieve the acute pain and prevent further attacks. In order to relieve the pain, various pain-relieving drugs are prescribed depending upon the severity. Additionally, a hot or cold pack can be tried at home to bring down the pain. In order to prevent further episodes of headaches, antidepressants, anti-seizure medications or blood pressure medications may be suggested.
Several lifestyle modifications can help to bring down instances of tension headaches. One must try to avoid their headache triggers. Efforts must be made to reduce physical stress by eating well and on time, getting enough sleep and not over-exerting yourself.
Efforts must be made to reduce mental stress by developing a good support system, adapting to changing circumstances and keeping your expectations practical. In addition therapies like Yoga, meditation, acupuncture and massages are extremely useful to relax the mind as well as the body.
Counseling, biofeedback and behavioral therapy offered by your mental health care provider also plays a pivotal role in preventing tension headaches caused by mental stress.
Recent updates (with references)
The International Headache Society has recently renamed ‘tension headache’ to ‘tension type headache’.
A recent study has concluded that a combination of stress management therapy and anti-depressant drugs provides greater benefit to patients with tension headaches compared with single therapy.
