Headache Tension

Headache Tension

OVERVIEW:

Tension headaches are divided into two types:
• Episodic: Usually linked to a stressful event; is of moderate intensity and self-limited; and usually responds to nonprescription remedies.
• Chronic: Often occurs daily; located on both sides of the head, usually around the back or front part of the head; and is associated with muscles of the neck and scalp.

SIGNS AND SYMPTOMS:

• Headache on both sides of the head
• Located in the front or back of the head, or generalized
• Dull, pressing or band-like discomfort
• The intensity of pain varies throughout the day.
• Often present upon waking or soon after
• For 75% of patients, chronic headaches occur for more than 5 years
• Insomnia
• Teeth grinding
• Not aggravated by physical activity
• Difficulty concentrating
• Muscular tightness or stiffness in neck and/or front or back of the head

CAUSES:

• Poor posture
• Stress and/or anxiety
• Depression
• Osteoarthritis of neck
• Blood vessel disorder

SCOPE:

Tension headaches are common in the United States.

MOST OFTEN AFFECTED:

60% of tension headaches begin after age 20 (unusual for tension headaches to begin after age 50). Tension headaches affect females more frequently than males. 40% of sufferers have a family history of headache.

RISK FACTORS:

• Obstructive sleep apnea
• Medications
• Excessive caffeine

DIAGNOSIS

PHYSICAL EXAMINATION:

• The Physician will perform a physical examination to identify the type and severity of headache.
• Other disorders that may cause similar symptoms include bone conditions, dependency on caffeine or analgesics, depression, head injury, and other medical conditions.

TESTS AND PROCEDURES:

• Blood tests
• X-rays may be taken of the neck.
• Computed tomography (CT scan) or magnetic resonance imaging (MRI) may be done to assist in diagnosis.

TREATMENT

GENERAL MEASURES:

• Tension headaches are managed in the outpatient setting.
• Relief measures: Relaxation techniques; rest in quiet, dark room with cold washcloth over eyes; hot bath or shower; massaging back of neck and temples
• Biofeedback training offers an alternative that is often helpful.
• Change lifestyle to minimize stress; counseling may help.

ACTIVITY:

Physical fitness and range of motion and strengthening exercises for the neck are encouraged.

DIET:

No proven link exists between diet and tension headache.

MEDICATIONS

COMMONLY PRESCRIBED DRUGS:

• Acute attack: nonsteroidal anti-inflammatory drugs (NSAIDs):
• Naproxen sodium (Naprosyn, Aleve)
• Fenoprofen calcium (Nalfon)
• Ibuprofen (Motrin, Advil)
• Ketoprofen (Orudis)
• Prophylaxis for chronic tension headache: antidepressants
• Amitriptyline (Elavil)
• Desipramine (Norpramin)
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)

CONTRAINDICATIONS:

• NSAIDs and antidepressants are generally not suitable for children.
• Antidepressants should not be used with monoamine oxidase (MAO) inhibitors.

PRECAUTIONS:

• Do not use antidepressants in presence of acute heart attack.
• Avoid dependence on nonprescription caffeine-containing preparations.
• NSAIDs should be used with caution in individuals with a history of peptic ulcer disease.

DRUG INTERACTIONS:

Antidepressants interact with alcohol.

Other Drugs:

• Propranolol (Inderal LA), nadolol (Corgard), atenolol (Tenormin)
• Isometheptene-dichloralphenazone-acetaminophen (Midrin)
• Other NSAIDs

FOLLOW UP

PATIENT MONITORING:

The Physician should be seen as often as necessary.

PREVENTION/AVOIDANCE:

• Physical therapy
• Biofeedback and relaxation
• Neck traction
• Injection of trigger points

COMPLICATIONS:

WHAT TO EXPECT:

• Tension headaches usually follow a chronic course when life stress is not changed.
• Most cases are intermittent and should not interfere with work or normal life span.

MISCELLANEOUS

OTHER FACTORS:

N/A

PEDIATRIC:

15% will have onset at age younger than 10 years.

GERIATRIC:

Onset of new headache in the elderly is cause for careful study.

OTHERS:

It is unusual for tension headaches to begin after age 50.

PREGNANCY:

N/A

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Medical Diagnosis » H » Headache Tension