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HeadachesTension Headache Overview More than 10 million people a year visit a doctor or an emergency department because of headache. With a complete history and physical examination, a doctor can correctly diagnose and treat a great majority of headaches. Tension headache is the most common type of headache. About 69% of men and 88% of women develop a tension headache sometime during their lives. Tension headache can occur at any age but most commonly begins during adolescence or young adulthood, with the highest frequency among those aged 20-50 years. More than 300 known medical disorders can produce headaches. In 1988, the International Headache Society developed a classification system for headache. Thirteen categories of headache are subdivided into 129 subtypes. Headache types are described as primary or secondary. Primary headaches include migraine, tension-type, and cluster headaches. More than 90% of people who see a doctor for headache pain have one of these types. Primary headaches are usually harmless, but they may come back again and again. Secondary headaches are often the result of some underlying disease, of which head pain is a symptom. The International Headache Society further divides tension headaches into episodic or chronic and on the presence or absence of pericranial muscle tenderness (pain on the outside of the skull). People with episodic tension-type headaches have at least 10 previous headache episodes lasting from 30 minutes to 7 days and occurring fewer than 180 times a year. The headache must have at least 2 of the following characteristics: Pressing/tightening (non-pulsating) quality, located on both sides of the head Mild or moderate intensity Not aggravated by routine physical activity No nausea or vomiting Possible sensitivity to light or sound but not both People with chronic tension-type headache have an average headache frequency of 15 days a month or 180 days a year for 6 months and must also meet the criteria for episodic tension-type headache. In addition, people with chronic tension-type headache must not have another disorder as shown by physical and neurologic examination. Tension Headache Causes Many people associate the onset of tension-type headache with stress or upsetting emotional situations. However, these factors have not been shown to lead to muscle contraction or reduced blood flow. Although people may have tenderness of the muscles surrounding the head, tension-type headache is not the result of sustained muscle contraction. The most compelling and current evidence points to a central nervous system dysfunction as the underlying cause of tension-type headaches. Thus, the muscle ache of tension-type headache is thought to be a result of increased sensitivity of the nervous system and pain from occasional or long-term imbalances in brain chemicals known as neurotransmitters (serotonin, dopamine, norepinephrine, enkephalins). Studies show that some people with primary headache disorders respond to medications that specifically target and influence serotonin. These are mostly people who have migraine or cluster headaches. Most of those who do not have migraine or cluster headaches do not respond to serotonin-targeted drugs. People with chronic tension-type headache may also have imbalances in neurochemicals. In fact, depression may be an underlying cause in some people with chronic tension headaches. Depression and some sleep disorders are linked to serotonin. Tension Headache Symptoms In general, a tension-type headache may cause diffuse (spread out, not in one place) pressure or tightness. Sometimes, muscles surrounding the head are tender. The pain may be on both sides of the head, or it may cause an aching or squeezing sensation located in the forehead, temples, or back of the head with radiation to the neck and shoulders. Pain is usually moderate in intensity, not severely disabling, and not associated with the typical symptoms of migraine, such as nausea, vomiting, or sensitivity to sound or light. The onset of pain is usually gradual and not associated with any prodrome or period in which a person can feel a headache coming on. People may associate the onset of a tension-type headache to periods during or after stress and usually toward the latter part of the day. If the tension-type headache is present for more than 15 days a month or longer than 6 months, it is considered chronic rather than episodic. When to Seek Medical Care People with episodic or chronic tension-type headache who experience a change in severity or frequency should consult with a doctor. People without a history of headache who are older than 50 years and experience pain in the temporal region (near the temple on the head) should see a doctor to be evaluated for temporal arteritis. In addition, those older than 50 years with new-onset headache should be evaluated for possible malignancy. When headache is associated with signs of infection, such as fever, rash, or stiff neck, a doctor should be seen to rule out conditions like meningitis, encephalitis, or Lyme disease. Persons with new-onset headache who either have risk factors for HIV infection, or who have HIV infection or cancer, may need imaging studies to rule out meningitis, brain abscess, or the spread of cancer. When to go to the hospital Certain headaches may indicate a more serious underlying problem. In these cases, the person should seek immediate medical attention at a hospital emergency department. People who may or may not have a history of headache and feel they are experiencing the worst headache of their life should seek emergency help, especially if the headache feels "explosive" and came on suddenly. This may suggest bleeding within or around the brain. The sudden onset, not necessarily the severity of the pain, is a signal that people with such headaches should be checked. People with headache and other associated symptoms, such as loss of vision in one eye, weakness on one side of the body, slurring or garbled speech, or inability to understand and follow commands, should be evaluated at once. Any person, but especially an elderly person, who sustains any form of trauma associated with the onset of headache must be evaluated in an emergency department. Self-Care at Home Most people with tension-type headache find relief with over-the-counter medications such as aspirin, acetaminophen, and other non-steroidal anti-inflammatory drugs (NSAIDs). Certain people may require prescription-strength pain relievers for particularly severe episodes. Frequent use of medications to treat symptoms of headache may actually cause episodic tension-type headache to become chronic in nature. There are many essential oils which can be used for headaches. The most popular are Lavender, Peppermint and Rosemary. Lavender essential oil can be rubbed onto the temples neat or made into a cold compress and applied to the temples, forehead or back of the neck. A mixture of Lavender and Peppermint essential oils in equal proportions can often be more helpful. It is worth noting that Peppermint is a stimulant and Lavender is more of a sedative. If the headache is caused by catarrh or sinusitis then inhaling with Lavender, Peppermint, Rosemary or Eucalyptus can sometimes help to relieve the symptoms. |
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