Tension-type headache
Tension-type headaches are very common, and in fact the most common neurological disorder in the world.
The prevalence is higher in European countries compared to the rest of the world and affects 80% of the population in their lifetime.
Tension-type headaches are typically experienced on both sides of the head and are described as a helmet or band sensation around the head.
The headache lasts from minutes to days or can be constant.
Physical activity does not aggravate the headache. Tenderness in the scalp may be experienced.
The intensity (degree of pain) is mild to moderate.
Mild nausea, light or sound sensitivity may be present, but only if the tension headache is chronic (more than 15 days per month).
Accompanying symptoms are usually more reminiscent of migraine than tension headache.
Tension-type headaches last from 30 minutes to days, or they can be uninterrupted.
1
The headache is usually on both sides of the head
2
It is usually described as a tight band
3
The headache is usually not aggravated by physical activity
How are you diagnosed?
The diagnosis of tension-type headache is mainly based on the criteria at the end of this article and the symptom description above. In addition, you need to see a clinician (doctor, neurologist, physiotherapist, chiropractor or other headache specialist) who can rule out other causes, perform a neurological examination, assess movement in the neck, back, shoulders and jaw, and feel the muscles and tenderness in the neck, jaw, face, skull and shoulders.
You are welcome to start with a digital consultation and/or a physical consultation by booking here.
Possible causes:
There are three likely causes of tension headaches:
- Muscle tension in the head, neck or shoulder muscles, or changes in blood flow to the brain (less important compared to migraine)
- Hereditary factors
- Increased sensitivity to pain signals over time, centrally in the brain (central sensitization). The chronic headache of tension headache usually develops from the frequent tension headache through a central sensitization process.
Who is most exposed / risk factors
The following can be factors that increase the risk of getting a tension headache:
- Inability to relax after work
- Few hours of sleep
- Coexisting migraine
- Overuse of acute headache medicines
- Depression
What can trigger a seizure / triggers
The most common precipitating factors/triggers are:
- Poor sleep routines
- stress
- High physical exertion
- Overuse of medication can be a factor.
Remember that what you think is a trigger is not a trigger every time. Read more about this here.
Aggravating factors, when you already have a seizure
Exposure to the above triggers can further aggravate the headache. As a general rule, physical activity does not exacerbate tension headaches when you have an attack, but can do so if the pain is intense.
What can you do yourself - during a seizure?
When you have a seizure, the following can work:
- Neck and shoulder stretching or massage
- Relaxation
- Sleeping
- Physical activity (mild to moderate level)
- Apply peppermint oil to your temples
What can you do yourself - preventively?
Prevention of tension headaches should include:
- Managing stress
- Optimizing sleep
- Improving lifestyle, especially sleep, ability to relax and good physical activity routines
- Avoid known triggers, or gradually expose yourself to triggers under controlled conditions.
If you have an increasing number of headache days, more than 2 days per month, you need to take your headaches seriously and seek help to reduce the risk of them becoming chronic. (Link to booking page)
Also remember to seek help if your pain changes, becomes more painful, and if you experience other changes such as weight loss, new neurological signs or symptoms, or changes in memory or personality. Read more here about red flags and secondary headaches.
Note!
Tension headache can coexist with migraine without aura.
Tension headache can also resemble medication overuse headache, post-traumatic headache and New Daily Persistent Headache.
A headache diary should be used to identify the correct type of headache as treatments differ.
Correct treatment of the headaches can also prevent medication overuse headaches.
Read more about the difference between tension headache and migraine, or about medication overuse headache, post-traumatic headache and New Daily Persistent Headache
Non-medical treatment
- prevention:
Non-pharmacological treatment is recommended before medical treatment of tension-type headache by the European guidelines for tension-type headache.
There is evidence that the following non-medical approach can be effective against tension headaches:
- Advice and guidance on lifestyle, sleep and exercise to prevent tension headaches
- Cardio training
- Strength training
- Massage
- Neck manipulation
- Acupuncture and dry needling
- Cognitive behavioral therapy (CBT)
- Mindfulness
- Progressive muscle relaxation
Medical treatment:
- Over-the-counter medicines such as Ibuprofen, Paracetamol and Aspirin can work as an acute treatment for tension headaches.
- Caffeine can be used in combination with the aforementioned medications.
- You need to be aware of the risk of medication overuse headache, especially when combining medications and with paracetamol, but the risk is lower with tension-type headache than migraine.
- Opioids must be avoided!
- Medication overuse headache should be managed by your GP.
Medical treatment
- preventive:
Prophylactic medication is suggested for frequent tension-type headaches (1-14 days per month) and chronic tension-type headaches (more than 15 days per month) in major review articles, and may include in the following order:
- Amitriptyline
- Mirtazapine
- Venlafaxine
Anesthetic injections into trigger points around the skull can be an effective treatment to reduce the frequency of tension headaches.
At the moment, there is less research on tension headaches compared to migraines.
Less is known about the causes of the pain, and as a result there are currently no good specific medications for tension headaches.
Note!
Children, pregnant, breastfeeding or elderly people, and people at risk of gastrointestinal problems, respiratory problems and cardiovascular problems should avoid especially anti-inflammatory (Ibuoprofen) and strong painkillers.
Talk to your doctor about the use of medicines.
limiceph
Don't hesitate to get in touch.
If you're unsure about what type of appointment you need for the first time, send us an email at post@limiceph.no with your phone number, and we will call you back at the earliest opportunity.
