Tension Headaches

Written by PainDoctor.com Staff | 21 July 2010

The most common headache in adults, tensions headaches are headaches that can be described as a pain that is encompassing the head. Those who suffer from tension headaches report that they are brought on by noise or unusually bright lights, but mainly by stress.

The precise origin of tension headache is unknown. Originally it was presumed the pain was due to muscle tightening in the face, neck and scalp.  However controversy arose because an electromyogram (EMG) often cannot detect increased resting muscle tension in patients diagnosed with tension-type headaches (Millea).

Given the lack of evidence supporting increased muscle tone in tension HA, another presumption is the etiology may be due to neurotransmitter or chemical changes surrounding the brain due to stress and emotional factors. According to Ashina, another possible cause of tension headaches could be related to other factors such as jaw clenching or poor posture.

Likely other factors that contribute to the development of tension headaches and triggers include:

• Depression and anxiety
• Stress
• Poor posture
• Jaw clenching

Those with chronic tension headaches also may experience poor sleep and trouble concentrating due to the pain and distraction of the headache.

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Diagnosis

The International Headache Society's established criteria for diagnosing tension-type headache (IHS):

1. At least 10 previous headache episodes fulfilling criteria B through D; number of days with such headaches: less than 180 per year or 15 per month.]
2. Headaches lasting from 30 minutes to 7 days
3. At least two of the following pain characteristics:
   1. Pressing or tightening quality
   2. Mild to moderate intensity
   3. Bilateral location
   4. No aggravation from walking stairs or similar routine activities
   5. Both of the following:
      1. No nausea or vomiting

Photophobia and phonophobia absent, or only one is present.

Treatments

When pharmacologic treatment is indicated for headaches, the treatment can be categorized as either preventative or abortive. Those categorized as preventative work toward lessening the frequency and/or intensity of a headache, while those categorized as abortive are aimed at curing present pain quickly. Abortive treatments are not always efficacious, and do not prove to be universal to every headache patient.

Abortive therapy

· Analgesics – Over the counter nonsteroidal anti-inflammatory medications (NSAIDs) are the first line of therapy. Tylenol®, the most commonly known form of acetaminophen and aspirin may provide some pain relief, but are more commonly seen to cause a headache from overuse.

Preventative therapy

· Tricyclic antidepressants – For prevention of chronic tension headaches, tricyclic antidepressants have been found to be the most effective. They're effective against both the episodic and chronic forms (Millea). Side effects of these medications may include weight gain, drowsiness and dry mouth (Epocrates).

· Selective serotonin reuptake inhibitor(SSRIs). Antidepressants such as paroxetine (Paxil), venlafaxine (Effexor) and fluoxetine (Prozac, Sarafem) produce fewer side effects than do the tricyclic antidepressants but generally aren't considered effective for tension headaches (Moja).
· Other medications - prescription pain medications (known as opioids or narcotics) are usually not prescribed to those suffering from chronic headaches because of the extreme side-effects and possibility of the patient becoming dependent upon them.