Tension headache, the most common headache

Tension headache affects up to 70-80% of the population at some point in their lives. Almost everyone has experienced it, and it is related to episodes of fatigue, overload, and emotional stress.

It is usually an occasional pain that subsides spontaneously or responds to analgesics. Therefore, it is rare to consult a doctor, as it does not cause alarm. The problem arises when this headache becomes chronic, i.e., it is suffered more than 15 days a month for three months.

Symptoms of tension-type headache: throbbing headache

The pain of tension headache is oppressive, dull or throbbing, around the skull. It is described as “helmet pain,” as the pain is usually located over the forehead, temples and in the back of the neck. But it can also affect different parts of the skull, even reaching the neck.

It is usually mild or moderate in intensity, annoying, continuous, and usually lasts from half an hour to a few days.

It is often associated with a feeling of mental dullness or lack of concentration, tiredness, blurred vision, and a tingling sensation in the scalp.

Palpation of the skull muscles produces discomfort or pain, even when passing the comb or brush through the hair. It may be accompanied by photophobia and phonophobia: discomfort to light and sounds.

Nausea is not frequent in this type of headache, it usually occurs more in women and adults (20-60 years), being rare in children and the elderly.

Causes of tension headache

The origin of tension headache is considered to be “muscle tension”: sustained contraction of the muscles of the scalp, neck and skull, including the masticatory and extra-ocular muscles. Its name often causes confusion, giving rise to the belief that it is due to arterial hypertension. However, its mechanism is not vascular, but muscular. It is not caused by cerebral alterations.

The causes of muscular tension are usually fatigue, lack of sleep, work and family overload, stress, anxiety and worries. Thus, it is common for it to be triggered by an upset or by a family or work conflict. Emotional tension often generates muscular contractures, and when the cranial muscles are contracted, tension headache occurs.

Poor posture and headaches

We must take into account that any other cause that produces muscular contractures can be the cause of tension headache. The most frequent cause is bad posture that overloads the cranio-cervical muscles.

This is called poor postural hygiene: sitting incorrectly at work, at home or in the car, as well as poor posture during sleep and the use of inadequate pillows. Degenerative changes in the cervical spine, i.e. osteoarthritis, cause alterations in the mechanics of the neck, with contracture as a result.

Other causes of cranial muscle overload are prolonged sun exposure without sunglasses (frowning), and the continued use of screens without rest, which overload the extraocular and periocular muscles.

Finally, there are other infrequent causes of tension headache. They are usually as a symptom due to other diseases and drugs.

Episodic headache and chronic headache: when headache persists

The different types of tension headache are basically defined by their frequency over time, the response to treatment and the disability they produce.

The most common is the episodic type: this is the occasional headache that lasts from half an hour to a few days, is usually relieved by analgesics and does not occur frequently.

However, up to 3% of the population may suffer from chronic tension headache, which is defined as pain at least 15 days a month in the last three months. It is a clinical condition that does not respond to the usual analgesic treatment and can be disabling. It can produce changes in personality and behavior, it reduces social and work activity, leading to situations of low work performance, even absenteeism.

Read Now 👉  How to exercise the memory so as not to forget

People who suffer from chronic tension headache usually present sustained anxiety, mild depressive symptoms, and sometimes personality disorders. Other diseases that can cause chronic headache are sleep disorders such as Sleep Apnea Syndrome. Exposure to certain toxic substances such as solvents, smoke, tobacco or alcohol also produce it.

Sometimes the excessive consumption of analgesics can produce a “rebound” phenomenon, turning an episodic headache into a chronic one. This is known as medication overuse headache: after excessive and repeated intake of painkillers, they lose effectiveness and produce pain the next day, usually in the morning, causing the painkiller to be taken again, thus closing a vicious circle.

Treatment of tension headache

The treatment of episodic tension headache is quite simple: it consists of taking an analgesic on time, and of course avoiding the causes that trigger the pain. Most of the time it will subside spontaneously.

When tension headache becomes chronic, it responds little or not at all to conventional analgesics. In this case, the physician must do a thorough job to identify the cause and remedy it, primarily by ruling out other underlying diseases, accompanying neurological diseases, neck disorders and sleep disorders. The best treatment is to eliminate the cause of the chronic pain.

In most cases, as the cause is an emotional problem, the treatment should be aimed at solving it: relaxation techniques, regular sports, and modification of lifestyle habits achieve good results in the medium to long term. Tobacco, alcohol, excess food and lack of sleep should also be eliminated.

From the pharmacological point of view, chronic tension headache is treated with preventive medication: a drug administered daily for three to six months that prevents the onset of pain. Its effect is usually evident after two or three weeks of use: the frequency of headache decreases notably and when it appears it responds adequately to an analgesic.

Preventive treatment should be maintained for a minimum of three months to avoid recurrence of chronic tension headache. However, it does not prevent the occasional occurrence of episodic headache. These drugs should be used under strict medical supervision.

The preventive drug should be considered a shock treatment to alleviate chronic pain and the disability it produces, but never a lifelong treatment. The most lasting and effective treatment is to have healthy lifestyle habits, resolve mood disturbances or correct the diseases that produce chronic tension headache.

Tension headache is a frequent and benign headache that, if it becomes chronic, can be very annoying, even exasperating, affecting the social and working life of the sufferer due to the disability caused by the pain. In this case, a neurologist, a specialist specifically trained to study and treat headaches, should be consulted. Based on the characteristics of the pain, the patient’s previous illnesses, the medication taken and the neurological examination, the neurologist will decide whether a diagnostic test is required or not and will propose the most effective treatment. Experience shows that with a correct diagnosis the vast majority of tension headaches respond to treatment.