Published on Nov 12, 2015 and last reviewed on May 10, 2019 - 5 min read
This article discusses in detail the signs and symptoms, pathophysiology, treatment and preventive measures of stress headache.
Headache means simply pain felt in head either one or both sides or all over the head. International headache society divides headache into two types such as primary and secondary headaches. Primary headache means headache is not associated with any cause. Secondary headache means headache is associated with some other underlying disease. Tension or stress type headache is one of the types of primary headache. Tension type headache (commonly called stress headache) encounters 69 % of the people with primary headache.
Stress headache is defined as chronic head pain with bilateral tight, band like discomfort. The main cause of stress headache is anxiety, aggressive nature, poor posture and depression.
Clinical Features of Stress Headache:
Headache starts suddenly and increases gradually. It is a type of chronic headache. Its intensity of pain fluctuates every minute and may last more or less continuously for many days and months. This type of headache has typical characteristics. Headache may be episodic (pain attack on and off), or chronic (present more than 10 to 15 days per month). Patients have throbbing type of pain in stress headache. Pain type has not pulsatile quality as in migraine. Pressure and tightening sensations are felt in head.
Location of the pain is usually occipitonuchal (nape of the neck), occipitofrontal (front of the forehead), bilateral, and fronto occipital region (all over the head). It is not aggravated by physical activity and intense light. Minimum 10 to 12 headache episodes are present.
Patient complains about band like squeezing pain in head. It may be elicited by excess stress and worry. Difficulties related to concentrating are present. Insomnia (disturbances while sleeping) may disturb patient’s life. Clinical approach for exact diagnosis for TTH (tension type headache) in persons with headache is absence of usual signs and symptoms associated with headache. Stress headaches are not associated with nausea, vomiting, photophobia (extreme sensitivity to light), osmophobia (increased sensitivity or headache due to odors), throbbing, flashing lights, blind spots, or numbness or weakness of the arms or legs and aggravation with movement.
Presence of one or more of these clinical features is the main difference from stress headache. International headache society stated definition of stress headache as, presence of various combinations of clinical features such as nausea, or photophobia, but appendix definition does not contain this, this suggests that there are so much difficulties in diagnosing stress headache.
Pathophysiology Behind Stress Headache:
It is not clearly understood. Presence of TTH is due to primary disease of central nervous system pain modulation mechanism which is absent in the migraine, which hampers generalized disturbance of sensory pathway. Some researcher suggests that TTH is due to genetic cause, similar to migraine. Some of them stated that pain is due to tension in the nervous system. Muscle contraction is also present in stress type of headache.
Treatment for TTH:
Sometimes patient does not pay attention to the headache, and gets relieved by pain killer. Sometimes this over the counter pain killer may increase the chance of overuse headache. Various techniques are used to relieve stress headache.
Hot and cold compress - sometimes patient may get relief from pain by using hot and cold pack. Hot pack causes increase in blood circulation in the head and removes waste products and toxins which are responsible for pain such as substance p (neurotransmitters which produce pain). Hot compress should be done for 5 times a day. It gives symptomatic relief. Some patients are comfortable with cold compresses. It creates "Lewis hunting reaction" which means repeated constriction of blood vessels followed by repeated vasodilatation of blood vessels which in turn causes removal of toxins and reduces pain.
Measures to Prevent Stress Headache:
Techniques such as biofeedback and relaxation therapy are used to get rid of stress.
These above stated modalities, pharmacological therapy, cognitive therapy and relaxation may help to alleviate headache. Stress headache is not as severe as migraine. It can be cured totally with some modifications in the lifestyle.
Do you have chronic headache? Consult a headaches and migraine specialist online --> https://www.icliniq.com/ask-a-doctor-online/general-medicine-physician/headaches-and-migraines
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