Tension Headache - A Variant Of Migraine

Introduction:

A tension headache is a dull, persistent pain that occurs in the temporal region (part of the head just above the ears) in a band-like distribution. It may radiate forward to the frontal (forehead) region or backward to the occipital (part of the head just above the neck) region. It is also referred to as a muscle contraction headache.

What Causes Tension Headache?

The causes of tension headache are open to debate.

• It has not been possible to relate it very well to any particular psychological profile.

• It may arise from tight, tense muscles, but this is still debated.

• It is also considered to be a variant of migraine.

What Are the Types of Tension Headaches?

There are two types of tension headaches. They are

• Episodic headache.

• Chronic headache.

Episodic tension headache is diagnosed when the headache lasts from 30 minutes to seven days and is accompanied by any two of the following characteristics:

• Tightening or pressing pain.

• Mild to moderate intensity of pain.

• Bilateral location (involving both sides of the head) of pain.

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• No aggravation of pain with physical activity.

Chronic tension headache is characterized by an average headache frequency of 15 days per month for six months a year, frequently associated analgesic overuse, and intermittently superimposed migrainous features.

How Is Tension Headache Diagnosed?

No specific diagnostic procedures are available to confirm a tension headache. The patient's personal and family medical history, a review of his symptoms, and a physical examination are used to diagnose it.

When patients present with suspected tension-type headaches, doctors usually take the possibility of a secondary headache into consideration. This is because tension-type headache-like symptoms are linked to secondary headaches (caused by an underlying cause or condition).

While taking a patient's history, the patient is asked the following questions:

• Timings of the headache.

• Location of the headache.

• The sensation and intensity of headache.

• The duration of the headache.

• Occurrence of any behavioral or personality changes along with headache.

• Is the headache triggered by shifting positions or standing up?

• Is the person having sleep issues?

• Is the person having a history of head injury?

• Is the person having a history of stress?

No more testing may be required if the history indicates tension headaches and the neurological examination is normal. However, if the headache is not confirmed to be the primary problem, various testing is needed to rule out the underlying medical conditions which are causing the headache, such as:

1. Blood Tests: Different blood tests are carried out to investigate any underlying condition.

2. Sinus X-rays: These X-rays are performed to look for infections, congestion, or other issues that could be rectified.

3. Magnetic Resonance Imaging (MRI): Imaging with an MRI of the brain is usually done to check a neurological problem triggering the headache.

4. Computed Tomography Scan (CT scan): A CT scan can detect subarachnoid hemorrhage, which can cause headaches. Intracranial vasospasms, a key characteristic of reversible cerebral vasoconstriction syndrome, are detectable by CT angiography.

How Is a Tension Headache Different From a Migraine?

Tension headache is a variant of migraine. Both closely resemble each other. Therefore, sometimes, it becomes difficult to distinguish between them. Contrary to some types of migraine, tension headaches are typically not accompanied by visual problems, nausea, or vomiting. Although physical exercise frequently worsens migraine pain, tension-type headache discomfort is not aggravated by exercise. A tension-type headache may accompany increased sensitivity to light or sound. However, this symptom is uncommon. Patients can get an online migraine prescription through a telemedicine portal or through an in-office doctor's visit.

What Are the Trigger Factors for Tension Headaches?

The most important step in the treatment of tension-type headaches is the identification of trigger factors. Triggering factors increase the risk of headaches. They are discussed below:

• Stress: Stress is the most common factor for trigging tension headaches. It may be physical or emotional stress.

• Alcohol: The use of alcohol can also trigger a tension headache.

• Caffeine: Too much intake of products containing caffeine, like coffee, tea, and some energy drinks, can also induce tension headaches. Apart from its intake, sometimes its withdrawal can also trigger headaches.

• Medical Conditions: Some conditions, such as flu, a sinus infection, or a cold, can trigger a tension headache.

• Dental Problems: Problems related to teeth, like teeth grinding or jaw clenching, have also been found to trigger tension headaches in some people.

• Eye Strain: People who wear glasses can have this kind of headache if their power increases, or people who constantly get eye strain due to excessive screen time or other factors.

• Smoking: Too much smoking has been a triggering factor for tension headaches.

• Overwork or Exhaustion: Sometimes, tiredness, lack of proper rest, or work overload may lead to tension headaches.

• Other Factors: These factors include skipping meals, dehydration, and rarely menstruation.

Apart from these triggering factors, tension headaches can also develop as a result of migraine. However, there is no connection between brain illnesses and tension headaches.

How Is Tension Headache Prevented?

Preventive treatment is advised if tension-type headaches are common, persistent, or linked to a significant level of impairment. These preventive measures include the followings:

1. Medications:

Medications like Amitriptyline are often used to prevent tension headaches.

2. Non-Drug Headache Treatments:

• Relaxation.

• Cognitive-behavioral therapy.

• Acupuncture.

• Massage therapy.

• Ice or hot packs.

What Is the Treatment for Tension Headaches?

Treatment is different from that of migraine.

• Treatment of acute pain includes drugs that are primarily analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs).

• Prophylactic therapy is usually required, and the most effective agents are tricyclic antidepressants like Amitriptyline.

• Other drugs used in prophylaxis are Propranolol, Valproate, and Topiramate.

• Non-pharmacologic approaches include physical therapy to the head and neck region and biofeedback. However, the benefits are generally short-lived, and long-term results are disappointing.

Conclusion:

Treatment of tension headaches usually works successfully. However, the long-term nature of the headaches can make life and daily work difficult. Additionally, tension headache episodes can be reduced if triggering factors can be identified and avoided. An individual should contact the physician immediately if the headache occurs suddenly, gets severe, and is accompanied by high fever and vomiting.