Introduction
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 headaches.
What Is Meant by a Stress 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.
Where Does Stress Headache Occur?
The 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.
What Are the Causes and Clinical Features of Stress Headaches?
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 headaches.
What Is the Pathophysiology Behind Stress Headaches?
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.
What Is the 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.
Pharmacological Treatment:
- Nonsteroidal Anti Inflammatory Drugs (NSAIDs) - It works by reducing the level of prostaglandin synthesis, reduced amount of production of serotonin, and blocking platelet aggregation. Ibuprofen - it is the first line of treatment. It is used in mild to moderate headache. Dosage: 200-400 mg for every four to six hours and dose should not exceed 1.2 g. Naproxen - it is also used for headache. Dosage - 500 mg initially, then 250 mg every six or eight hourly or 500 mg for every twelve hours.
- Acetyl Salicylic Acid - This agent helps to alleviate mild to moderate headache. It works by inhibiting prostaglandin production. Aspirin is a best example of this group. Dosage: 325-650 mg every four or six hours depending upon the symptoms.
- Barbiturates - It is best used in conjunction with Aspirin and Acetaminophen. Precaution should be taken with the use of barbiturates because, its overuse does not relieve headache but increases headache. It works by depression of the central nervous system. Dosage of Acetaminophen/ barbiturates/ caffeine - 50 mg/ 300-325 mg/ 40 mg, 2 tablets/capsules every four hours, not to exceed 6 tablets or capsules/day. Dosage of Aspirin/ barbiturates/ caffeine - 1 to 2 tablets/capsules every four hours, and not to exceed 6 tablets/capsules per day.
- Analgesics - Infrequent headache is best treated by analgesics. Acetaminophen is a best example of this. It is used in patients with hypersensitivity of the gastrointestinal tract, allergy for Aspirin and who are taking oral contraceptive pills. It is used for moderately severe to severe headache. Dosage: 325-650 mg every four or six hours depending upon severity of the symptoms.
- Analgesic With Antiemetic or Sedatives - This relieves acute pain and chances of vomiting or both.
- Massage - Sometimes massage with deep pressure on the head with pain reliever gel is most effective. It contains Diclofenac gel, linseed oil, camphor, etc., to relieve pain. It can be used many times in a day. It will also give relief from nasal congestion and provides muscle relaxation.
- Sometimes when patient has severe headache and does not get cured with medicine, hospitalization is necessary. Prehospital management - person should not take opioid analgesics before doctor's evaluation for neurologic system. High analgesic medication with oxygen administration may relieve pain.
What Are the Measures to Prevent Stress Headaches?
Techniques such as biofeedback and relaxation therapy are used to get rid of stress.
- Biofeedback Training - this technique includes control and relaxation of sustained contracted muscle to relieve pain and tightness. Headache may be relieved by relaxation of neck, shoulder and arm muscles. It improves outcome with the help of visual positive feedback. In this treatment, patient is connected to one specialized device that is made for specified function and gives feedback about contractile muscle tension, heart rate and breathing pattern. It induces pain relief as well as provides relaxation.
- Cognitive Behavioral Therapy (CBT) - These techniques include talk therapy with self, to relieve tension. It also reduces attack of headache and severity of pain. Talking with ourself is sometimes beneficial to relieve mental tension.
- Other Relaxation Techniques - Deep breathing, yoga, meditation and muscle relaxation helps to improve circulation in brain and to wash out waste products which produce pain sensation. Modifications in the lifestyle are necessary such as proper sleep, smoking cessation, physical exercises, balanced diet, and proper hydration. Avoid excess intake of alchohol, caffeine and sugar. Sometimes massage is also useful. It relieves excess tension in muscle, and improves circulation in back, neck and head.
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.
Conclusion
Stress headache also known as tension headache is almost experienced by everyone, but it is not necessary that the person should suffer from pain. Over-the-counter painkiller medication can help to deal with mild symptoms. Medications along with stress management help people to lower the impact of tension headaches. A few other options which can help people to deal with tension headaches are massage, medication, exercise, and talking out with someone. Some lifestyle changes also help to reduce stress headaches.
