Tension headache

Tension headaches, often described as a feeling of a tight band around the head, are the most common type of headache. They can be episodic or chronic and are often related to stress, muscle strain, or anxiety.

Causes:

  • Stress: The most common cause, leading to muscle tension in the neck, scalp, and jaw.
  • Poor Posture: Leading to strain in the neck and scalp muscles.
  • Eye Strain: Often due to prolonged computer use.
  • Dehydration and Hunger: Can trigger headaches.
  • Lack of Sleep: Or changes in sleep patterns.
  • Environmental Factors: Such as bright light, noise, or strong odors.
  • Mental Health Issues: Such as anxiety or depression.

Diagnosis:

  • History:
    • Pattern and Duration: Frequency, duration, and time of occurrence.
    • Location and Quality: Typically bilateral, pressing/tightening quality, not pulsating.
    • Intensity: Usually mild to moderate.
    • Associated Symptoms: Lack of nausea or vomiting (unlike migraines); may have light or sound sensitivity, but not both.
    • Triggers: Stress, posture, eye strain, etc.
    • Effect on Activities: Generally does not prohibit daily activities.
  • Physical Examination:
    • Neck and Shoulder Examination: Checking for muscle tenderness or stiffness.
    • Head and Scalp Examination: Looking for any tenderness.
    • Neurological Examination: To rule out other causes, though typically normal in tension headaches.
  • Investigations:
    • Generally not required for a classic presentation of a tension headache.
    • Imaging: MRI or CT scans may be considered if the headache pattern changes, or if atypical or alarming symptoms (like visual changes, weakness, or loss of consciousness) are present.

Differential Diagnosis (DDx):

  • Migraine: More severe pain, often pulsating, with nausea/vomiting and strong light/sound sensitivity.
  • Cluster Headaches: Very severe pain, usually around one eye, with tearing and nasal congestion.
  • Medication Overuse Headache: From chronic use of headache medications.
  • Secondary Headaches: Due to:
    • sinus disease,
    • cervical arthritis, or
    • intracranial pathology.

Management:

  • Lifestyle Modifications:
    • Stress Management: Techniques such as relaxation, meditation, or yoga.
    • Ergonomics: Improving posture, especially during prolonged sitting or computer work.
    • Regular Exercise: To reduce muscle tension.
    • Adequate Hydration and Regular Meals.
    • Good Sleep Hygiene.
  • Non-Pharmacological Therapy:
    • Physical Therapy: Focusing on neck and shoulder muscles.
    • Biofeedback and Cognitive Behavioral Therapy (CBT): Especially in chronic cases.
  • Pharmacological Treatment:
    • Pain Relievers: Over-the-counter (OTC) painkillers like ibuprofen, aspirin, or acetaminophen.
    • Muscle Relaxants: In some cases, but generally not recommended for long-term use.
    • Preventive Medications: Such as tricyclic antidepressants, in chronic tension headaches.
    • Avoiding Medication Overuse:
      • Limit Use of Painkillers: To avoid the development of medication overuse headaches.
  • Regular Follow-Up:
    • Monitoring: Especially if preventive medications are used.
  • Patient Education:
    • Recognizing Triggers: And how to avoid or manage them.
    • Understanding the Benign Nature: Of tension headaches and the importance of lifestyle changes.

Tension-type headaches typically respond well to lifestyle changes and over-the-counter pain relief medications. However, if they become chronic, more structured management may be necessary. It’s important to avoid overuse of pain medications to prevent rebound headaches.