tension headache

1 July 2014

Let’s Talk About Tension-Type Headache.

James Information, Medications, Tips, Treatments 0

It’s often called the most common headache. It’s been labelled stress headache, or tension headache, but research has shown us that these headaches don’t tend to come from either stress or muscle tension.

Just what a tension-type headache (TTH) is is still a bit of a mystery. We do know that the line between migraine and TTH isn’t as clear as most people think. Many people who think they just have a “normal” headache are actually suffering from migraine. And even those who really do have TTH may have a headache that has roots in common with migraine.

“Ordinary headache”, like migraine, seems to have a neurobiological basis. It’s diagnosed by the way it shows itself, not by what causes it. So a TTH will probably involve a “tight” pain, usually on both sides of the head, and it will lack typical migraine symptoms like nausea and sensitivity to light and sound.

Already someone out there is saying,”But wait – I am sensitive to light when I have a tension headache.” Guess what – you may have been misdiagnosed.

Treating Tension-Type Headache

The most important advice when it comes to TTH is this: see a doctor who takes your symptoms seriously. That’s it.

Why? Because the common course of action – take painkillers, take painkillers again, it’s just a headache – take more painkillers – is causing more problems than it’s solving.

First you need to get to a doctor and get a proper diagnosis. Is it really TTH? If so, what kind? Yes, there are various varieties of TTH which may call for different treatments. Is it mixed with other types of headache? If so, the treatment may be different.

Once you’re under the care of a doctor, common treatments include paracetamol / acetaminophen (Tylenol) and aspirin, depending on your symptoms and medical history.

In some cases, preventative medication may be required, at least for a time. This would include tricyclic antidepressants such as amitriptyline (Elavil, Endep, etc).

If you have more than one type of headache, other medications may be recommended.

Depending on the severity and frequency of your headaches, your doctor may also recommend lifestyle changes such as more activity and changes in your diet. Biofeedback has been shown to be beneficial for tension-type headache as well. Other complimentary treatments may help.

Remember, tension-type headaches are not normal, and they can be treated. They can be disabling, and significantly impact your day-to-day life. Don’t ignore them while they steal away bits of your life.

For more information:

Do you have tension headache symptoms?
Tension-Type Headaches (Cleveland Clinic)
Management of tension-type headache (British Medical Journal)

30 April 2013

Help! I have a Headache!

James Information, Tips 2

It’s probably one of the most common questions I hear (or see). Basically, someone has a headache – maybe it’s getting worse and worse – and they don’t know what to do.

A lot of different people fit into this category. Maybe they’ve had something similar a few times, and they’re getting fed up. Maybe it feels like it’s the worst headache they’ve ever had. Maybe they get headaches all the time, but have never really taken the time to stop and look for answers.

So you have a headache – a bad headache. What should you do?

What to do when you get a headache…

Recognize that this is not “normal”. You should not “just live with it”. It’s not “just your imagination”. It’s not something “everyone just has to deal with”.
See a doctor. If this is something that has happened many times, you could schedule an appointment for next week and discuss your symptoms with your doctor. If it’s the worst headache you’ve ever had, or the symptoms have changed, or it’s the first headache of its kind that you’ve ever had, get to a doctor now. Pay attention to your symptoms and tell the doctor anything you can. Yes, a headache can be a sign of something very serious.
Do NOT take someone else’s prescription medication. Medications and even dosages can vary drastically based on your weight, your age, your medical history, your symptoms, and other factors. Medication that is considered “safe” for one person can be dangerous for someone else. Resist the temptation.
Be very cautious with “over the counter” medications, and supplements. It’s usually not a bad thing, in rare cases, to take an Advil (ibuprofen) or Tylenol (paracetamol/acetaminophen) while you’re waiting to see the doctor. However, recognize that almost any medication – and many supplements – have the potential to make your symptoms worse over time. Herbal supplements and vitamin treatments can be dangerous because they’re not regulated in the same way as drugs usually are. Taking a couple of painkillers before going to the doctor isn’t usually a problem. Avoiding the doctor and taking painkillers every week is.
Cautiously consider “home remedies”. I’ve already talked about vitamins and herbs and things like that. Here I’m talking about other things you can do to soothe your headache (while you’re waiting to see a doctor). This may mean lying down in a dark room. A cold pack on the head. Breathing exercises. A warm bath. A cup of tea. There are many things you can try, depending on the type of headache you have. There’s no magic formula for everyone, but there are a number of things that can help you feel better. There may come a time to get a friend to watch the kids, to take the day off work, and deal with the pain. Sometimes you have to keep going, but many of us keep going to the detriment of our future health. (PS – don’t spend two hours scouring the internet for home remedies. Just do something now that will help you feel a little better.)
Make a note of your symptoms. The more you can do this, the better your doctor can help you. How bad is the pain on a scale of 1 to 10? When did it start? Does light bother you? Is the pain pounding, or sharp, or a constant pressure? What makes it worse? What helps you feel better? All these details can help you get the treatment you need.
Don’t be overwhelmed with information. There’s a lot of information on this site and elsewhere that can be a lot of help as time goes by. But be careful about printing off too much information before you’ve even talked to your doctor. A headache can be caused be a lot of different things, and there are countless treatments. Take things one step at a time.

Yes, but my Doctor isn’t helping Me!

Sadly, there are times when this initial visit to the doctor is less than helpful. I’ll write more about that situation later. But in the mean time, here are a couple of things to keep in mind…

If your doctor says it’s not “serious” – she may actually be telling you that she’s fairly certain that your condition is not life-threatening. And that’s not a bad thing. Ok, maybe she doesn’t realize the pain you’re going through, or maybe she’s taking it too lightly. But she does have a lot of training, and she has seen a lot of patients, and it’s possible that she’s not just trying to get you out of her office. Don’t assume immediately that your doctor doesn’t know what she’s talking about.
At the same time – don’t be afraid to find another doctor. If you really feel that your doctor isn’t listening, or simply that you need another opinion – take the time to go to someone else. I know it’s frustrating, and that you shouldn’t have to go through all this trouble when you already feel terrible. But your health is important. And this is something to take seriously.

Conclusion

I know you’re in pain, and I know it was a pain to read all of this, and I know you want to relieve the pain NOW. Trust me, I’ve been there. And I’m trying to save you a lot of pain down the road.

This post doesn’t answer all of your questions. That’s because I want you to focus on what you need to focus on first – noting your symptoms, and getting to a doctor. It’s not a solution, but it’s critical to start there.

31 August 2012

Just what is the “Common Headache”?

James Discoveries & Stats, Information 0

We’ve known for centuries that headaches come from different sources, and they come with different symptoms. A hundred years ago we were calling some forms of migraine "sick headache". Somewhere along the line we started talking about"tension headache" – just a little pain from muscle tension and stress.

Or so we thought.

We started to associate the so-called common headache with tension headache. As we learned more about the anatomy of the head, we theorized that the muscle around your skull was getting tense and causing changed in blood flow.

But as we started to study migraine and other types of headache more closely, the mystery deepened.

Studies of tension headache weren’t always turning out the way we thought. Why were people getting tension headaches when they weren’t even under stress? And – wait – why do so many people with tension headache not have any more muscle tension than anyone else?

So we changed the name from tension headache to tension-type headache (meaning that we had no idea what caused it, but it certainly doesn’t seem to be muscle tension!).

Now comes another debate – how can we diagnose tension headache or migraine headache? If we go by the symptoms, it would seem that tension-type headache is the most common headache. What if we go by how many people actually go to the doctor? Well, migraine is starting to gain on other types of headache.

But research is pointing in a new direction. We now think that the mechanism of tension-type headache and the mechanism of migraine may not be so different. In fact, many of the treatments for migraine seem to work well for those diagnosed with tension headache!

In his book The Keeler Migraine Method, Dr. Robert Cowan suggests that migraine is in fact the most common cause of headache. In fact, he writes:

Studies suggest that 40 percent of migraineurs may be misdiagnosed as suffering from tension-type headaches because, unfortunately, both headache types may include features that we commonly associate with the other. This happens because both headache types involve the trigeminal nerve system. The trigeminal nerve system dips down well into the cervical spinal cord, and in tension-type headaches it can irritate the nerves that travel to the neck muscles and the muscles that tense the forehead and temples. Almost anyone with a headache of any type is likely to tense the shoulder and neck muscles, so muscle tension is not a reliable indicator for headache type.

So if the common headache is actually a result of migraine, how can you be sure to get the right treatment?

Because primary headache is generally diagnosed by symptom, pay close attention to your symptoms. Tell your doctor about anything you notice, such as sensitivity to light, the location of the pain, nausea, and what the pain feels like. That will give you a better chance of getting the right treatment, whether for the tension-type headache, or the headache from migraine – which is probably a lot more common than we used to think.

22 June 2010

Migraine and Tension Type Headache Triggers in Adolescents (new study)

James Discoveries & Stats 0

A study of 1260 students in Germany set out to find out if certain adolescent behaviours were contributing to migraine or tension-type headache (TTH) attacks.

The researchers diagnosed students in grades 10 and 11 (ages 14-20) with either migraine, tension-type headache, and migraine + TTH. It turns out that about 83.1% had had at least one attack in the last 6 months. 10.2% had migraine, 48.7% had TTH, and 19.8% had combined migraine and TTH.

But were there common factors among students with migraine or TTH?

For the combination TTH and migraine, the common threads were high consumption of cocktails, coffee, and smoking. A lack of physical activity also seemed to contribute.

For migraine alone, high coffee consumption and a lack of physical activity seemed to be big contributors.

For TTH alone, a lack of physical activity was the only common thread.

So a lack of physical activity seemed to be related to all three. For both sets with migraine, drinking lots of coffee contributed.

On a fascinating side note, there were a couple of things that didn’t seem connected at all. Those two things were skipping meals or snacks, and not drinking enough fluids. These are traditionally mentioned as key triggers, but in this case they didn’t seem to play a role. Would it be different in adults?

Read the abstract of the study here: Associations of Diet and Lifestyle With Headache in High-School Students: Results From a Cross-Sectional Study

2 June 2009

Major shift in Migraine Thought? (part 1)

James Discoveries & Stats, Information 4

There seems to be a major shift taking place in the medical world when it comes to migraine. It’s actually been going on for many years, and it will probably continue for many years to come, but many people are still unaware of it.

At the heart of the shift is the question of just how widespread migraine is. It’s not going to come as a shock that this is confusing to many people. Some people still think of migraine as a bad headache. Others don’t realize that it’s possible to have a mild migraine attack. Others are still confused about basic terms, like cluster headache, migraine, sinus headache, and so on.

The "Common" Headache?

Before we talk any more about migraine, probably the best thing to do is go back and talk about the common headache. Most people generally think of the most common type of headache as the tension headache (now more properly called the tension-type headache).

It might surprise you to know that we actually know very little about what a tension-type headache really is.

Wait a minute now – you just get tense, stressed, muscles get tense for one reason or another – you get a headache. What can be simpler than that?

It seemed that simple, until researchers actually started to investigate the actual muscle tension in the so-called tension headache. The surprise result was that a lot of people were getting the headache without any muscle tension at all!

Hence the name change.

Is it psychological? Well, some psychological factors seem to influence some headaches, but there have been no consistent findings that show that the common headache is due to psychological factors. In other words, people with fewer anxiety or mood problems do not get fewer headaches.

So in the end, we know even less about tension-type headache (TTH) than migraine! And just like migraine, we don’t know what causes TTH.

So, could TTH be connected somehow to migraine? Currently we’re usually looking at symptoms and ruling out other causes before we put a headache and other symptoms into a category of migraine or TTH. But what if many of the migraine attacks and TTH attacks actually had the same root cause?

What if the common headache was actually migraine?

A shift of thought

Many specialists are becoming convinced that most of the headaches out there are actually coming from migraine. And this changing opinion is showing up in popular literature about migraine. Take for example:

I was taught – as most doctors were taught, and still believe – that tension headache accounts for the vast majority of chronic headaches … Migraine, not muscle contraction, is what causes headache ascribed to tension. These mild-to-moderate, nonspecific headaches stem from low-level activation of the mechanism of migraine … it arises from a single mechanism, but since the degree of activation fluctuates, it is expressed to varying extents and in many different ways.

Dr. David Buchholz, Heal Your Headache

While it is true that an unlucky few have common migraine as well as hypnic headache, or both hemicrania continua and cluster headaches, such cases are extremely rare. What most of us construe as "different headaches" are actually different presentations of one headache type, and that is usually migraine … The overwhelming majority of headache patients have one kind of headache and, usually, that is migraine. Migraine is by far the most common kind of headache.

Dr. Robert Cowan, The Keeler Migraine Method

This shift in thought has huge implications for research, treatment … and for you. And we’ll talk more about that in part 2.