Joseph R. Antiicaglia MD
Medical Advisory Board
Headaches can be baffling. They can be divided into two categories: Secondary headaches are symptoms secondary to a known disease process. For example, the headache might be due to sinusitis or tumors. Primary headaches, such as tension-type and migraine headaches, have no known recognized disease process causing the pain.
The most commonly encountered headache among adults is the “tension-type” headache. The pain is usually moderate with people complaining of a heavy, achy, tightness in the neck and shoulder. At times, they report it feels as if someone is: “tightening a belt around my head.”
The headache is thought to be due to irritation of the pain-sensitive nerve endings in the neck and scalp. But experts aren’t sure exactly why they happen. It’s often referred to as a muscle contraction headache or stress headache, although these terms are used less and less frequently today.
Consider Alexa, a 37 y/o H.S. computer science teacher who for years has complained of what she describes as “tension headaches.” She tells her doctor, “I get an achy, heavy sensation in the back of the neck that can last for several hours and go away. More often, I get tightness in the neck and shoulders. As the discomfort worsens, pain radiates upwards on both sides of the head, over the scalp toward the forehead.” She continued,
“It feels as if there’s a vise squeezing my head. In the past, I got the headaches once in a while. Now, I get them most of the month. She finished by saying, “I’m stressed, on the computer too long and if I slept poorly the previous night, I’m in for a bad day.”
Symptoms: “Tension-type” headache
- Usually moderate (non-throbbing) pain
- Described as vise-like or band-like having a pressing-squeezing quality
- All over the head (not just on one side)
- Causing tightness of neck, scalp and shoulder muscles.
- They can start in the forehead and go back towards the neck or vice-versa. They can also start in the temples.
- Headaches can be episodic or chronic (see below)
Tension-type headache is not made worse by ordinary physical activity, are not associated with nausea or vomiting and are not sensitive to light There are various factors that can trigger i.e. predispose a person to a Tension-type headache
Triggers
- Stress
- Head immobility for long periods of time
- Jaw clenching or grinding of teeth
- Eye strain
- Long, uninterrupted periods of time at the computer
- Poor sleep habits
As suggested above, Alexa’s headache initially bothered her periodically, less than 15 times per month lasting hours to several days (episodic headaches). Gradually, the headaches became chronic occurring more than 15 times per month causing her to seek medical treatment.
Regarding treatment, the goals are to achieve pain relief with analgesics, control or eliminate triggers and prevent chronic daily headaches by avoiding the use of analgesics more than two times weekly. For chronic Tension-type headache, certain drugs to treat migraine headaches may be helpful.
Treatment
Over-the-counter (OTC)
- Analgesics
Acetaminophen, aspirin, NSAIDs-Non-steroidal anti-inflammatory drugs
Combination of analgesics with caffeine
Complementary Medicine
- Ice packs
- Massage
- Acupuncture
- Relaxation techniques
- Stress management
- Psychotherapy
Tension-type headache is not a migraine, not sinusitis and not related to organic disease, such as tumors. They cause a steady ache of varying intensity that can involve the neck, shoulders and entire head. It’s not a one sided throbbing pain.
OTC medication is usually enough to relieve the pain and discomfort. One important question for chronic pain sufferers, “Is the current pain you’re experiencing different?” If the answer is yes, do not hesitate to check it out!
References
Millea, P.J.; Brodie, J.J.; Tension-Type Headache; Am. Fam. Phys. Sept. I, 2002
Firetag, F; Managing and Treating Tension-type Headache; Med Clinic North Am. Dec 27, 2013
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.