What are tension-type headaches?
Tension-type headaches are the most common type of headache in
adolescents. They are commonly referred to as muscle contraction headaches,
stress headaches, daily headaches, or chronic non-progressive headaches. When a
patient has both tension-type headaches and migraine, the headache is often
referred to as chronic migraine or transformed migraine.
A tension-type headache might occur periodically (episodic,
less than 15 days per month) or chronically (daily or > 15 days per
month). The headache is described as a mild to moderate constant band-like
pain or pressure that lasts from 30 minutes to all day in duration. Tension
headaches usually begin gradually, and often occur in the middle of the day.
The "severity" of a tension headache may increase significantly
with its frequency. Severe tension-type headaches occur daily or almost daily
and the pain is usually described as a throbbing pain affecting the front, top,
or sides of the head. Although the intensity of the pain may vary throughout the
day, the pain is almost always present. It is important to realize that although
tension headaches come and go over a prolonged period of time and might impair
your day-to-day function, they do not cause neurological damage, or affect
vision, balance, or strength.
What causes tension-type headaches?
There is no single cause for tension-type headaches. This type
of headache syndrome may be an inherited trait that runs in families. In some
people, tension-type headaches are thought to be associated with or result in
tightened muscles in the back of the neck and scalp. This muscle tension may be
caused by (1) inadequate rest, (2) poor posture, or (3) emotional or mental
stress, including depression. This stress may be known (overt) or unknown
(covert) to the patient and his or her parents. The most common sources of
stress in children and adolescents include school, family, and friends or peers.
Examples of stressors (not in any particular order) include:
- Not getting enough sleep
- Being on the honor role or a straight-A student
- Having problems at home/difficult family life
- Going to a new school
- Having overly permissive or overly strict parents
- Having a substitute or strict teacher
- Having a new brother or sister
- Being a "teacher’s pet"
- Having no close friends or having bad friends
- Being bullied
- Preparing for school tests or exams
- Learning to drive
- Joining too many extra-curricular activities
- Starting a new part-time job
- Going on a field trip or vacation
- Being overweight
- Having other children make fun of you
- Competing in sports or other activities
- Learning difficulties
- Recent move
- Divorce
- Death of a family member
Having the adolescent seen by a headache specialist might be
helpful, particularly when the cause of tension-type headaches is difficult to
identify. Once the evaluation is completed, it is important to reassure the
patient that the headache pain they are experiencing is NOT due to a brain
tumor.
What are the symptoms of tension-type headaches?
Patients with tension-type headaches commonly report these symptoms:
- Constant or episodic, mild-to-moderate head pain
- Headache upon awakening
- General muscle aches
- Difficulty falling asleep and staying asleep
- Chronic fatigue
- Irritability
- Disturbed concentration
- Mild sensitivity to light or noise
- Occasional dizziness
- Occasional nausea
The presence of an aura (physical warning sign), significant
sensitivity to light or noise, nausea and vomiting are not symptoms
associated with this type of headache syndrome (they are more frequently seen in
migraine). Often, the pain associated with a tension headache is difficult for
the patient to describe. There are no associated neurological symptoms (for
example, balance or visual disturbances) in patients with tension-type headaches.
How common are tension-type headaches?
Tension-type headaches affect 15 to 20% of adolescents and a
lower percentage in younger children. The percent of adults who suffer with
occasional tension headaches ranges from 30% to about 80%. Women are twice as
likely to suffer from tension-type headaches as men. Tension-type headaches are
more common in patients with a history of migraine -- the resulting dual
headache condition is called mixed headache or chronic migraine or transformed migraine.
Most people with episodic tension headaches have them no more
than once or twice a month, but the headaches can occur more frequently. Nearly
60 percent of people with tension headaches report that their daily activities
are impaired because of the headaches.
Chronic tension headaches tend to be more common in females and
in students who are "high achievers," (eg, straight As or overly involved in
extracurricular activities). Many patients with chronic tension headaches have
already had the headaches for more than 60 to 90 days when evaluated. Many have
missed an excessive amount of school and more patients with this type of
headache overuse their pain medications, causing even more headache problems.
How are tension-type headaches diagnosed?
The correct headache diagnosis is needed to develop an effective
treatment plan. The most important aspect of the headache evaluation is the
headache history, which should be obtained from both the teen and his or her parents.
The history includes asking patients to describe how they feel
with the headache, what happens when a headache occurs, the frequency and
duration of the headaches, and any associated symptoms experienced. A
description of previous and current medications taken to treat the headaches is
also an important part of the headache evaluation. The results of any previously
conducted studies or tests should be brought with you to the headache evaluation.
After completing the medical history part of the evaluation,
your doctor will perform physical and neurological examinations. Usually, the
results of these examinations are normal for people with tension-type headaches.
An interview with a psychologist is commonly a part of the
headache evaluation. The psychologist usually meets with the child and the
parents together, and then with them separately for structured interviews. The
parents may be asked to complete computerized questionnaires in order to provide
more in-depth information. Usually, no severe problems are discovered, but
stress factors are often identified.
After evaluating the results of the headache history, physical
examination, neurological and psychological examination, your doctor should be
able to determine what type of headache you have, whether or not a serious
problem is present and if additional tests are needed. Often, no additional
blood tests or scans are needed.
How are tension-type headaches treated?
Tension-type headaches are treated using several drug and
non-drug strategies. Among the non-drug strategies are lifestyle changes (sleep,
dietary changes), physical therapy, stress management/relaxation training, and counseling.
Stress Management, Relaxation Training, Counseling. Both
episodic and chronic tension headaches can be improved using stress management
and relaxation training. This is an essential part of managing these types of headaches.
Recognizing and treating the underlying stress and tension that
is causing the headaches is very helpful. Often, however, patients forget what
stressful events initiated their headaches. Counseling helps patients identify
their headache triggers and learn useful coping methods.
Relaxation techniques include deep breathing exercises,
progressive muscle relaxation, mental imagery relaxation or relaxation to music.
Ask your doctor for more information about these techniques.
Biofeedback is another method of learning how to manage stress.
During biofeedback, a series of sensors are connected to your body. The sensors
detect changes in physical functions, such as muscle tension, blood pressure,
heart rate or skin temperature, and provide immediate feedback through a tone or
display on a computer screen. Biofeedback helps you recognize that your body is
tense, identify the things that make it tense, and learn ways to reduce the
tension. Biofeedback usually requires several sessions with a skilled
biofeedback therapist.
If you miss more than 5 days of school per term, your counselor
will need to work with you and your parents to develop a plan so that you can
make up missed school work and ensure a smooth transition back to school.
Continued excessive school absence is a significant impediment to recovery.
Medications. For occasional symptomatic relief of
infrequent tension headaches, over-the-counter (nonprescription) medications are
recommended. Ask the advice of your doctor or pharmacist about the use of
acetaminophen (Tylenol®), ibuprofen (Advil® or Motrin®)
or naproxen sodium (Aleve®). The use of aspirin in children under age
14 is not recommended. Also, avoid compounds that contain caffeine. Do not use
these products more than 2 days a week.
For relief of chronic tension headaches, daily preventive
medications may be prescribed. These medications -- which are aimed at reducing
both the frequency and severity of the headaches -- may include antidepressants,
such as amitriptyline hydrochloride (Elavil®); topiramate (Topamax®),
and cyproheptadine (Periactin®). These medications are not habit-forming.
Benzodiazepines, butalbital combinations and narcotics (Codeine)
should be avoided because these medications could become habit-forming or addictive.
Be sure to take medications only as prescribed by your doctor.
Also, inform your doctor of any over-the-counter medications you may be taking.
Read the ingredient label of all nonprescription drugs to make sure they do not
contain the same ingredients as other over-the-counter or prescription drugs you
are taking. For example, Excedrin® contains acetaminophen, aspirin,
and caffeine -- ingredients often found in other headache-relieving products.
Overuse of these medications or the daily use of pain-relieving medications can
cause analgesic rebound headaches -- a condition described below.
Medication Overuse can Increase Headaches. An extremely
important factor contributing to the development of chronic daily headaches is
the overuse of pain medications. Medication overuse can occur in any type of
headache patient.
Medications associated with analgesic rebound headaches include
acetaminophen, ibuprofen, NSAIDs, triptans, ergotamine preparations, butalbital
combination analgesics, opiates and caffeine-containing combination analgesics.
Effective treatment of headaches associated with medication overuse requires
withdrawal from the medications causing the rebound headaches. Rebound headaches
might not go away for weeks after the medications are discontinued.
Treating Tension Headaches without Medications. Although
medications are helpful, it is important to learn other headache treatment
methods. Here are some relaxation strategies:
- Apply an ice pack to the painful area of your head. Firmly position it
on your forehead, temples, or the back of your neck (for example, first
place a thin cloth on your forehead, followed by the ice pack, then finally
secure it in place with a headband).
- Take a warm bath or shower; take a nap; or take a walk.
- Ask someone to rub your neck and back, or treat yourself to a massage.
- Apply gentle, steady rotating pressure to the painful area of your head
with your index finger and/or thumb. Maintain pressure for 7 to 15 seconds,
then release. Repeat as needed.
- Rest, sit or lie quietly in a cool, low-lit room. Close your eyes and
try to release the tension in your back, neck and shoulders.
- For patients who have excessive muscle contractions in the neck,
physical therapy exercises performed daily are often helpful.
If your headaches are not lessening/improving, contact your doctor.
How can I help reduce or prevent headaches?
- Follow your treatment plan. Avoid taking medications that have
not been ordered by your physician. Do not overuse over-the-counter medications.
- Reduce emotional stress. Take time to relax and take time away
from stressful situations. Learn relaxation skills, such as deep breathing
and progressive muscle relaxation.
- Reduce physical stress. Proper rest and sleep will allow you to
deeply relax so you can face the stressors of the new day. When sitting for
prolonged periods, get up and stretch periodically. Relax your jaw, neck,
and shoulders.
- Exercise regularly. Get at least 30 minutes of exercise three
times a week.
- Talk to a friend, family member, religious professional or health
care professional if your problems are getting to you.
What types of headache management programs are available to patients?
There are several, including:
Clinical Trials. Some children and adolescents with
migraines don’t experience headache relief despite trying many of the currently
available medications. If this is the case for your child, ask your doctor about
possible participation in a clinical trial. Clinical trials provide access to
drugs not yet approved by the FDA. Such drugs are not available through
"regular" doctors’ offices; they are only available through doctors and health
care organizations that have agreed to participate in the clinical trials. Your
doctor will help determine if your child is an appropriate candidate for this
type of research study.
Rehabilitation Program. Some hospitals and/or other
health care facilities offer inpatient program for children and adolescents; ask
your doctor if their facility offers such programs. Patients typically accepted
into these programs are those who are missing school, overusing medications, and
whose headache pain is controlling their lives.
Infusion Suite. When headaches last longer than 24 hours
and other medications have been unsuccessful in managing the attacks, medication
administered in an "infusion suite" can be considered. An infusion suite is a
designated set of rooms at a hospital or clinic that are monitored by a nurse
and where intravenous drugs are administered. The intravenous drugs are usually
able to end the migraine attack. Patients’ length of stay at the infusion suite
can range from a several hours to all day.
Headache ‘Checklist’ of Management Suggestions
1) Educate yourself and your family. Read about your type of
headache and its treatment.
2) Maintain a headache diary.
3) Ask your doctor for written instructions about what to do
when you have a headache.
4) Limit your use of over-the-counter (nonprescription)
medications to no more than two days per week. Excessive use can actually
increase headaches.
5) Follow a regular schedule:
- Don’t skip meals, especially breakfast
- Get 8 hours of sleep nightly
- Exercise 30 minutes/day
- Drink 6 to 8 glasses of water/day
- Learn to identify and avoid headache "triggers." Common triggers include
caffeinated foods and beverages (chocolate, teas, colas, coffee), nitrates
(luncheon meats, sausage/hot dogs, pepperoni), tyramine (aged cheeses,
pizza), Doritos®, Ramen® noodles, other "junk" foods,
and Oriental foods containing MSG
- Minimize stress and other headache triggers
6) Daily school attendance IS A MUST!
7) Initiate non-drug measures at the earliest onset of your
headache:
- Seek rest in a cool, dark, quiet, comfortable location
- Use relaxation strategies and other methods to reduce stress
- Apply a cold compress
8) Don’t wait!! Take the maximum allowable dosage of recommended
medication(s) at the first sign of a severe headache.
9) Take prescribed medication regularly, as directed, and
maintain regular follow-up visits.
10) Call your doctor when problems arise.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/1/2009...#11203
