Tension-type headache (TTH)
Tension headaches are caused by muscle tension in the scalp, forehead, and back of the neck. A tension-type headache is the most common type of headache, yet its causes aren't well understood. Several causes of headaches are known, but the exact cause is unknown. Here we will be discussing in depth about tension headaches in order to provide you with a better understanding.
- It was found that 79% of patients had TTH at some point in their lifetime, with 3% experiencing CTTH (i.e. headache occurring on more than 15% of the days per month). It seems that TTH occurs more in women than in men, and it declines with age for both sexes.
- With TTH, women are only slightly more likely to suffer (the female-to-male ratio is 5:4) and the onset period (25 to 30 years) is delayed compared to migraine.
- As one age, there is a slight decrease in prevalence, which occurs most commonly between ages 30 to 39.
- Episodic tension-type headaches happen less often (less than 15 days a month). Your provider may call them “infrequent” if you have one or fewer headaches every month.
- Can be an infrequent or frequent episodic headache.
- The infrequent type occurs once or twice a month.
- The frequent type occurs less than 15 days per month.
- At least 10 episodes occur more than 1 day and less than 15 days per month for at least 3 months.
- It usually starts slowly and progresses throughout the day.
- It can last from 30 minutes to a week.
- Chronic tension-type describes when you have more headache days than headache-free days. Chronic tension headaches occur 15 or more days per month for more than three consecutive months.
- Occurs more than 15 days a month for at least 3 months consecutively.
- It starts slowly and lasts for days. The pain can exacerbate or ease as the day progresses, but it is always there.
- More than 180 days/year
- tension and stress,
- long periods of reading, typing, or concentration (eye strain),
- poor posture,
- spine and neck injuries,
- high blood pressure, and
- physical or emotional stress.
🧠 Insights: There is growing evidence that emotional disturbances may increase the risk of TTH. Stress and mental tension are the most common causes of TTH and in patients with TTH, headaches have been shown to be positively correlated with stress. It has been proven that chronic recurrent headaches, mainly chronic tensional headaches (CTTH), are associated with an increase in the frequency and severity of minor life events as well as daily hassles.
- Tender points are areas where manual pressure induces local pain; and
- Trigger points tenderness that induces referred pain in another part of the region from localized deep tenderness.
- Over-reliance on non-prescription caffeine-containing analgesics
- Dependence on/addiction to narcotic analgesics
- GI bleed from the use of NSAIDs
- Risk of epilepsy 4 times greater than that of the general population
- Medication overuse headache
- The overall quality of life is compromised
- Absence from school and work
- Decreased productivity at work
- Inability to take part in physical activities
- Pain relievers such as paracetamol or aspirin are commonly used and are often effective. It's best to take a pain reliever as soon as a headache starts to develop. This can "drive away" the headache more effectively than treating it once it has fully developed. A second dose of aspirin or paracetamol can be taken 4 hours later if needed. (Pills combined with a small amount of codeine such as co-codamol are best for avoiding headaches. They are more likely to cause "rebound" or drug-induced headaches as described above).
- Anti-inflammatory pain relievers are an alternative. One example is ibuprofen. This medication can be purchased from pharmacies, but a prescription is required elsewhere. Anti-inflammatory drugs may be slightly more effective than paracetamol or aspirin. However, side effects such as an upset stomach are sometimes a problem. Always read the leaflet that comes with the anti-inflammatory medication. They may not be recommended for people with other medical conditions such as duodenal ulcers or asthma.
💡 Note: Painkillers for headaches should not be taken for more than a few days at a time. They should not be used more than 15 days per month. More than that can lead to the drug-induced headaches described above. Don't have to take a pain reliever all the time to stop a headache. Do it every day as it comes. See your doctor if you need a daily pain reliever for your headache.
- As one of the most researched prophylactic agents for chronic tension-type headaches, Amitriptyline (Elavil) has received a great deal of attention. This drug is typically used in dosages of 10 to 75 mg before bed to minimize the drowsiness associated with waking up in the morning.
- Relaxation: Different people find different things helpful. For example, walking, exercising, or taking a break from your normal routine can help. Massaging the shoulder and neck muscles is often helpful. Applying a warm flannel to your neck or taking a warm bath may help.
- Prophylactic non-pharmacotherapy - It is the aim of prophylactic non-pharmacotherapy to reduce headaches by combining several different modalities such as electromyographic biofeedback, physical therapy, acupuncture, and exercise therapy (exercise that relaxes the neck muscles and occipital muscles), psychotherapy, and lifestyle counseling in order to reduce headaches.
- Biofeedback - These are just some of the behavioral medicine techniques proven to relieve headaches and improve functioning, including biofeedback and progressive muscle relaxation. By combining regular use with preventative medication and optimal acute therapy, quality of life is significantly improved compared to medication alone.
- Get enough sleep. Research has shown that getting enough sleep can reduce the frequency and severity of headaches, while too little or too much sleep can increase them.
- Don't smoke. Smoking has been linked to many different health problems, including heart disease and cancer, but it also contributes to headaches in smokers and non-smokers alike. If you smoke, it's time to quit!
- Exercise regularly. Getting regular exercise helps reduce stress levels and maintain blood pressure within normal limits, which means less risk for headaches!
- Shift to a regular, balanced meal. Eating right is key when it comes to staying healthy—and eating regularly throughout the day will help keep your blood sugar levels steady so that cravings don't drive you crazy (or send your head into overdrive).
- Rehydrate. Drink plenty of water. Water helps flush toxins out of your system and keeps your organs functioning properly, which will help prevent headaches too!
- Diary/Journaling. A headache journal diary can be helpful if headaches are frequent. Note when, where, how severe the headache occurs, and for how long. Also, be aware of anything that may have caused it. A trend can emerge and a trigger can be identified. For example, if they seem to appear in direct sunlight, when tired or hungry. Situations that cause eye strain, poor neck posture, stress, anxiety, anger, or other emotions can be identified as headache triggers. Headache situations can be avoided or modified.
- Avoid stressful situations whenever possible. It is common for headaches to be caused by stress. Sometimes we are stressed without realizing it. Sometimes a stressful job or situation cannot be avoided. Relaxation exercises can help you cope with stress. Stress can be reduced using breathing exercises or coping strategies. You can buy books (and tapes) on relaxing, and sometimes you may be referred to a counselor or psychologist for help.
- Regular exercise can reduce stress and tension. This can work to relieve occasional headaches. Moderate exercise for 30 minutes at least 3 times a week is best. However, any increase in exercise can be beneficial.
- Depression can lead to frequent headaches, and if you suspect this, talk to your doctor.
- Preventive medicine may be consulted. These are different from pain relievers and must be taken daily. These include some antidepressants and beta-blockers. They work best for migraines, but may also help some people with frequent tension headaches.
- You get a headache that is severe and ‘out of the blue’ (a sudden onset).
- The pain is worse when you cough, sneeze or strain.
- The pain is getting worse, despite taking pain relief.
- The pain is worse when you lie down.
- You become drowsy, or confused.
- Your vision becomes blurred, or you have any visual disturbance.
- You are generally unwell, including vomiting.
Headaches can develop gradually or suddenly, last less than a minute or last a few days. A headache disorder is characterized by head, neck, and shoulder discomfort. Throughout this article, we will discuss headaches as well as all the other factors that provide a basic understanding of headache disorders.
Migraines are also used to describe headaches, however, they are much more chronic and have a localised effect. It is also a condition that occurs only in a specific area of the head. Globally, it is one of the leading causes of disability and it is the second leading cause of death. There is a genetic link between migraine and migraine sufferers. Let us take a close look at the causes and symptoms of migraine headache and other factors that contribute to the disorder.