Tension Headaches

Tension headaches often present with a dull, steady, moderate to severe pain on both sides of your head. You may have trouble focusing and sleeping, feel fatigued or seem irritable, and be mildly sensitive to light and noise. Having a headache can make you distressed over minor issues and lead to impatience and frustration.

If your headache is severe, it may seem like a migraine. However, tension headaches are not generally accompanied with nausea, vomiting, or visual disturbances the way migraines often are.

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The primary causes for tension headaches appear to be stress — whether from work, school, or family — and fatigue, whether mental or physical. Certain foods can act as triggers; caffeine withdrawal can also give you a headache. Bad posture — when, for example, you are cradling a phone between your shoulder and your neck, or hunched over reading too long with your neck lowered — positions that strain your head and neck muscles — can result in a headache. Eye strain can also be a cause.

There is also a theory that people who get tension headaches have a heightened sensitivity to pain. So, for example, increased muscle tenderness can cause a headache.

Prevention

The first step in preventing tension headaches is to isolate what causes them for you. Avoid foods that seem to trigger them, or environments that provoke them. (Maybe having a piece of dense chocolate cheesecake with a strong cup of coffee in a noisy pub isn’t the best idea for you.) Above all, learn to breathe through stress and come up with coping mechanisms for it. Make sure you get enough sleep.

Isolate possible physical causes. Observe your posture and your habits: how do you hold your phone? How do you sit in your desk chair? Get your vision checked to find out if you need glasses for the first time or a change in prescription if you already wear them.

If headaches persist despite controlling what you can for stress, fatigue, and physical causes, there are medical and alternative medicine treatments that can help prevent headaches or relieve your pain. See the Treatments section below. Your physician at the St. Luke’s Headache Center can advise you on the best method for you.

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Some methods of handling stress that work for tension headache patients include the consistent practice of yoga or meditation, and taking long walks outdoors on a regular schedule. “Clean” sleep — where you have a regularly scheduled bedtime in a dark, quiet room, avoiding cellphone and computer use for at least an hour beforehand — is also recommended, to avoid both mental and physical fatigue.

Deep breathing exercises can be helpful. Start by paying attention to your breathing pattern. Then slowly, take a deep breath in through your nostrils, exhaling slowly through your mouth. Make sure you allow your stomach to expand through the inhalation so that you know you are taking a deep a breath as possible. Do this three to five times regularly a day — and whenever stress or tension becomes overwhelming. It gives you a “time out,” to slow down and think, calms your nerves, and lowers your blood pressure. All of this can act to prevent a headache coming on.

Massage, especially for your neck, head, and shoulders, is a powerful tool against tension and stress buildup. If you view it as pampering, stop — think of it as a medical aid. (And if you feel that you don’t have enough time in your schedule for a massage, well, that may be part of the problem.) A licensed massage therapist can provide muscle and tendon relief that will help stop headaches before they start.

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At the St. Luke’s Headache Center, the first step is to perform a physical evaluation and take a thorough medical history. Your doctor might ask you a series of questions to pinpoint the exact kind of pain you are feeling, and also ask for information about your life in general to see what stress level you are carrying.

Depending on what your physical exam shows and what answers are given about your life style, imaging tests such as an MRI or a CT scan may be performed to rule out underlying conditions.

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Treatments for tension headaches can include over-the-counter medicines such as aspirin, ibuprofen, acetaminophen and naproxen. Combination medicines — those that combine aspirin, for example, with caffeine — are often more effective than a single medicine. Too much of these kinds of medicines, however, can cause a rebound effect that produces more headaches or can cause gastrointestinal problems.

Triptans are sometimes prescribed for those who suffer from both tension headaches and migraines. If you have frequent or chronic tension headaches, tricyclic antidepressants are sometimes effective, and anticonvulsants and muscle relaxants are being studied for effectiveness.

For persistent tension headaches, injections of Botox can also be helpful; the drug interferes with the transmission of pain along the receptor’s path.

Alternative medicine routes that have proven effective include acupuncture and deep breathing exercises. Biofeedback — where you learn, through electrodes attached at various points to your body what your skin temperature, brain waves, and muscle tension, among others, are — and then how to control these — can also be helpful. Behavior therapy that teaches you how to find your triggers and react to them in a different way has been shown to work for some patients, as well.

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