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Tension Headache

Tension Headaches

What is a tension headache?

Tension headaches, also known as tension-type headaches, are the most prevalent type of headaches affecting around 7 million Australians every year.1 Recent studies have shown that females are more prone to tension headaches (42%) compared to males (36%).2

According to the Mayo Clinic, tension-type headaches can be differentiated into two categories based on their frequency. The two categories being:3

  • Episodic tension headaches
  • Chronic tension headaches

Episodic tension headaches occur for less than 15 days a month for up to three months and they can last from 30 minutes to a week.4

Chronic tension headaches are more severe. This type of tension headache can typically last for a few hours or last for 15 days or more. This headache can persist on and off for at least three months.5

The difficulty with identifying a tension headache is that it can often be confused with a migraine. Tension headache symptoms are not accompanied by visual disturbances, nausea or vomiting, whereas these symptoms are often at the core of a migraine.6 Nevertheless, some people can often experience both types of headaches.7

What are the tension headache causes and triggers?

Tension headaches and instigated pain associated with them are caused by tender, tight and knotted muscles.8,9 Tension headache causes may include poor posture, stress or injury and can often lead to aggravated head and neck muscles, which then forms hyper-irritable areas.10,11

Hyper-irritable areas develop when the knotted muscles are inflamed and contributing to the overall muscular tissue known as myofascial trigger points.12,13 The release of inflammatory mediators causes

the pain receptors on the nerve endings to be sensitive to pain, which produces these myofascial trigger points.14,15,16

Below are some of the most common tension headache causes and triggers:17

  • Stress
  • Irregular or unhealthy meals
  • Coffee or caffeine-based soft drinks
  • Caffeine withdrawal
  • Dehydration
  • Too much or too little sleep
  • Reduced physical activity or undertaking unsuitable exercise
  • Complications to menstrual cycle

What are the tension headache symptoms?

Most of us will suffer a tension-type headache at some point in our life. The tension headache symptoms and the pain associated with them can range from mild to moderate. Below are some of the common tension headache symptoms: 18

  • Normally, the pain is experienced on both sides of the head, spreading to the neck and shoulders
  • Pain is often steady, non-throbbing and mild to moderate in intensity
  • Band of pressure around the head
  • Usually last for a short period of time (30 minutes – 6 hours) but can sometimes last longer
  • Not irritated by normal routines of physical activities (i.e. walking or climbing stairs)
  • Normally, they don’t stop a person from continuing their daily activities
  • Not accompanied by other symptoms (i.e. nausea, vomiting)
  • Can be triggered by stress, lack of sleep, bright sunlight, dehydration, caffeine withdrawal, alcohol or poor posture

How can I treat a tension headache?

Tension headache treatment options vary depending on whether it is an infrequent tension-type headache, a chronic tension-type headache or a tension-type headache experienced by a child. Refer to the section below to understand these types of headaches and how to treat each one.

Infrequent tension-type headaches (fewer than 2 days per week) 19

If tension headache relief is required, short term analgesics such as ibuprofen and paracetamol are appropriate. Ibuprofen is a pain relieving medication that is available over-the-counter in pharmacies and supermarkets. The active ingredient ibuprofen contains anti-inflammatory properties that can help reduce and control the pain caused by a tension headache.20

If you are experiencing a tension headache, the recommended dose of ibuprofen is 200-400mg every 4-6 hours if required and it is important to not take ibuprofen for more than a few days at a time.21 The recommended maximum amount of ibuprofen consumed per day is 1200mg. Be careful not to consume more than the recommended dose and always follow the label.

Chronic Tension-type headaches (more than 2 times a week on a regular basis)22

Chronic tension-type headaches are experienced more than twice a week on a regular basis, and if they are experienced every day, a doctor should be consulted.23 A doctor may be able to recommend a preventative treatment for chronic tension-type headaches.

Tension-type headache in Children

Ibuprofen is a suitable medicine for children who are experiencing tension-type headaches.24 Be careful not to administer more than the recommended dose and always follow the label. In the event that headaches symptoms persist or worsen or should you have any concerns be sure to seek medical advice from your family doctor.

How can I prevent a tension headache?

Most tension-type headaches are relieved by adopting lifestyle changes. Below are some tips that may help prevent tension headaches from reoccurring:

  1. Create a comfortable work environment

Due to many people having a desk job, it is important to reduce the risk of a tension headache by creating a supportive environment so the key muscles can be relaxed. Ergonomic chairs can help support the spine’s natural curve which helps relieve muscle tension around the head and neck.25,26

Relocating phones and keyboards such that they are in easy reach and muscles aren’t being strained, can help reduce the risk of tension headaches.

2) Minimise stress levels

Most people tend to respond to everyday stressors by tensing muscles, grinding teeth or stiffening shoulders which ultimately triggers tension headaches in some individuals.27 Taking the initiative to step away from the desk and get some fresh air can be beneficial to helping avoid tension headaches.

3) Exercise Regularly

Individuals who don’t exercise regularly are more susceptible to tension headaches. Incorporating daily exercise can help reduce the risk of tension headaches.28 Exercise can be as simple as walking instead of driving to work or taking the stairs.

4) Avoid or minimize caffeine intake

Consuming more than 200 milligrams (around two regular cups of coffee) per day can contribute to both tension headaches and irritability.29 Reducing caffeine consumption can help alleviate tension-type headaches.

5) Treat tension headaches with an appropriate analgesic

If other forms of prevention are not successful, the use of over-the-counter pain relievers may be the best option to help relieve tension headaches.30 Faster pain relief in the onset of a tension headache can assist in longer lasting pain relief and management.31

When should I see a doctor?

For an adult, if you are experiencing unusual symptoms that don’t normally occur or if you have had at least 10 days of tension-type headaches in a month, it is best to consult your doctor on managing your condition.

References:

  1. 1 Headache Australia, Tension-Type Headache, [Accessed 13 January 2017] http://headacheaustralia.org.au/headachetypes/tension-type-headache/
  2. 2Headache Australia, Tension-Type Headache, [Accessed 13 January 2017] http://headacheaustralia.org.au/headachetypes/tension-type-headache/
  3. 3 Mayo Clinic, Tension Headache, [Accessed 13 January 2017] http://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/dxc-20211470
  4. 4 Mayo Clinic, Tension Headache, [Accessed 13 January 2017] http://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/dxc-20211470
  5. 5 Mayo Clinic, Tension Headache, [Accessed 13 January 2017] http://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/dxc-20211470
  6. 6 Mayo Clinic, Tension Headache, [Accessed 13 January 2017] http://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/dxc-20211470
  7. 7 Mayo Clinic, Tension Headache, [Accessed 13 January 2017] http://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/dxc-20211470
  8. 8 Headache Classification Committee of the International Headache Society (IHS). Cephalalgia 2013; 33(9): 629-808
  9. 9 Jensen R. Cephalagia 1999; 19: 602-21
  10. 10 Jensen R. Cephalagia 1999; 19: 602-21
  11. 11 Abboud J et al. Cephalalgia 2013; 33(16): 1319-36
  12. 12 Gerwin RD et al. Curr Pain Headache Rep 2004; 8(6): 468-75
  13. 13Shah JP et al. J Appl Physiol (1985) 2005; 99(5): 1977-84/span>
  14. 14 Shah JP et al. J Appl Physiol (1985) 2005; 99(5): 1977-84
  15. 15Shah JP et al. Arch Phys Med Rehabil 2008; 89: 16-23
  16. 16Bendtsen L et al. Neurol Clin 2009; 27: 525-35
  17. 17 NPS Australia, Triggers for tension-type headaches, [Accessed 17 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/headache/for-individuals/tension-headache/triggers
  18. 18 NPS Australia, Symptoms and signs of tension-type headache, [Accessed 17 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/headache/for-individuals/tension-headache/symptoms-and-signs
  19. 19 NPS Australia, Infrequent Tension-type headache, [Accessed 17 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/headache/for-individuals/tension-headache/medicines-and-treatment/infrequent-tension-type-headaches
  20. 20 NPS Australia, Infrequent Tension-type headache, [Accessed 17 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/headache/for-individuals/tension-headache/medicines-and-treatment/infrequent-tension-type-headaches
  21. 21 NPS Australia, Infrequent Tension-type headache, [Accessed 17 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/headache/for-individuals/tension-headache/medicines-and-treatment/infrequent-tension-type-headaches
  22. 22 NPS Australia, Frequent and Troublesome Tension-type headache, [Accessed 17 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/headache/for-individuals/tension-headache/medicines-and-treatment/frequent-and-troublesome-tension-type-headache
  23. 23 NPS Australia, Frequent and Troublesome Tension-type headache, [Accessed 17 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/headache/for-individuals/tension-headache/medicines-and-treatment/frequent-and-troublesome-tension-type-headache
  24. 24 NPS Australia, Tension-type headache in children, [Accessed 17 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/headache/for-individuals/tension-headache/medicines-and-treatment/tension-type-headache-in-children
  25. 25 Jensen R. Cephalagia 1999; 19: 602-21
  26. 26 Abboud J et al. Cephalaigia 2013; 33(16): 1319-36
  27. 27The Mayo Clinic, Headaches: Reduce stress to prevent pain, [Accessed 17 January 2017] http://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20046707?pg=1
  28. 28 Steiner et al Lifting the Burden: The Global Campaign to Reduce the Burden of Headache Worldwide J Headache Pain (2007) 8:S1
  29. 29 The Mayo Clinic, Tension Type Headache: Self-care measures for relief [Accessed 17 January 2017] http://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20047631
  30. 30 Moore RA et al. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain, Pain 2013; doi: 10.1002/ejp.536
  31. 31Moore RA et al. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain, Pain 2013; doi: 10.1002/ejp.536