|
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.
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-type
headaches usually begin gradually, and often occur in the middle of the day.
The "severity" of a tension-type headache might 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 might vary throughout the
day, the pain is almost always present. It is important to realize that although
tension-type headaches come and go over a prolonged period of time and might impair
your day-to-day function, they do not cause neurological symptoms, 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 is not usually an inherited trait that runs in families. In some
people, tension-type headaches are thought to be caused by or result in
tightened muscles in the back of the neck and scalp. This muscle tension might be
caused by (1) inadequate rest, (2) poor posture, or (3) emotional or mental
stress, including depression. This stress might 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
- 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
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 likely to be 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. Often, the pain associated with a tension-type 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 percent to 20 percent of adolescents and a lower
percentage of younger children. The percent of adults who suffer with occasional
tension-type headaches ranges from 30 percent to about 80 percent. Women are twice as
likely to suffer from tension-type headaches as are men.
Most people with episodic tension-type headaches have them no more than once or
twice a month, but the headaches can occur more frequently.
Chronic tension-type headaches tend to be more common in females and in students
who are "high achievers." Many patients with chronic tension-type headaches
have already had the headaches for more than 60 to 90 days when evaluated, and
many have missed an excessive amount of school.
Nearly 60 percent of people with tension-type headaches report that their daily
activities are impaired because of the headaches.
Chronic tension-type headaches might co-exist in adolescents and children who
already have a history of migraines. These are called mixed headaches.
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 child 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 medicines 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
are typically 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 examinations, 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
X-rays 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. Regardless of the treatment, tension-type headaches are best treated
before the headaches become more frequent and painful — that is, when the
symptoms first begin and are mild.
Stress management/relaxation training and counseling
Both episodic and chronic tension-type 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 are 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, and skin temperature, and provide immediate feedback through a tone
displayed 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 five 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 an impediment to recovery.
Medicines
For occasional symptomatic relief of infrequent tension-type headaches,
over-the-counter (non-prescription) medicines 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 because of aspirin's link with Reye's syndrome.
Also, avoid compounds that contain caffeine.
For relief of chronic tension-type headaches, daily preventive medicines
might be prescribed. These medicines — which are aimed at reducing both the
frequency and severity of the headaches — might include antidepressants, such as amitriptyline hydrochloride (Elavil), and non-steroidal anti-inflammatory
medicines (NSAIDs), such as naproxen sodium (Aleve). These medicines are not
habit-forming.
Benzodiazepines, butalbital combinations, and narcotics (Codeine) should be
avoided because these medicines could become habit-forming or addictive. Overuse
of these medicines or the daily use of pain-relieving medicines can cause
analgesic rebound headaches, described below.
Medicine overuse can increase headaches
An extremely important factor contributing to the development of chronic
daily headaches is the overuse of pain medicines. Medicine overuse is most
likely to occur in patients with chronic tension-type headaches.
Medicines associated with analgesic rebound headaches include
acetaminophen, ibuprofen, NSAIDs, triptans, ergotamine preparations, butalbital
combination analgesics, opiates, and combination analgesics containing caffeine.
Effective treatment of headaches associated with medicine overuse requires
withdrawal from the medicines causing the rebound headaches. Rebound headaches
might not go away for weeks after the medicines are discontinued.
Treating tension-type headaches without medicines
Although medicines are helpful, it is important to learn other headache
treatment methods. Here are some suggestions:
- 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 seven to 15 seconds,
then release. Repeat as needed.
- Rest, sit, or lie quietly in a 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.
How can I help reduce or prevent headaches?
- Follow your treatment plan — Avoid taking medicines that have not
been ordered by your doctor. Do not overuse over-the-counter medicines.
- 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 20 minutes of exercise three times
a week.
- Talk to a friend, family member, religious professional, or health care
professional — This can help if your problems are getting to you.
|
