Tension Headache
Tension Headache
Tension headache is the most common form
of headache. Painkillers taken 'as required'
work well in most cases. Attention to lifestyle
factors such as stress, posture, and exercise
may help to prevent headaches. Medication to
prevent headaches may help if you have
frequent tension headaches.

Who gets tension headaches?
Most people have a tension headache from time
to time. It is common to have 1 or 2 each month.
Sometimes they develop more often than usual,
typically during times of stress. Some people
have frequent headaches. About 3 in 100 people
have a tension headache on most days.
What causes tension headaches?
Some, but not all, may be due to tension. The
term 'tension-like' headache is preferred by
some doctors as the cause is often not clear.
Many tension headaches develop for no
apparent reason. Other causes include the
following.
·        Emotional tension, anxiety, or stress
may cause some headaches.
·        Physical tension in the muscles of the
scalp and neck may lead to a headache. For
example, poor posture at a desk may cause
the neck and scalp muscles to tense. If you
squint to read because you cannot see well,
this may tense your scalp muscles too.
·        Something may trigger a tension
headache. For example: a food, bright sunlight,
illness, a side-effect of medication, depression,
cold, heat, tiredness, noise, alcohol, caffeine, etc.
·        Painkillers which you may take regularly
can sometimes cause headaches similar to
tension headaches. For example, you may take
a lot of painkillers for a bad spell of headaches.
You may end up using painkillers every day,
or on most days. Your body then becomes used
to painkillers. A 'withdrawal' headache then
develops if you do not take painkillers each day.
Daily use of painkillers for headache is a
common cause of frequent headaches.
(This is called 'medication headache'. A
separate leaflet discusses this further.)
What are the symptoms of tension headache?
·        Typically the pain is like a tightness
around the 'hat-band' area. Some people feel
a 'squeezing' or 'pressure' on their head. It is
usually on both sides of your head, and often
spreads down your neck or seems to come
from your neck. Sometimes it is just on one
side. The pain is usually moderate or mild,
but sometimes it can be severe.
·        A tension headache can last from
30 minutes to 7 days. Mostly they last a few
hours or so.
·        The headache normally comes on
during the day, and gets worse as the day goes on.
·        There are usually no other symptoms.
Some people feel slightly dizzy, tired, anxious,
and feel a little sick with a tension headache
(but vomiting is not a feature of tension headaches).
How can I be sure it is not a more serious type
of headache?
With tension headaches, you are normally well
between headache attacks, and have no other
ongoing symptoms. A doctor can be confident
that headaches are the tension type by their
description, and they find nothing abnormal
when they examine you. Tests are not usually
done unless you have unusual symptoms, or
something other than tension headaches is suspected.
Compared to migraine (the other common type
of headache that comes and goes), a tension
headache is usually less severe, and is constant
rather than throbbing. Also, migraine usually
causes a one-sided headache, and other
symptoms such as vomiting are common.
In general, unlike migraine, you are usually
able to continue with normal activities if you
have a tension headache. Some people have
both migraine headaches and tension
headaches at different times.
What are the treatments for tension headache?
Relaxation
Different people find different things helpful.
For example, a walk, some exercise, or simply
taking a break from the normal routine may
help. A massage of your shoulders and neck
is often helpful. A hot flannel on your neck or
a warm bath may also help.
Painkillers
·        Paracetamol usually works well. It
is best to take a full dose as soon as a headache
starts. This may 'ward off' the headache better
than treating it after it has fully developed.
You can take a second dose after 4 hours if
necessary. (For headaches, it is best not to
use combination tablets which contain paracetamol
and codeine, such as co-codamol. They are more
likely to cause 'medication headaches' as described above.)
·        Anti-inflammatory painkillers are alternatives.
For example, ibuprofen which you can buy at
pharmacies, but you need a prescription for
other types. Anti-inflammatories may be more
effective than paracetamol. However, some
people develop side-effects such as stomach
problems. Always read the leaflet which comes
with the medicine packet.
You should not take painkillers for headache
for more than a few days at a time. Also, in total,
do not take them for more than 15 days in any
month. If you take them more often, you may
develop medication headaches (described above).
Do not take painkillers all the time to prevent
headaches. Take each day as it comes. See a
doctor if you need painkillers for headaches on
most days.
How can I prevent frequent tension headaches?
Diary. It may be useful to keep a diary if you
have frequent headaches. Note when, where,
how bad, and how long each headache lasts.
Also note anything that may have caused it.
A pattern may emerge and you may find a trigger.
For example, hunger, eye strain, bad neck posture,
stress, anxiety, anger, or other emotions. You may
be able to avoid or change situations that trigger
your headaches.
Stress is a common trigger for headaches. Avoid
stressful situations whenever possible. Sometimes
a stressful job or situation cannot be avoided.
Learning to cope with stress and to relax may
help. Breathing and relaxation exercises, or
coping strategies, may ease anxiety in stressful
situations and prevent a possible headache.
There are plenty of books and tapes which can
teach you how to relax. Sometimes a referral to
a counsellor or psychologist may be advised.
Regular exercise such as brisk walking, jogging,
cycling, swimming, etc, helps some people to ease
stress and tension. This can have a knock-on effect
of reducing frequent headaches.
Depression can cause frequent headaches. Tell your
doctor if you feel that you are depressed.
Medication is sometimes used to prevent frequent
headaches.
·        Amitriptyline is the medicine most commonly
used. This is not a painkiller. It is an antidepressant
and you have to take it every day. (One effect of some antidepressant medicines is to ease pain and
prevent headaches even in people who are not
depressed.) A low dose is usually started at first
and may need to be increased over time. Once
the headaches have been reduced for 4-6 months,
the amitriptyline is stopped.
·        Sodium valproate is sometimes used.
Again this is not a painkiller. It is usually used to
control epileptic seizures. However, it has been
found to prevent tension headaches in some
cases.