Tension Headache

GENERAL INFORMATION:

What are tension headaches? Tension headaches are a very common type of head pain. They often start during the late afternoon, and may get worse as the day goes on. Tension headaches can last anywhere from 30 minutes to several days. Although they are uncomfortable, tension headaches usually do not cause any serious problems.

What causes tension headaches?

• Tension headaches are often caused by tense (tight) muscles in your head and neck. These muscles can become tense if you feel stressed, anxious, or upset (emotional stress). Holding your head in one position for too long can also cause your muscles to become tense. Temporomandibular (tem-poh-roh-man-DIB-u-lar) joint, or TMJ problems can cause tension headaches. TMJ problems involve the area where the lower jaw joins your skull, by your ears. Grinding your teeth, or other jaw or dental problems can cause tension headaches.
  
  
• Other things that may cause tension headaches include eye strain, poor posture, not getting enough rest, or skipping a meal. An injury (such as a neck injury from a car accident) or an illness may cause a tension headache. Certain foods that you are sensitive to may cause them. For example, gluten (a protein found in wheat) may cause headaches in some people. Sometimes headaches are caused by a sleep problem, such as sleep apnea (brief periods of not breathing during sleep). Ask your caregiver for more information about things that may be causing your tension headaches.

What are the symptoms of a tension headache? You may feel dull, constant, or throbbing (pounding) pain above your eyes and across the back of your head. The pain may spread to your whole head or travel down into your neck and shoulders. The muscles in your neck or shoulders may also feel tight. You may feel like there is a band wrapped around your head that is pushing or squeezing your head. Your headache may be worse around bright lights or loud noise. The pain usually goes away within a few hours after treatment (such as heat or pain medicines).

How are tension headaches diagnosed?

• History and exam: Your caregiver can usually tell if you have tension headaches just by asking you questions. A neurologic (nu-roh-LAH-jik) exam to check your brain and nerves may be done also.
  
  
• Headache diary: Keeping a diary or calendar of your headaches can help your caregiver decide what may be causing them. Write down when your headaches start and stop, what you were doing when they started, and your symptoms. Record anything you ate or drank during the 24 hours before the headaches. Describe how the pain feels, where it is, and how bad it is. Keep track of the things you did to help your headaches and when you did them. Make a note of whether these things helped your symptoms or not. This record will help you learn what may trigger (start) your headaches, and what helps them the most.
  
  
• Tests: If your headaches happen very often or the pain is very bad, you may need tests. Tests can help your caregiver make sure that your headaches are not caused by a more serious problem. These tests may include an MRI or a CT ("cat") scan to check the tissue and blood vessels of your head. If you often wake up with headaches, you may need a sleep study. A sleep study can make sure that you are not having problems during sleep that may be causing headaches. Ask your caregiver for more information about any tests you may need.

How are tension headaches prevented and treated? Things that may help prevent or treat headaches may include:

• Apply heat or cold:
  
  
  • Heat or cold applied to the headache area may ease your pain. Heat can be used to decrease muscle pain and tension elsewhere in the body as well. Use a heating pad (turned on low), a hot water bottle, or warm shower. Do not sleep on the heating pad or hot water bottle. This can cause a bad burn.
    
    
  • Cold packs may decrease your headache pain. Put ice in a plastic bag and cover it with a towel. Place this over the painful area for 20 minutes out of every hour, for as long as you need it. Do not put the ice pack directly on the skin because you can get frostbite.
  
  
• Avoid eye strain: Try to avoid squinting or straining to see or read. Make sure you have good lighting when you read or perform tasks. Have yearly eye exams, and wear your eyeglasses if you need them.
  
  
• Live a healthy lifestyle: Having healthy habits can help you deal with stress and decrease your chance of headaches or illness. Some ways to live a healthy lifestyle include the following.
  
  
  • Change your diet. Poor eating habits (like missing meals) and certain foods may cause headaches in some people. Eat healthy foods from all of the five food groups: fruits, vegetables, breads, dairy products, meat and fish. Eating healthy foods may help you feel better and have more energy. Talk to your caregiver if you are on a special diet, or you think you should be.
    
    
  • Do not drink alcohol or overuse over-the-counter or prescription medicines. Drinking alcohol can cause sleep problems, depressed feelings, and increased stress. This can cause tension headaches to start, or make them worse. Alcohol and some drugs can be habit-forming. This means that you may not be able to stop using them, even if you want to, without professional help. Taking too much medicine, even if it is over-the-counter medicine, can cause serious health problems. Always take medicines as instructed on the label or by your caregiver.
    
    
  • Exercise. Begin a regular exercise program to decrease tension and feelings of stress. Something as simple as walking 20 minutes a day, three to four days a week can help. Exercising also makes the heart stronger, lowers blood pressure, and keeps you healthy. Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you.
    
    
  • Quit smoking. It is never too late to quit smoking. Besides triggering headaches, smoking increases your chance of having a heart attack, lung disease, and cancer. Ask your caregiver for help if you have trouble quitting smoking.
  
  
• Medicines: Over-the-counter medicines, such as aspirin, acetaminophen (a-seet-a-MIN-oh-fen) or ibuprofen (eye-bu-PROH-fen), are often helpful. Ask your caregiver which over-the-counter pain reliever is right for you. You may also need medicines to control other problems, such as depression or anxiety. These problems may make your headaches worse if they are not treated.
  
  
• Relax your muscles: Muscle tightness, especially in the shoulders and the neck, can start a headache. Avoid sitting still for too long when doing things like reading, sewing, or working at a computer. If you wake up with sore neck and shoulder muscles, you may need to use a different pillow. Some other ways to relieve muscle tightness include muscle relaxation exercises and massage.
  
  
  • Tighten and relax the muscles of one body area at a time. For example, when your shoulders are tense you can shrug them up to your ears. Try to tighten your muscles as much as possible while you do this. Then, completely relax your shoulders. Do this a few times, and then move on to another area of the body. Also, stand up and stretch at least once an hour as you do your daily work. Ask your caregiver for more information about muscle relaxation exercises.
    
    
  • Find any sore or tight areas in your neck or shoulders. Press these areas with your fingertips, and then gently rub them in a circle motion. You can also have someone do this for you. Have the person stand behind you while you are sitting in a chair.
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• Stress and rest: Stress is the most common cause of many types of headaches. Avoid or control stress as much as you can. Learn new ways to relax, such as deep breathing, meditation (med-i-TAY-shun), relaxing your muscles, music, or biofeedback. Ask your caregiver for more information about any of these. Talk to someone about things that upset you. Not getting enough sleep can cause tension headaches. Get plenty of rest. During a headache, rest in a dark, quiet room.
  
  
• Other treatments: You may need to see caregivers that specialize in back, muscle, or posture problems. Other caregivers may help you with jaw or teeth problems. Other therapies, such as acupuncture, may be needed. The treatments you need may depend on what is causing your headaches. Ask your caregiver about other treatments you may need to help your headaches.

For more information: Contact the following organizations for more information about headaches.

• National Headache Foundation
  820 N. Orleans, Suite 217
  Chicago, IL 60610
  Phone: 1-888-NHF-5552
  Web Address: http://www.headaches.org
  

• National Institute of Neurological Disorders and Stroke
  P.O. Box 5801
  Bethesda, MD 20824
  Phone: 1-800-352-9424
  Web Address: http://www.ninds.nih.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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