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Mixed Tension Headache

Alternate Names

  • mixed tension migraine
  • mixed-pattern headache
  • Brain structures

Definition

A mixed tension migraine is a chronic, daily tension headache (also called muscle-contraction headache) that occurs in addition to periodic migraine headaches.

What is going on in the body?

Tension headaches are the most common type of headache. Most people have them at some point in their lives. These headaches are thought to be due to abnormal muscle tension or contraction. They can also be caused by a poor dental bite or clenching of the jaws. They are usually described as a general pressure, tightness, or aching sensation.
Migraine headaches are less common and are often only on one side of the head. They are usually described as a throbbing type of pain. They may be severe and cause nausea, vomiting, and even vision and strength problems during the headache.
Some people get tension headaches daily in addition to occasional migraines. This is known as a mixed tension headache. It is very common to have both tension and migraine headaches.
Different headaches may need different treatments. Keeping a headache diary can help sort symptoms, determine if more than one type of headache is happening, and show how well treatment is working.

Risks

What are the causes and risks of the condition?

The exact reason people get either of these headaches is not known. Stress, fatigue, anxiety, or depression can cause tension headaches.
Migraines are thought to be due to spasms of blood vessels inside the skull. Bright light, noise, tension, or certain things in the diet, such as alcohol or caffeine, often bring them on. There seems to be an inherited risk of migraines in many people.
People who have both types of headaches usually have depression that contributes to the headaches. People with daily chronic headaches often overuse pain medicine, which may aggravate or even cause headaches in many people.

Prevention

What can be done to prevent the condition?

Pain medications should be used only as directed and as little as possible. This could probably prevent many of the daily headaches that occur in those who suffer migraines. Reduction of stress and avoidance of any food triggers can also help in some cases. Relaxation methods and treatment of any depression may also help prevent some cases.

Diagnosed

How is the condition diagnosed?

Diagnosis of mixed tension migraines begins with a history and physical exam. Depending on the clinical presentation, the healthcare provider may decide to evaluate for other causes for headachesand order tests, such as a cranial CT scan or cranial MRI.

Long Term Effects

What are the long-term effects of the condition?

The main long-term effects are related to the severity of headaches. Those with severe headaches may be unable to engage in regular activities. The headaches themselves pose no threat to physical health in most cases. Severe migraines are quite rare but may cause stroke or paralysis.

Other Risks

What are the risks to others?

Mixed tension migraines are not contagious and pose no risk to others.

Treatments

What are the treatments for the condition?

Treatment begins with a limitation on pain medications. This may cure the daily headaches completely. If this doesn't work, a person is usually started on other treatments which may include behavioral and drug therapy.
Stress-reduction methods may be effective. These methods include relaxation techniques, such as meditation. Biofeedback may also be useful. This involves the use of special machines to help a person reduce muscle tension. The machine may make a sound every time the muscles get tense, making someone aware of when they are getting tense. The person can then learn to reduce muscle tension, which makes the sound disappear. Eventually, people no longer need the machine to help them relax their muscles.
A headache diary or journal may help identify headache triggers. Counseling and therapy may also help a person deal with depression, tension, or anxiety.
Medicines may be needed to treat depression. Other medicines may be given for the migraine headaches. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (i.e., Aleve, Naprosyn) or ibuprofen (i.e., Advil, Motrin) or acetaminophen (i.e., Tylenol), may be given for daily tension headaches.
Long-term treatment involving medicine and behavior methods may be needed. The goal of treatment is to reduce the number and severity of headaches as much as possible.

Side Effects

What are the side effects of the treatments?

When pain medications are stopped, the person may have worse headaches for a short period of time. NSAIDs may cause allergic reactions and stomach upset.

After Treatment

What happens after treatment for the condition?

If the headaches improve or go away, no further treatment may be needed. Many people continue to have headaches that require behavioral or drug treatment.

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

Sources

Principles of Neurology, 1997, Adams et al.

The [hyperLink url="http://www.headache.org" linkTitle="National Headache Foundation"]National Headache Foundation[/hyperLink] website

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