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Tension Headache

Alternate Names

  • stress headache
  • Brain structures

Definition

There are two major types of tension headaches.

What is going on in the body?

Episodic tension headaches follow a stressful event. Chronic tension headaches are associated with contraction of the muscles that stretch from the back of the neck over the top of the head.

Risks

What are the causes and risks of the condition?

Tension headaches are associated with muscle contractions, but there is no proof that the contractions cause the headache. The following are believed to contribute to tension headaches:
  • anxiety
  • depression
  • poor posture
  • psychological disorders
  • social concerns
  • stress

Prevention

What can be done to prevent the condition?

Stress management may prevent some cases of tension headache, as can relaxation routines, biofeedback and meditation.
Medications used to prevent chronic tension headaches include:
  • amitriptyline (i.e., Elavil)
  • desipramine (i.e., Norpramin)
  • imipramine (i.e., Tofranil)
  • nortriptyline (i.e., Pamelor)
  • beta blockers such as propranolol (i.e., Inderal), nadolol (i.e., Corgard) or atenolol (i.e., Tenormin)
  • isometheptene-dichloralphenazone-acetaminophen (i.e., Midrin)

Diagnosed

How is the condition diagnosed?

Diagnosis of a tension headache begins with a history and physical exam. The healthcare provider may order tests to rule out other causes of the headache. These may include a cranial CT scan or cranial MRI.

Long Term Effects

What are the long-term effects of the condition?

While some tension headaches may improve with resolution of stressors or triggers, some tension headaches may become relentless and daily. On rare occasion the treatment may require hospitalization.

Other Risks

What are the risks to others?

Tension headaches are not contagious, and pose no risk to others.

Treatments

What are the treatments for the condition?

Medications used to treat tension headaches include the following:
  • aspirin
  • barbiturates, such as butalbital in combination with various pain medicines
  • opioids, such as codeine with acetaminophen
  • nonsteroidal anti-inflammatory drugs, NSAIDs, including ibuprofen (i.e., Advil, Motrin, ketoprofen (i.e., Orudis), ketorolac (i.e., Toradol), fenoprofen, and naproxen (i.e., Aleve, Naprosyn)
  • sedatives, such as prochlorperazine or promethazine
However, the same medicines can cause or at least trigger tension headaches if they are taken too frequently. As such, opioids should usually be avoided, but can be useful for occasional severe headaches. Physical therapy, including ice packs and massage, can help relieve pain.

Side Effects

What are the side effects of the treatments?

Medications used to treat tension headaches may cause stomach upset, drowsiness, rash, or allergic reactions. Individuals who are given long-term treatment with opioids may develop dependence.

After Treatment

What happens after treatment for the condition?

A person with tension headaches may benefit from stress management techniques. Biofeedback and relaxation therapy can teach the individual to control the responses that lead to the headache. Counseling or cognitive-behavioral therapy can be helpful for some individuals.

Monitor

How is the condition monitored?

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

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