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tension headache

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Alternative Names
muscle contraction headache, stress headache

Tension headaches are periodic headaches that may develop into a chronic, everyday headache. Tension headaches tend to occur on both sides of the head. The headaches are pressing or tightening in quality, and the headaches are of mild to moderate severity.

What is going on in the body?
Tension headaches are thought to be caused by contraction or "tension" of the muscles from the back of the neck over the top of the head, involving the forehead muscle and back, or posterior, neck muscles. Tension headaches are less common in older people. It is estimated that 95% of men and 99% of women have headaches of some kind at some time in their lives, and that 69% of men and 88% of women have tension headaches at some point.

What are the signs and symptoms of the condition?
Symptoms of tension headache include tight, squeezing, gripping pain across the forehead, behind the eyes, and over the top of the head, often settling in the back of the neck. Pain tends to increase with movement. Tension headaches do not involve any neurologic symptoms such as tingling, numbness, or weakness of one side of the body. Rarely, nausea or sensitivity to light or sound occurs.

What are the causes and risks of the condition?
The causes of tension headaches are unknown but may involve multiple medical conditions such as sinusitis, or inflammation of the sinuses, otitis, or inflammation of the ear, and dental conditions.

Arthritis or trauma to the upper spine may also cause tension headaches. Headaches caused by head trauma may be indistinguishable from migraine or tension headaches.

Chronic tension headaches are often related to long-term use of caffeine, alcohol, ergotamines (class of drugs used to treat migraines), or nitrates (class of drugs that cause blood vessels to dilate), or even daily use of painkillers such as aspirin, ibuprofen, and paracetamol.

What can be done to prevent the condition?
Tension headaches can be prevented by minimising daily stress, which is difficult for many people.

How is the condition diagnosed?
Clinical diagnosis is based on the presence of the above symptoms and absence of symptoms of migraines such as vomiting, auras (sensation that a headache is impending), and flashing lights. During tension headaches, visual symptoms other than mild light sensitivity usually are absent.

What are the long-term effects of the condition?
Tension headaches may become relentless and daily, and treatment may require hospitalisation.

What are the risks to others?
There are no risks to others from tension headaches.

What are the treatments for the condition?
Symptomatic treatments include routine analgesics, such as aspirin, paracetamol, non-steroidal medications (including ibuprofen, naproxen, naproxen sodium, and indomethacin).

As previously mentioned, however, the same medications can cause tension headaches if these medications are taken too frequently. Narcotic analgesics should be avoided, but can be useful for occasional severe headaches. Multiple drug and non-drug protocols are available for severe persistent tension headaches. These should be discussed with a doctor.

What are the side effects of the treatments?
Side effects of the treatments are multiple, but usually mild. Specific side effects are often particular to one medication or another.

How is the condition monitored?
Ways of avoiding headaches, such as behavioural interventions, including biofeedback, behavioural counselling, family therapy, physical exercise and dietary instruction, should be monitored, as well as the headaches themselves. As with any other conditions, contact with a doctor is important.

Author: Tim Allen, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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