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Overview |
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Definition |
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Tension headaches are frequent, intermittent, moderate headache pain
originating occipitally or bifrontally. Tension headaches may be episodic or
chronic, characterized by a dull, persistent sensation of tightness, pressure,
or stiffness that may spread to both temples and the entire head. With chronic
tension headache, muscles in the neck, shoulders, and jaw may be tight and sore.
Duration ranges from 30 minutes to several days, or longer. Tension (also called
muscle contraction) headaches account for the majority of all headaches. Most
resolve spontaneously. Surveys indicate higher incidence in women, which might
be explained by women's greater likelihood of seeking medical
assistance. |
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Etiology |
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Prolonged contraction of shoulder, neck, face, and scalp muscles constricts
blood vessels, which irritates surrounding nerves and triggers pain. Restricted
circulation also causes oxygen deficiency in muscles, resulting in excessive
accumulation and impaired circulatory removal of pain-producing
toxins.
- Referred pain from forehead, scalp, mouth, throat, eyes, sinuses, and
meninges serviced by the trigeminal nerve
- Prolonged sitting, sitting in an uncomfortable position, or
immobility
- Anxiety or stress
- PMS, hypoglycemia, dehydration, food allergy, insomnia
- Depression
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Risk Factors |
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- Family history of tension headache; although tension headaches are
probably not inherited, family members may share personality traits, behavior
patterns, and poor stress management skills
- Chronic stress or anxiety
- Depression
- Poor posture
- Irritability
- Excessive caffeine intake (including caffeine withdrawal)
- Fatigue, lack of sleep, and overwork syndrome
- Deficient exercise pattern
- Eyestrain
- Temporomandibular joint dysfunction
- Cervical spine mechanical problems
- Hypothyroidism and low adrenal function
- Carbon monoxide exposures
- Artificial sweeteners (up to 14% incidence in aspartame [Nutrasweet]
users)
- Trichloroethylene (industrial chemical) contamination of the water
supply
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Signs and Symptoms |
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- Originates bifrontally or occipitally, then spreads to entire
head
- Often described as feeling as though one's head were being squeezed
in a vise or constricted by a tight hatband
- Chronic or continuous headache lasting 30 minutes to days, or
longer
- Morning or early afternoon onset with pain continuing through the
day; headache may be present on waking but does not disrupt sleep
- Grinding teeth
- Insomnia
- Tight, sore muscles in neck and shoulders
- Pain is not aggravated by routine physical activity
- Headache is often associated with emotional stress or depression, or
may occur premenstrually in
women
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Differential
Diagnosis |
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- Acute headache
- Brain tumor or brain abscess
- Eye lesions, eyestrain, iritis, glaucoma
- Toxic states, including infections, alcoholism, uremia, lead,
arsenic, morphine, CO poisoning, encephalitides
- Overuse of caffeine
- Premenstrual syndrome
- Migraine or sinus headache
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Diagnosis |
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Rule out organic disease and cranial trauma. |
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Physical Examination |
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Patients are generally in good health. Patient may present with tight muscles
in face, scalp, and neck. |
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Laboratory Tests |
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Diagnostic tests for tension headache are not available. Laboratory tests may
be used to rule out other causes of headache
symptoms. |
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Treatment Options |
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Treatment Strategy |
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Educate patient in stress avoidance and stress management to prevent
recurrence of tension headaches. Physical fitness should be encouraged.
Biofeedback, yoga, and relaxation techniques can be quite effective for both
acute relief and decreasing headache frequency. |
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Drug Therapies |
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- Nonprescription analgesics are usually effective temporary remedies;
to prevent rebound headaches, educate patient about proper use of analgesics.
Caffeine enhances effect of analgesics for some people; excessive caffeine or
caffeine withdrawal may itself cause headaches. Prescription analgesics
containing codeine or oxycodone relieve severe headache.
- For acute attack, NSAIDs: naproxen (500 mg bid), ibuprofen (400 mg
tid)
- As prophylaxis for chronic headache, antidepressants: amitriptyline
(50 to 100 mg/day), imipramine (50 to 100 mg/day)
- Beta-blockers as a prophylaxis: propanolol (80 mg/day), atenolol (50
to 100 mg/day)
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Complementary and Alternative
Therapies |
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The main emphasis of therapies is stress managment and muscle
relaxation. |
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Nutrition |
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- Micronutrients: Because tension headache is so often related to
increased stress, replacement of micronutrients which are depleted in times of
stress is essential; the most critical are vitamins C, E, beta-carotene,
B-complex and minerals magnesium, potassium, calcium, zinc, manganese, and
selenium. Magnesium (aspartate or glycinate, up to 750 mg/day) is especially
critical because of its antispasmodic action.
- Avoid caffeine: Increased caffeine intake is correlated with
increased incidence of headaches. Cessation of caffeine may lead to withdrawal
headaches that should resolve in two to four days.
- Essential fatty acids: regulate platelet aggregation and arachidonic
acid metabolites. Dietary manipulation includes reducing animal fats and
increasing fish. A mix of omega-6 (evening primrose) and omega-3 (flaxseed) oils
may be most optimum (2 tbsp. oil/day or 1,000 to 1,500 IU bid).
- Vitamin E: 400 to 800 IU/day may decrease muscle cramping.
- Elimination/challenge diet: The most common allergic foods are wheat,
dairy, corn, soy, and chocolate. Avoid these foods completely for two weeks,
then reintroduce the foods one at a time, every three days, and note symptoms.
Citrus, alcohol, red meat, flour products, spices, and carbonated drinks may
also aggravate headaches.
- Calcium/magnesium: 1,000/500 mg/day may help to regulate muscle
contraction and relaxation.
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
- Peppermint oil (Mentha piperita)—a
natural antispasmodic and diuretic, was shown in German studies to be as
effective against tension as extra-strength Tylenol. Add two drops of peppermint
or lavender essential oil to one cup of water. Soak a cloth in the solution and
apply as a compress.
- White willow bark (Salix
alba)—contains salicin, the pain reliever in
aspirin.
- Meadowsweet (Filipendula
ulmaria)—contains salicylic acid. Relieves pain,
reduces nausea and heartburn; particularly effective for tension with digestive
effects
- Valerian (Valeriana
officinalis)—sedative and antispasmodic, digestive
bitter, particularly for tension with anxiety and/or digestive
effects
- Jamaica dogwood (Piscidia
piscipula)—sedative, pain reliever,
antispasmodic
- Ginkgo (Ginkgo biloba)—increases
circulation to the brain, regulates platelet aggregation, particularly for
tension with difficulty concentrating or circulatory problems
- Combine white willow, meadowsweet, and two of the above herbs. Use
equal parts of either herb or tincture. Herbs: 1 tbsp. in 1 cup water tid.
Tincture: 60 drops tid.
- Kava kava (Piper methysticum)—45 to
60 mg of kavalactone content tid, has a calming effect if anxiety is
prominent.
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Homeopathy |
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An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
- Aconite for sudden onset tension headaches with anxiety that
follow shock or are accompanied by a fever
- Bryonia for congestive headaches that feel worse with movement
and better with pressure and/or eyes closed; headaches may start on the left and
spread to the whole head
- Gelsemium for heavy feeling headaches and confusion, especially
with blurry vision or vertigo
- Belladonna for throbbing headaches of sudden onset, that feel
worse with motion, but the pain keeps the patient from being able to be
still
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Physical Medicine |
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During any of these therapies, patient should be instructed to practice deep
breathing, visualization, or relaxation techniques.
- Biofeedback helps patients learn to control muscle tension and to
relax problem areas.
- Neck stretches can relieve pain. Gently stretch by moving the head to
one side, then the other, resting it against the palm of the hand. Shoulder
rolls will also help to relax the upper torso.
- Press an ice pack to the forehead to constrict swollen blood vessels
and relieve pain.
- Acupressure points at the web between thumb and first finger. Press
in small circular motions at the tender points.
- Regular exercise, with an emphasis on both upper and lower back and
abdominal areas increases muscle tone (better contraction but also better
relaxation).
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Acupuncture |
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May be helpful for pain relief and decreasing frequency of
headaches |
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Massage |
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Gentle massage of shoulders and neck to loosen tight muscles and relieve
tension can be very helpful. |
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Patient Monitoring |
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A sudden change in symptoms may indicate possible serious
illness. |
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Other
Considerations |
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Prevention |
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- Patient should learn to avoid stressors that trigger
headaches.
- Psychological counseling may benefit patients whose headaches stem
from suppressed emotions, depression, or
anxiety.
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Prognosis |
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Most tension headaches are self-limiting or rapidly remedied with patient
education and analgesics. Underlying factors should be addressed to decrease
frequency of occurrences. |
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Pregnancy |
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Care should be taken when using analgesics or alternative remedies during
pregnancy. Some headaches resolve during
pregnancy. |
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References |
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Berkow R. The Merck Manual. 15th ed. Rahway, NJ: Merck Sharp &
Dohme Research Laboratories; 1987.
Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed. Durango,
Colo: Kivaki Press; 1994.
Walker L, Brown E. The Alternative Pharmacy: Break the Drug Cycle with
Safe Natural Treatment for 200 Everyday Ailments. Paramus, NJ: Prentice
Hall; 1998. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |