Tension headache

Tension headache: description

Tension headache is one of the “primary” headaches. This means that they are not due to a specific cause. A tension headache does not arise because of another illness such as a head injury, a metabolic disease or chronic medication – this pain has a specific cause and are therefore counted as a “secondary” headache.

The tension headache is described by those affected as a dull, squeezing pain (“vice feeling”). According to the German Society of Neurology, more than half of adults and about one fifth of children and adolescents suffer from tension-type headache at least once a year. For the most part, he first appears between the ages of 20 and 40 years.

Episodic tension headache vs. chronic tension headache

The International Headache Society (IHS) distinguishes episodic (random) and chronic tension headache. Of the episodic tension headache is defined as the onset of tension-type headache for at least one and at most 14 days per month, over a three-month period. Episodic tension-type headache affects women more often. The onset of illness is often between the ages of 20 and 30, but children or older people may also be affected.

If, on the other hand, it occurs over a period of three months, lasting more than 15 days per month, it is considered chronic tension headache designated. Transitions between the two forms are possible, especially from episodic to chronic tension-type headache. About 80 percent of patients with chronic conditions previously suffered from episodic tension-type headache. Chronic tension-type headache is particularly common between the ages of 20 and 24, and after the age of 64. Women and men are affected about the same number of times.

Tension headache: symptoms

Tension headache duration varies from person to person and from pain attack to pain attack. It usually lasts for hours to several days. Typically, tension-type headache occurs in contrast to migraineboth sides on and is perceived by those affected as oppressive and restrictive (“vice feeling”) but not as pulsating. Overall, it is mild to moderate headache, the not amplified by routine physical activity become. Everyday tasks may be more difficult, but can usually be done. Unlike migraine, nausea, vomiting, and blurred vision are not typical tension-type headache symptoms. Accompanying but one Light and sound sensitivity occurrence. Neck or shoulder muscles are often strained in tension-type headache.

Distinction between tension-type headache and migraine at a glance

	Tension headache	migraine
localization	On both sides, with regard to the whole head, as if it were clamped in a vise	Mostly one-sided, often on the forehead, temples or behind the eyes
pain characteristics	Dull boring, oppressive	Pulsating, hammering
Phenomena during headache	No, possibly moderate light and noise sensitivity	Aura: blurred vision, speech disorders, nausea and vomiting
Aggravation of pain due to physical activity	No	Yes

Tension headache: causes and risk factors

Although tension-type headache is the most common type of headache, it has not been possible to fully clarify the exact causes. It used to be thought that the triggers of tension-type headache were tension in the neck, neck and shoulder muscles. That’s where the name “tension” headache comes from. Although these tensions are probably involved in the development of tension headaches, the exact mechanisms are still unclear.

Some researchers assume that certain trigger points in the musculature of the head, neck and shoulder are particularly sensitive to pain in people with tension-type headache. Other scientists point out that in tension headaches blood and nerve water are altered or blood flow disturbances of the veins may cause the disease. Magnetic Resonance Imaging (MRI) imaging has been shown to alter certain brain regions of pain processing in tension-type headaches.

Although the exact processes that lead to the development of tension-type headache are still unclear, there are some known ones risk factors: Stress, feverish infections and a muscular strain are common triggers. While genetic factors may not be very relevant in episodic tension-type headache, they do play a role in chronic tension-type headache. If a family member suffers from the chronic form, the risk is about three times as high, also to get it. In addition, women, low-educated, post-partum, overweight, diabetic, and arthritic patients have a higher risk of developing tension-type headaches.

Another striking feature of chronic tension-type headache is the association with mental symptoms: it frequently occurs in patients with panic disorder, anxiety disorders, depressive symptoms or sleep disorders.

Tension headache: examinations and diagnosis

The right contact person for suspected tension-type headache is a specialist in neurology. For headaches, the interview between the patient and the doctor is particularly important, because the doctor can use targeted questions to better assess which of the many causes are most likely responsible for you. In the anamnesis interview, the doctor first asks you to give him precise information about the tension headache. Possible questions could be:

• How strong are the headaches (low, bearable, hard to bear)?
• Where exactly do you feel the headache (one-sided, bilateral, temples, back of the head, etc.)?
• How does the headache feel (dull, boring, oppressive or pulsating, hammering)?
• Do you experience other disorders before or during the headache, such as blurred vision, speech problems, photophobia, nausea and vomiting?
• Do the complaints become worse during physical exertion?
• Do you have a headache after a certain situation or have you identified triggers for the headache?

Since other forms than tension-type headache can also be caused by illness or medication, the doctor must rule out these other causes. For example, he could ask you the following questions:

• Do you take any medicine? If yes, which?
• How much do you sleep? Do you have sleep problems?
• Have you recently hurt or bumped your head?
• Do you suffer from seizures?
• Are you sick on a regular basis (for example, morning vomiting)?
• Are you very sensitive to light or are you experiencing impaired vision?

Diagnostic criteria tension headache

According to the International Headache Society (IHS) definition, tension-type headache can be diagnosed if headaches have occurred at least 10 times, meeting the following criteria:

1. Duration between 30 minutes and seven days
2. Neither accompanying nausea nor vomiting
3. little or no accompanying light or noise sensitivity
4. Have at least two of the following characteristics: bilateral localization, oppressive / constricting / non-pulsatile pain, mild to moderate pain intensity, not enhanced by routine physical activity
5. Not due to another illness

After the anamnesis a detailed neurological examination, In doing so, the doctor roughly tests the function of the brain and spinal cord with various tests. If necessary, he also tests various reflexes, such as the pupillary reflex or the Achilles tendon reflex.

In addition to the neurological examination, the physician palpates the muscles of the head, neck and shoulders with his hands. If the muscles on these parts of the body are obviously tense, this could be an indication of a tension headache. In addition, the doctor measures the blood pressure, as well as increased blood pressure can be a cause of headaches. Optionally, there is also one Blood useful to detect abnormalities (eg increased inflammatory levels).

If the doctor is unsure whether tension headache or secondary headache is behind the condition, further investigation is needed. These include, above all, imaging procedures with which the brain can be visualized. In addition, special examinations such as the recording of cerebral currents (EEG) and the analysis of the cerebrospinal fluid (CSF) are sometimes necessary.

Imaging procedures: CT and MRI

If it is suspected that an abnormally dilated blood vessel in the brain (aneurysm) or a brain tumor is responsible for the symptoms rather than tension-type headache, an imaging procedure such as computed tomography (CT) or magnetic resonance imaging (MRI) is usually used. In order to better visualize blood vessels, the person concerned is first injected with a specific contrast agent into a vein, before he is driven on a movable couch with his head into the examination tube (CT angiography).

Electroencephalogram (EEG)

To distinguish tension-type headache from an undiagnosed spasm, brain tumor, or other structural change in the brain, an electroencephalogram (EEG) is performed. For this purpose, small metal electrodes are attached to the scalp, which are connected with cables to a special measuring device. Thus, the brain waves are measured at rest, in sleep or under light stimuli. This procedure is neither painful nor harmful and is therefore particularly popular for the study of children.

Nerve water examination (CSF)

To exclude altered brain water pressure (cerebrospinal fluid) or meningitis, a nerve water puncture may be necessary. The patient with the suspected tension-type headache usually receives a sedative or light sleep medication in this study. In children, a general anesthetic is usually performed. Then first the lumbar area on the back is disinfected and covered with sterile towels. So that the patient has no pain during the puncture, a local anesthetic is injected under the skin. The physician can then advance a cannula to a CSF reservoir in the spinal canal, determining CSF pressure and removing nerve water for a laboratory examination. The spinal cord ends already above the puncture site, which is why it can not be injured in this investigation. Most people find the examination uncomfortable but bearable, especially as the CSF usually takes only a few minutes.

Tension headache: treatment

Against tension-type headache, sufferers can take painkillers from the group of so-called “painkillers”.Nonsteroidal anti-inflammatory drugs-“Take. These medications prevent certain pain-transmitting substances from being formed in the body. Ingredients such as paracetamol, ibuprofen, diclofenac, naproxen, metamizole or acetylsalicylic acid (ASA) are eligible. The drug-induced tension-type headache therapy can also be carried out with combinations of ASA, paracetamol and caffeine that have already been put together. This combination proved to be more effective in studies than the single substances and as the combination of acetaminophen and aspirin without caffeine.

However, the drugs can cause unwanted side effects such as blood thinning effects or stomach discomfort and also lead to headache even if used too frequently (painkiller-induced headache). For this reason, they should be used so rarely and in the lowest effective dose. For tension-type headache, they should be taken for a maximum of three consecutive days and not more than ten days a month. In children, flupirtine also has an effect on tension-type headache. Therapy options include peppermint oil applied to the temples and neck and preventative measures.

Tension headache: Prevent

Because the disease is recurrent or even chronic in many sufferers, long-term preventive measures are essential for tension-type headache. What to do? Affected persons can regularly attend recurring episodes (two to three times a week) endurance training like jogging, swimming or cycling and also specifically training your shoulder and neck muscles. In addition, there are other targeted measures to prevent tension headache.

Non-pharmacological measures

relaxation techniques and stress management training have a positive effect. Most of the time, these changes improve tension-type headache but can not cure it in the long term. Whether acupuncture treatment can help the patient is controversial.

In addition to the above options should also biofeedback Reduce tension headache. It teaches you how to influence your bodily functions yourself. It is therefore particularly suitable for people who suffer from muscle tension in tension headache. You can learn to solve them consciously. The method is very effective in some studies. That’s why some health insurance companies cover the costs of this treatment.

In biofeedback, a device measures certain physical parameters such as heart rate, blood pressure, skin resistance, body temperature, heart rate and respiratory rate. The patient can see the results on a screen. He recognizes whether they deviate from the norm and by what thoughts or feelings or moods he can positively influence them. The more he trains, the better he can perceive and control his body. Eventually, this also succeeds without direct feedback from the meter. Thus, people with tension headaches can improve symptoms and, in the long term, the frequency of pain episodes.

Tension headache prevented by medication

Especially with a chronic course of tension-type headache, regularly taken medications can improve the clinical picture. The antidepressant amitryptilin, which is also effective against pain, is used. Alternatively, other drugs such as doxepin, imipramine or clomipramine may be used. Since these preparations may have many undesirable side effects, the dosage must be slowly increased. The effectiveness appears at the earliest after four to eight weeks. Approximately half of patients with tension-type headache should benefit from this drug therapy, according to one study. Among experts, however, the effectiveness is controversial.

If this therapy is not sufficiently effective, further groups of active ingredients, such as the used in migraine epilepsy drug topiramate or the muscle relaxing drug tizanidine can be prescribed. In addition, it seems to make sense to combine the medication with stress management therapy.

Tension headache: disease course and prognosis

Basically, the prognosis of tension-type headache is good. Frequently a tension headache disappears by itself.

In about three to twelve percent of those affected, however, the headache turns into a chronic form. This is often very stressful for those affected, which is why they should pay attention to competent support when dealing with mental health problems. However, this form also heals on its own in about the same number of patients. In women, the symptoms often improve when they are pregnant. Only eight percent of those affected suffer from the beginning of a chronic form ofTension headache.