By Victor Tension headache is a benign type of primary headache disorder that affects mostly adults. There is no pathology that can be identified but is usually caused by psychosocial stress, overthinking and other benign factors.
Tension headache is under the class of primary headache disorders together with Cluster headache and Migraine. It can be treated with analgesia and some form of counselling or reassurance.
Causes of Tension Headache
Social stress is the most common cause of tension headache. Anything that causes a person to be upset acutely such as temporary financial situation, relationship arguments or fights. Some people get upset by children that are misbehaving.
In young adults tension headache can be triggered by approaching exams. Anything that causes overthinking can trigger tension headache.
Other causes of tension headache are:
- Alcohol use and withdrawal
- Caffeine withdrawal
- Lack of sleep
- Dehydration
- Eye strain
- Depression
- Common cold and flu
- Sinusitis
Symptoms
Headache is the [resenting feature of tension headache. It’s described as tight band around the sides of the head. Sometimes it remains frontal or on the sides of the head.
Headache develop slowly over few hours, more gradual than Migraine. It’s also less severe than migraine and is not affected by physical activity.
Neck muscle pain and tightness is also common. Other symptoms associated with tension headache are:
- Insomnia
- Fatigue
- Depressive symptoms
- Temporal muscles pain
Differences between Migraine and Tension Headache
The following table illustrate differences between migraine and tension-type headache
| Migraine | Tension Headache |
|---|---|
| Unilateral headache | Bilateral Headache |
| Sudden onset | Gradual onset |
| Severe pain | Mild to Moderate |
| Exacerbated by activity | Not Affected by activity |
| Needs specific treatment (triptans) | Responds on Analgesia |
Diagnosis
There are no tests needed to diagnose tension headache. History and physical examination is enough for diagnosis.
If the patient has headache typical of the one described above and normal physical examination then tension headache is the likely diagnosis.
Treatment
Non pharmacological management is very important in preventing recurrence. The important thing is to identify trigger factor and deal with it.
If headache was triggered by psychological stress, patient should receive counselling or psychotherapy.
If it’s lack of sleep then advise the patient to practice good sleep hygiene.
Pharmacological treatment of tension headache is as follows:
- Paracetamol 1g oral 4 to 6 hourly. Maximum 2.4g per day. And
- Amitriptyline 10mg oral nocte for a week. (low dose). OR
- Ibuprofen 400mg oral 8 hourly after meals
Amitriptyline is a Tricyclic Antidepressant that works best when combined with paracetamol and in low dose. For other patients, combination of paracetamol (acetaminophen) and NSAIDs is enough.