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woman holding her neck in pain

In the second part of my blog post series on headaches, I’m going to discuss a different type of headache – tension headaches. Unlike migraines, tension headaches have some very distinct and specific characteristics that make them much easier to diagnose. However, as I discussed in my post on migraines, in order to overcome headaches and achieve lasting relief, the treatment you receive must match the type of headache that someone you’re suffering. You can’t treat a migraine headache and a tension headache the same way and expect the same results because they have distinct causes and mechanisms for producing their unique headache symptoms. So let’s talk about tension headaches and what you can do to start taking some steps toward freedom from these painful and nagging headaches.

Tension headaches are extremely common. In fact, up to 78% of people experience a tension headache in their lifetime, and it is estimated that 20% of the population currently suffers from regular tension headaches. Tension headaches are more common in women but can still occur in men, and they tend to peak in an individual’s 30’s (Source). Tension headaches have a few known triggers including prolonged poor posture, stress, and anxiety. Tension headaches are believed to be caused by hypertonicity or contraction of the muscles of the head,neck and scalp. However the fact that people have “tension” in the muscles of their neck does not mean those muscles are strong. In fact, several studies have shown significant strength deficits in the muscles of the head and neck in people experiencing tension headaches when compared to people who don’t experience tension headaches (Source). As you could probably guess, that will come up again later when I talk about treatment options!

Tension headaches are typically described as a feeling of “tightness” or “pressure” in the neck, head, and scalp region. Someone who is suffering from a tension headache may report stiffness in the neck and may even say that the headache feels better if she presses on the place where she feels the pain is originating from (usually in the shoulders, upper neck or at the base of the skull). Unlike migraines, tension headaches do not induce autonomic symptoms such as swelling, tear production, facial drooping, etc. The medical community often dismisses tension headaches as harmless and self-limiting, but tension headaches show a propensity to become a chronic problem if left untreated or not treated effectively. The consequences of allowing a manageable condition such as occasional tension headaches to become a chronic issue can’t be overstated. Your nervous system is highly adaptable to whatever stimuli that is it is exposed to, so if it is constantly bombarded with headache pain signals, it becomes more sensitive to painful stimuli in general. In other words, allowing yourself to continue to experience these types of headaches without treating them can decrease your nervous system’s ability to process and tolerate pain – so now it takes less of a trigger to cause a headache! So, here we are again – what can we do to treat these tension headaches?

Treatment of tension headaches begins in the same place we began when discussing treatment of migraines – discovering and avoiding triggers. If prolonged computer work or reading triggers a tension headache, then a more ergonomic workstation might be enough to minimize or eliminate these headaches. For others, stress is a common stressor, so removing the source of these stressors along with better and more consistent sleep can be a game-changer. But for those who have been suffering tension more frequently or for longer than a month or two, those changes alone are not likely to be sufficient. Sadly, opioids are prescribed 35% of the time for those presenting to the emergency department with tension headaches (Source). There is no literature available supporting the use of opioids for management of tension headaches, so let’s not even go there. The most frequently prescribed medications for these types of headaches are “muscle relaxers,” which provide temporary relief for some individuals, but usually have a side effect of extreme drowsiness. These medications are also ineffective at long-term management due to only treating the symptoms and not the cause of the headache (Source). In more extreme or chronic cases, some physicians will consider trigger point injections or nerve blocking procedures to dull the nerves that are believed to be transmitting the pain signals leading to the feeling of a headache. Again, these interventions have limited supporting evidence and are often unnecessary if an individual takes opts for a more active treatment approach (Source).

Unlike pharmacological management, there is an abundance of evidence for manual therapy (massage, dry needling, ischemic compression, and joint mobilization/manipulation), aerobic exercise, and exercises aimed at improved head, neck, and shoulder range of motion and strength (Source). Several studies have done direct comparisons between “usual care” (medication) with non-pharmacological care (techniques listed above) and have found non-pharmacological care to be far superior in both short-term and long-term outcomes (Source). In fact, one study compared “usual care” to self-management, and found more significant improvements in the self-care group (Source). So you would be better off sticking it out by yourself than taking medication for your tension headaches…yikes!

The solution is pretty clear at this point – if you’re having tension headaches, exercise caution if you’re prescribed medication such as muscle relaxers or opioids. The evidence supporting an active treatment approach centered around manual therapy and exercise is almost overwhelming at this point, so do yourself a favor and take the first step towards recovery today by reaching out to me and discussing your symptoms. If I can’t help you, I’ll direct you to someone who can! But there’s no need to suffer any longer – today can be the day you break the cycle of that 3:00 afternoon headache that you get every day!