Tension-type headaches: Stress or neurological problem?

Tension-type headaches are common and can significantly decrease one’s quality of life. Although it is a neurological condition, it has been related to stress, anxiety, and depression. In the last decades, an increase in frequency has been observed. It is therefore useful to learn more about them in order to treat them early and prevent them.

This article will help you recognise the typical features and learn about the possible causes, the treatment options and the way to prevent them through stress management.

It is the most common type of headache amongst people. It has been related to stress and anxiety, although its exact mechanism is still yet to be understood. Other name: Stress headache.

How does a tension-type headache hurt? The pain feels like a pressure on both sides of the head, as if an elastic band were squeezing the entire head. Unlike a migraine, the pain is not so much throbbing, but rather continuous and persistent. The intensity may be mild to moderate, and the duration is variable, lasting from hours to days.

Depending on their frequency and duration, they are divided into two subtypes. Episodic headaches, which occur for less than 15 days in a month, and chronic headaches, which are present for more than 15 days in a month.

Physicians are generally able to diagnose tension-type headache through medical history. Physical and neurological examination helps them rule out other conditions, and brain imagery such as Computed Tomography or MRI can help clarify uncertain cases. Doctors ask over features, location, duration, intensity and frequency of pain. They also ask for symptoms of other conditions such as vision problems, language, sensitivity, and mobility disturbances, which are not typical of tension-type headache.

Call 112 in case of headache of sudden and severe onset. Also, if it comes with weakness or numbness of the face, arm, or leg, or if there is difficulty in walking, seeing, speaking or understanding.

It is recommended to schedule an appointment when headaches are not relieved with usual medication, when they interfere with daily life, or when there are changes in the features. In most cases, General Practitioners are familiar with tension-type headaches, although the specialists are the Neurologists. When major affective disorders are suspected at the origin, an assessment by a psychiatrist or a psychologist is advised, to treat them. At Sinews, we can help you with specialized care aimed at solving the underlying emotional disorder.

Over-the-counter medications are available to treat acute episodes. For episodic headache, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin or naproxen are indicated. For those who do not tolerate NSAIDs or who have allergies, paracetamol is recommended. It is very important to limit the use of analgesics to prevent the headache from becoming chronic and transforming into analgesia abuse headache, which appears when these drugs are taken regularly. Patients suffering from chronic tension headache (for more than 15 days per month) should consult a physician for preventive treatment. Amitriptyline is usually recommended for those cases.

When a tension headache occurs, in addition to analgesics, other non-pharmacological measures can help to manage the pain. In an acute episode, irritants (such as coffee, nicotine, alcohol or other intoxicants) should be avoided and environmental irritants (noise) should be minimized. Home remedies: Isolate yourself in a quiet room. Lying in bed. Close your eyes and focuse on your breathing, which should be slow and deep. Apply light pressure on the temples with the tips of the fingers. In case of muscular tension in the neck or shoulders, a physiotherapist can help to treat the contractures and soreness. If this is not possible, gentle heat can be applied to the most tense area with a seed bag or simply with water from the shower. Also, one can gently massage the painful area of the shoulders and back of the neck, by gently pressing with the fingers in circles.

To improve the quality of life, the most important thing is to prevent headaches so that they become less frequent and limiting. Tips to prevent tension headaches:

Reduce tension headache by managing stress. To prevent headaches from becoming prolonged or chronic, it is essential to address the stress and anxiety that facilitate them.

Tension headache is very common and can limit the quality of life of those who suffer from it. Although the causes are not fully understood, neurological sensitization to pain may in part be explained by underlying anxiety, depression and stress. There are different ways to treat acute episodes, although if the response is not as expected, it may be necessary to consult a physician. It is important to treat underlying emotional problems to prevent tension headaches. An assessment by psychiatry or psychology may be necessary if you are unable to manage your anxiety or depression on your own. At Sinews we can offer you targeted psychological or psychiatric treatment to help you overcome your discomfort.

María Isabel Zamora is a physician with a double specialty in Psychiatry and Neurology. She has experience in the care of patients in general psychiatry consultations, and in a more specialized way, in the care of patients who combine psychiatric and neurological symptoms. She has worked with psychogeriatric patients and patients with functional diversity. She has experience in cognitive impairment, psychological and behavioral symptoms of dementia, psychiatric symptoms related to neurological disorders or chronic pain, autism, ADHD, adaptive disorders, depression, anxiety, addictions, bipolar disorder, obsessive-compulsive disorder, sleep disorders, eating disorders, etc.