Tension headache can be described as a pressing or clamping headache in one or more places of the head, lasting from a few minutes to many days. Normally, a tension headache is not accompanied by nausea or vomiting. A distinction is often made between episodic tension headache (less than 15 days per month of headache complaints) and chronic tension headache (more than 15 days per month of headache). The location of the pain and the extent to which the headache manifests itself varies from person to person. It can feel different for everyone. Tension headaches have no clear cause, but there are factors that can trigger tension headaches. The most common trigger is stress. An incorrect (work) posture or changing positions too little, poor sleep, fatigue or dreading something are other possible triggering factors. Seeking distraction or relaxation can reduce these headaches.

• What is tension headache?

• Pressing, pinching pain
• Episodic and chronic muscle tension headaches

• Cause and triggers
• Tension headache symptoms
• Complications
• Examination and diagnosis
• Treatment of tension headaches

• Painkillers
• Preventive treatment
• Physiotherapy
• Avoid triggering factors

• Self-care measures
• Supplements

• Butterbur, Q10, magnesium and vitamin B2
• Miginal tablets

• Herbal medicine for tension headaches

• Linden blossom
• Lavender
• Skullcap

• Preventing tension headaches
• Prognosis

What is tension headache?

Pressing, pinching pain

Tension headaches are experienced as a pressing, pinching pain on both sides of the head, or as a tight band around your head. This form of headache is caused by muscle contractions in the head and neck region. Painkillers can be used to relieve tension headaches. Tension headaches are usually mild or moderate in intensity, compared to migraines, which cause severe throbbing pain that may be accompanied by nausea, vomiting, and sensitivity to light and sound.

Episodic and chronic muscle tension headaches

Most people who suffer from tension headaches have episodic headaches, which occur on average once or twice a month. However, tension headaches can also be chronic. About 3 percent of the Dutch population suffers from chronic tension headaches, with headaches occurring more than 15 days per month. Women are twice as likely to suffer from tension headaches than men.Fatigue is a trigger for muscle tension headaches / Source: Istock.com/BartekSzewczyk

Cause and triggers

Tension headache is one of the most common types of headache and is often the result of stress and tension and increased muscle tension of the neck and skull muscles. There are all kinds of triggering factors, i.e. circumstances and stimuli that can trigger the headache. Many of these factors cause the muscles of the shoulders, neck and head to be tense for too long, which can result in headaches. Triggering factors are:

• stress and tension;
• alcohol;
• smoking;
• caffeine (in coffee or energy drinks);
• dry eyes;
• exertion (which, like stress, leads to muscle contraction);
• fatigue;
• cold, flu or sinus infection;
• eye strain (strong tightening of the eye muscles, for example by reading in poor light);
• posture and movement errors (which cause muscles to be overloaded);
• overload of the chewing muscles (for example, due to frequent chewing of gum);
• weather conditions and environmental factors (changes in weather, but also staying in a smoky room can trigger headaches);
• hormonal fluctuations;
• nutrition (certain foods can trigger headaches).

 More women than men suffer from tension headaches / Source: Istock.com/JackFSlightly more women than men suffer from tension headaches.

Tension headache symptoms

Tension headaches are characterized by a pressing, throbbing or pinching pain in one (for example above the eyes or in the back of the head) or more places of the head or everywhere in the head (like a pinching band around the head), usually present continuously. Sometimes you also suffer from pain in the neck and shoulders. This form of headache is usually not accompanied by nausea and vomiting, as is the case with migraines. It may take several minutes or hours or even days. The pain does not get worse with normal physical exertion such as climbing stairs. Occasionally, people with tension headaches are hypersensitive to bright light or loud sounds.

Complications

Because tension headaches can occur frequently, they can have a negative effect on your work or school performance and significantly affect your general quality of life, especially if the complaints are chronic. The frequent pain can prevent you from attending (social) activities. You may have to miss work or school because of your complaints and you may have to miss social activities.

Examination and diagnosis

History and physical examination If you suffer from chronic or recurring headaches, it is wise to make an appointment with your doctor. The GP will carry out a physical and neurological examination, which will be preceded by an extensive interview (anamnesis). The doctor will ask many questions about the nature and intensity of your complaints, for example:

• The nature of your headache: is the headache throbbing? Is the headache intermittent or constant? Is the pain sharp or stabbing? Is it pressing, pinching pain?
• Pain intensity: A good indicator of the severity of your headache is your ability to function while you have it. Can you work? Does your headache wake you up or prevent you from falling asleep at night?
• Location of the headache: Do you feel pain all over your head, or on one side of your head, or just on your forehead or behind your eyes? Or like a tight band around your head?

 MRI scan / Source: Istock.com/© james steidlImaging examination If you have unusual or complex headache complaints, your GP may find it necessary to have imaging examinations carried out in order to rule out serious causes of headache, such as a brain tumor. Two common tests used to create an image of your brain are:

• Magnetic resonance imaging (MRI). Imaging technique based on the use of a magnetic field to produce clear images.
• Computed tomography (CT). In a CT scan, multiple thin cross-sections of the body part to be examined, in this case the brain, are made using X-rays.

 Paracetamol for tension headache / Source: Martin Sulman

Treatment of tension headaches

Painkillers

Painkillers can relieve pain, but keep in mind that painkillers can also cause headaches when used frequently, which are called medication-related headaches. You can take a simple painkiller such as paracetamol or an NSAID, which have a beneficial effect on the duration and intensity of an episode of tension headache.

Preventive treatment

Preventive treatment, also called prophylactic treatment, may consist of the use of amitriptyline , which belongs to the group of tricyclic antidepressants. Effects can only be expected after about six weeks. A treatment period of 3 to 6 months is often sufficient.Physiotherapy for tension headaches / Source: Istock.com/KatarzynaBialasiewicz

Physiotherapy

The GP can also refer you to a physiotherapist or a manual therapist for relaxation of the neck and shoulder muscles and loosening the cervical vertebrae. Cognitive behavioral therapy is also increasingly used, which is often combined with relaxation therapy.

Avoid triggering factors

Furthermore, it is wise to avoid triggering factors as much as possible, so that the headache is reduced or prevented.

Self-care measures

Other ways to relieve tension headaches include:

• Apply cold packs to the head several times a day;
• Take a warm bath or shower to relax tense muscles;
• Improving your working posture;
• Frequent computer breaks to avoid eye strain;
• A lifestyle that is as regular and healthy as possible with sufficient rest for the eyes and body;
• Don’t take naps during the day;
• The use of caffeine, nicotine, alcohol and large meals before going to sleep is not recommended;
• If you have sleeping problems, it is wise to find another room with little light;
• Prayer, relaxation techniques and breathing exercises often help with stress and tension.

Supplements

Butterbur, Q10, magnesium and vitamin B2

Some supplements may also help relieve tension headaches. Since alternative medicines can interact with conventional medicines, it is wise to discuss this with a doctor or pharmacist first. According to the National Center for Complementary and Integrative Healthcare (NCCIH), the following supplements can prevent tension headaches from occurring:

• Butterbur (Petasites);
• Coenzyme Q10;
• Magnesium;
• Riboflavin (vitamin B2).

 St. John’s wort / Source: Fir0002, Wikimedia Commons (GFDL-1.2)

Miginal tablets

Miginal tablets are also recommended for tension headaches, especially when stress is involved. Miginal relaxes the head and helps with mental pressure. Composition per tablet:

• 260 mg feverfew;
• 85 mg gold poppy; and
• 100 mg St. John’s wort.

Feverfew has a combination of natural ingredients for a relaxed head. Golden poppy is soothing and relaxing, while St. John’s wort supports inner relaxation. Together, these ingredients ensure that your head relaxes and you can continue with your activities and tasks.

Herbal medicine for tension headaches

Herbal medicine can provide relief for tension headaches.

Linden blossom

A decoction or infusion is prepared from lime blossom. It is drunk warm for headaches, among other things.Lavender / Source: Off2riorob, Wikimedia Commons (CC BY-SA-3.0)

Lavender

Lavender is a soothing herb that is used for anxiety and tension. The herb calms overactive nerves and relieves tension headaches. Lavender is also a good sleep aid. This applies to both the volatile oil (a few drops on a burner or rubbed on the skin), the dried flowers (in a herbal pillow) and the tincture (1 teaspoon before bedtime.

Skullcap

Skullcap, whether or not in combination with other herbs, can provide relief from headaches, among other things. It is also used for restlessness and sleep disorders.

Preventing tension headaches

Since tension headaches are often caused by specific triggers, it is important to identify and then avoid them. Keeping a headache diary can help you determine the cause of your tension headaches. You can make an overview of your daily meals, drinks and activities, as well as situations that cause stress. Make a note for each day that you experience a tension headache. After a few weeks or months, you can make connections between triggers and your headaches. For example, if your diary shows that the headaches mainly occur on days when you have eaten certain foods, then these foods may be a trigger. By eliminating these foods from your diet, you can then see if your headaches become less frequent.

Prognosis

Tension headaches often respond well to treatment. Yet chronic tension headaches can seriously affect your quality of life. These headaches can also make it difficult to participate in many activities. This can also cause you to miss many days from school and/or work. If it becomes a serious problem, discuss it with your doctor.Alarm symptoms It is important not to ignore serious symptoms. Seek immediate medical attention if you experience a headache that begins suddenly or a headache that is accompanied by loss of speech, loss of balance, or high fever. This could indicate a much more serious problem, such as a stroke, tumor or aneurysm.

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