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• Introduction
• Prognosis
• Causes
• Risk Factors
• Diagnosis
• Managing Tension-Type Headaches
• Medications
• Treatment
• Lifestyle Changes
• Resources
• References

Headaches - tension

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of common headaches.

Risk Factors

Tension-type headaches are the most common headaches. According to one study, nearly 40% of Americans have at least one episode of tension headaches during the course of a year. Some reports estimate that over 85% of women and about 63% of men will experience a tension-type headache at some point during a year. Virtually everyone, then, has at least one tension-type headache during the course of their lives.

Individuals at highest risk for chronic headaches are middle-aged women, Caucasians, and people who are well-educated. Surveys indicate that about 3 - 5% of the general population has chronic tension-type headache, with the prevalence possibly being higher in women.

Age

About 40% of people with tension-type headaches first have them before they are age 20, and another 40% first experience them between ages 20 - 40. Most of the remaining headache sufferers first have tension-type headaches in the decade between ages 40 - 50. Chronic tension-type headache tends to occur in older adults.

Headaches in Children. Headaches are rare before age 4 but increase in prevalence throughout childhood, reaching a peak around age 13. In one large study, about 7% of seven year olds and 15% of 11 year olds had headaches. Ten percent of these childhood headaches were recurrent. In many of these patients, chronic headaches persist into adulthood. In addition, as adults these patients have a tendency to develop multiple physical or psychiatric complaints, such as back pain, muscle aches, digestive complaints, and depression.

Studies have found that only a minority of chronic childhood headaches are due to physical conditions, such as head injuries or medical problems. In one study, over 62% of children with tension-type headache episodes suffered some form of emotional disorder. In the study, every child reported the presence of a stress factor.

Psychological factors associated with childhood tension-type headaches include:

• Sleep problems. According to one study, more than two-thirds of children who experience chronic daily headaches suffer from sleep disturbances, especially difficulty falling asleep.
• Moderate or severe depression.
• Emotional rigidity in a child and more repressed anger than their peers.
• Family stress. This includes maternal illness or separation, family bereavement, relationship problems, mental illness in a family member, and other stressful family events.
• Problems at school. According to a National Headache Foundation survey, nearly 30% of children miss school because of headaches. For many children, the start of the school season can be a particularly stressful time.

The National Headache Foundation recommends these tips for parents:

• Keep a diary of child’s headaches noting time of onset, length and intensity of attack, location of pain, and food triggers
• Make sure child gets plenty of sleep at regular times
• Avoid changes in child’s eating routing (hunger and eating at irregular times can trigger headaches)
• Discuss any headache concerns with child’s doctor

Some Specific Risk Factors for Tension-Type Headaches

The following conditions can make people susceptible to tension-type headaches.

• Chronic poor posture
• Chronic overwork
• Upper respiratory tract infections, such as colds and flu
• Sleep disorders. Sleep problems, such as insomnia, sleep apnea, or habitual snoring, are common in all primary headaches. Headache can disturb sleep, but sleep disorders may also contribute directly to tension headache, particularly those that occur at night or early morning. (In one study, treating people who had chronic headaches for sleep apnea cured the headaches in many cases.)
• Obesity
• Hypothyroidism (decreased thyroid function)
• Dental problems
• Allergies
• Substance or alcohol abuse
• Temporomandibular joint dysfunction (TMJ, also called TMD). This is a condition in which there are abnormalities in the jaw joints. TMJ itself can cause headache, and it also often coexists with chronic tension headache.

Triggers for Tension-Type Headache Episodes

Certain triggers, including the following, may cause headache episodes in people with chronic tension-type headaches:

• Specific stressful events
• Not eating on time
• Fatigue or lack of sleep
• Crying. In one study, only stress, anxiety, and menstruation were more important headache triggers in women.
• Withdrawal from over-used substances (caffeine, nicotine, alcohol, pain relievers)
• Eyestrain
• Intense physical exertion, including sexual activity. Athletes are at higher risk for headaches. Patients with tension-type headaches should not avoid exercise, however. Ordinary levels of physical activity do not usually precipitate these headaches. Furthermore, a sedentary lifestyle may increase the risks for stress and obesity and thereby for tension headaches in susceptible people.
• Certain foods, such as chocolate, cheese, and the flavor enhancer monosodium glutamate (MSG), are commonly cited as triggers for tension headaches as they are for migraines.
• Medications (overuse of headache medications, nitrates, certain anti-depressants, some drugs used to treat high blood pressure, and many others.)
• Hormonal changes, such as specific menstrual phases, in women.

Weather conditions, certain smells, smoke, and light, which can set off migraines, are not common triggers for tension-type headaches.

Ice Cream Headache The rapid consumption of ice cream or other very cold foods or beverages is a well-known trigger of sudden headache pain -- the so-called "ice cream" headache. It can be easily prevented by warming the food or drink for a few seconds in the front of the mouth before swallowing. Drinking a glass of room-temperature water quickly relieves the pain.

• Review Date: 10/3/2006
• Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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