An individual with a chronic tension headache experiences a headache at least 15 days every month for at least three months. Chronic tension headaches are often difficult to diagnose and treat. It may be possible to prevent headaches with the medicine amitriptyline.
What is chronic tension headache?
Chronic tension headache is characterized by an average of 15 headaches a month and lasting at least three months. This can be depressing and tiresome. Many people suffer from tension headaches (also called tension-type headaches) from time to time.
Rare studies have examined this issue in-depth, so it’s unclear exactly how common chronic tension headaches are. One study estimates that 1 in 30 adults suffer from chronic tension headaches – which is defined as a headache occurring on more than half of all days over the course of three months.
In some patients with tension headaches, however, medication-induced headaches (medication-induced headaches) may manifest as a result of medication overuse. It’s therefore difficult to determine whether medications are the cause of their headaches.
Chronic refers to something that is persistent; it does not mean severe. Mild headaches to severe headaches vary in severity. Since this condition is characterized by persistent headaches, however, patients often take preventative medications to prevent it from becoming more severe.
Read: Cluster Headaches
What are the symptoms of each tension headache?
- It’s common to feel tension headaches as a band or across the forehead. They can be painful and tiring, but they usually don’t interfere with sleep. Some people experience head pressure or squeezing.
- Both sides typically have it, and it often extends down your neck or appears to be coming from your neck. Occasionally, only one side is affected.
- Most victims are mild to moderately affected. The headaches caused by tension can interfere with concentration but are rarely severe enough to prevent you from going to sleep. When tension headaches really need to be worked through, most people are able to do so.
- It is often contagious and people suffer from tension headaches for weeks at a time. The headaches usually last for about a day or two.
- The intensity of tension headaches tends to increase throughout the day, and they’re usually milder in the morning. Generally, physical activity doesn’t exacerbate tension headaches.
- It would be an exception if a headache resulted from sleeping in an awkward position, or if a sore neck was caused by teeth grinding.
- The condition usually does not cause other symptoms.
Chronic tension headaches are sometimes confused with migraines. When they have a tension headache, some people feel unable to handle bright lights or loud noises. However, migraine is more likely to be diagnosed if you have a marked dislike of light or loud noise, as well as visual disturbances, like zigzag lines. It is common to experience nausea when taking a lot of painkillers. Nevertheless, marked nausea is more common in migraine sufferers.
Chronic tension headache is characterized by frequent headaches. Sometimes it seems that headaches are permanent and hardly ever disappear, or sometimes they only lessen but never go away entirely.
The majority of people suffering from chronic tension headaches put up with their symptoms without seeing a doctor. The average wait time for a first visit to the doctor was seven years for two thirds of people diagnosed with chronic tension headache.
Many of these people went on to work or school, but they did not perform as well as they could. The majority of headache sufferers reported anxiety or depression. If you believe you suffer from chronic tension headaches, you should consult a doctor, as treatment can often be helpful.
Read: Chronic Migraine
What causes chronic tension headache?
Tension headaches tend to develop in people who have them infrequently at first until they become frequent. It is not always clear how tension headaches are caused, and the cause may be more than one. Occasionally, they can be the result of tension in the neck and head muscles, but this is not the only cause.
Patients also report stress, tiredness, hunger, and eye strain as causes. There is no obvious reason why chronic tension headaches occur. The most likely cause is prolonged computer work.
Stress headaches can result from drinking too much caffeine or alcohol, drinking too little water, or going too long without eating and becoming fatigued. It is possible to get tension headaches from poor vision, especially if you read in low light for a long period. An uncomfortable environment, such as heat, cold, brightness or wind, can trigger some of these reactions.
There is some evidence that your genetic make-up might play a role. People with such an inherited tendency may be more prone to stress-induced or anxious tension headaches than others.
An underlying condition cannot cause tension headaches. When a doctor examines you for chronic tension headaches, you will have no abnormal findings except for the fact that the muscles around the head might be tender. All tests will be normal.
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What are the treatments for chronic tension headache?
There is no doubt that you are accustomed to taking painkillers such as paracetamol, aspirin, and ibuprofen. However, you shouldn’t take painkillers for headaches for longer than two or three days at a time. You should also limit your use of them to two days per week per headache.
Medication-induced headaches (medication-overuse headaches) may develop if you take them more frequently. Do not prevent headaches by taking painkillers. Just go with the flow. Only take painkillers on the worst days.
It is not normal to recommend opioid painkillers for tension headaches such as codeine, dihydrocodeine and morphine. Paracetamol and codeine combination tablets, such as co-codamol, fit into this category. You can become drowsy from opiate painkillers. Additionally, regularly taking these painkillers can cause medication-overuse headaches.
Keeping a diary
If you suffer from frequent headaches, you may benefit from keeping a diary. Keep track of when, where, and what sort of headache each person has, and how long they last. Note any possible reasons for the headache as well. If a pattern emerges, you may be able to avoid the trigger. You might be hungry, stressed, angry, or have bad posture.
You might want to consider reviewing your diet, according to some doctors. Some people are triggered by foods such as caffeinated drinks, chocolate, cheese and alcohol. Other doctors recommend a balanced diet that includes slow-release energy foods such as slow-release carbohydrates (taken in small, regular meals) and a low intake of refined sugars.
Read: Thunderclap Headaches
Stress and depression
Certain people who suffer from tension headaches are triggered by stress. If possible, stay away from stressful situations. However, it may not always be possible to avoid stressful situations. You can learn how to deal with stress by relaxing and learning how to cope.
Stress-relieving breathing exercises and relaxation techniques can ease anxiety and prevent headaches. These methods can be learned through books and apps. If necessary, a psychologist or counselor may be consulted.
Exercise has been found to reduce headaches in people with frequent headaches. Exercise may benefit you if you don’t do much of it. Brisk walking, jogging, cycling, swimming, etc. are good exercises (which have other health benefits too). It’s unclear how exercise may make a difference. It is possible that exercise can reduce tension headaches by reducing stress and tension.
Additionally, it may strengthen your core and upper back muscles as well as improve your posture. Therefore, you are less likely to ‘droop’ and tighten the muscles in your neck and upper back when you sit. Also, it may be because it increases the blood flow around the upper body, supplying more oxygen to the muscles in general.
The use of relaxation techniques and breathing exercises may help alleviate chronic tension headaches. Physical habits that contribute to headaches may also be detected and changed with this method. Poor posture is one example. This kind of therapy requires the patient’s active participation and regular exercise.
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Chronic daily headaches can be effectively treated with acupuncture in combination with medical treatment.
Cognitive behavioural therapy (CBT)
Chronic daily headaches can be treated more effectively with cognitive behavioral therapy. Chronic tension headaches can be treated with behavioral therapies that address the stress that contributes to them. It is common for patients to dislike talking therapies as they believe the doctors think their headache is caused by depression.
Nevertheless, talking therapies appear to help some patients. This may be due to chronic pain itself being stressful, and CBT and other talking therapies help break the cycle of stress and headaches.
Medication for prevention
In the treatment of chronic tension headaches, amitriptyline is commonly used. There are no painkillers in this medicine, so if a headache occurs it won’t go away. It is an antidepressant drug that you should take every day in order to prevent headaches.
The antidepressant effect of some antidepressants is to ease pain, thus amitriptyline is not used to treat depression. (Some antidepressants are also effective in preventing headaches, so even though it is classed as an antidepressant, we do not use them for that purpose.)
Initially, a low dose is administered and then may need to be increased over time. This medication takes longer to take effect – it is packaged at a low starting dose in order to allow you to tolerate it more easily. You may become tired if you start taking higher doses immediately. Therefore, the medicine might need to be gradually increased over a few months before it really takes effect.
Amitriptyline can be stopped after 4-6 months of reducing headaches. Should symptoms return (recur) amitriptyline can be resumed? When amitriptyline does not work or is not suitable, other medications are sometimes tried. These medications are topiramate (more often prescribed to prevent migraines), gabapentin (more often prescribed to treat nerve inflammation) and tizanidine (more often prescribed for muscle spasms). Chronic tension headaches are typically less well treated with modern SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine (Prozac®).
Preventative treatments aim to reduce headache frequency or severity. The headaches will therefore become less frequent and less severe even if they do not completely disappear. In addition, unavoidable headaches that occur while taking preventative medications may be eased more effectively by a painkiller than previously.
It is difficult to measure the effectiveness of preventative treatment in retrospect. Keeping a headache diary for a week or two before beginning preventative medication is therefore advisable. Each headache will be noted along with how well it was eased by painkillers and when the headache started.
Afterward, maintain your diary to see if things improve as you take the preventative medicine. Although the headaches will probably not completely go, a significant improvement in the diary is likely.
People who suffer from chronic tension headaches usually take over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen. In the beginning, tension headaches seem to be manageable with these medicines, but if they become chronic, they can worsen (see Medication Overuse Headache). It’s for this reason that you should speak with your doctor before taking even seemingly safe medicines, such as those listed above, if you suffer from headaches often.
There are also other ways to manage headaches, like reducing stress, relaxing, and biofeedback. It’s also effective to get a massage. It’s also important to avoid bad posture, use computers properly, and limit eye strain.
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