What are Tension Headaches?

Tension headache, also known as muscle contraction headache, is the most common type of primary headache, accounting for about 70% to 80% of headache patients. It manifests as tightness, pressure, or dull pain in the head, more typically with a feeling of girdle. As a transient disorder, tension headache is mostly related to stress in daily life, but if it persists, it may be one of the characteristic symptoms of anxiety or depression.

Basic Information

nickname: Muscle contraction headache
Visiting department: Neurology
Multiple groups: Young people, middle-aged people

Common locations: head
Common causes: Due to persistent contractions of the head and neck muscles
Common symptoms: Uncertain headaches, dull pain in the head, no pulsation; headaches in the parietal, temporal, forehead and occipital regions, sometimes pain in several parts

Causes of tension headache

Tension headache is caused by the permanent contraction of the head and neck muscles. The causes of this contraction are: as a result of anxiety or depression accompanied by mental stress; as a result of headaches or other parts of the body for other reasons This kind of secondary symptoms; due to poor posture of the head, neck and shoulder straps.

Clinical manifestations of tension headache

The disease is more common in young and middle-aged children. It can also be affected by children, and it is more common in women. Symptoms are mild at the beginning of the disease and gradually worsen later. The clinical features of tension-type headaches are that the location of the headache is erratic, the head is dull, and there is no pulsation. The headache is located in the parietal, temporal, frontal, and occipital regions. Sometimes the pain in the above areas is mild. The headache is mild or moderate. It is not aggravated by physical activity, often complains of tight pressure on the top of the head or a tight hoop on the head, and it is stiff and stiff on the pillow and neck, especially when turning the neck, without photophobia or photophobia. A few patients have mild Excessive irritability or depression, and many patients also have symptoms such as dizziness, insomnia, anxiety or depression. Examination includes no positive signs of the nervous system examination. The cranial muscles such as the cervical occipital muscles, the muscles on the top of the head and the shoulders are often tender. Sometimes they are gently pressed and rubbed. The patient feels relaxed and comfortable. CT or MRI of the brain There should be no abnormalities without hypertension and obvious otolaryngology.

Tension headache test

1. EEG, EMG examination.

2. Special ophthalmological examination.

3. Radionuclide (isotope) examination, X-ray examination, nuclear magnetic resonance (MRI) examination, CT examination.

Tension headache diagnosis

According to the clinical manifestations of patients, the diagnosis of craniocervical diseases such as cervical spondylosis, mass lesions and inflammation is usually confirmed.

Differential diagnosis of tension headache

Migraine

It is a vascular headache that is common in young people and children. The headache is located in the orbit of the unilateral temporal forehead. It is pulsating, often accompanied by nausea and vomiting. It is an episodic headache. Before the headache, there may be visual disturbances such as blurred vision of the vision, vision with blind spots or hemianopia, or no precursors, that is, migraine usually begins to resolve within several hours or days. Very few patients have a persistent state of migraine. . A small number of patients may have coexisting migraine headaches, making it difficult to distinguish between the two.

2. Cluster headache

It is a vascular disease and is related to hypothalamic dysfunction. The headache is located in the orbit of the unilateral temporal forehead. In severe cases, it spreads to the entire head. Headaches are dense, severe and no warning. Headaches can be rapid and stop suddenly, with conjunctival congestion, tears, runny nose, and sweating. A small number of ptosis occurs, which occur several times a day, and can occur during sleep, each attack lasting from tens of minutes to several hours, and can continue for several days to weeks. However, the remission period can be as long as several months to several years. It is not difficult to identify the tension headache after detailed inquiry of the patient's medical history and seizure observation.

3. Trigeminal neuralgia

It is paroxysmal transient pain in the trigeminal nerve distribution area. Each pain is only a few seconds, and there are several to dozens of attacks per day. The pain is like cutting, burning or acupuncture. It is often induced by washing your face, brushing your teeth, talking, and chewing. Patients can often indicate where the pain is induced, called the "trigger point." The disease occurs in middle-aged and elderly people, and the trigeminal nerves are more affected.

4. Headaches due to intracranial space-occupying diseases

Such diseases include intracranial tumors, intracranial metastatic cancers, brain abscesses and cerebral parasitic diseases. This type of headache is caused by increased intracranial pressure. As the disease progresses, it is often accompanied by jet vomiting and fundus edema, but it can be misdiagnosed as tension-type headache at an early stage. In patients with short-term headaches, in addition to paying attention to fundus changes, careful neurological examination should also be performed. If signs of pathological reflexes are found, it often indicates that it is not a tension headache. Instead, brain CT or MRI should be used in time to help identify.

5. headache caused by chronic intracranial infection

Such diseases include tuberculous meningitis, fungal meningitis, porcine cysticercosis (cysticercosis) meningitis, and syphilitic meningitis. These meningitis all have headache as an early symptom, usually accompanied by fever, but some atypical patients have only low fever in the early stage, and the negative meningeal irritation sign is easily misdiagnosed as tension headache.

6. Headaches caused by autoimmune meningoencephalitis

Such diseases include Behcet syndrome, Vogt-Koyanagi-Harada syndrome, and central nervous system sarcoidosis. These diseases can cause inflammatory reactions and headaches when they involve the meninges or the brain, and they are not necessarily accompanied by fever. It is easy to be misdiagnosed as tension-type headache.

7. Headaches due to abnormal intracranial pressure

Such diseases include intracranial hypotension syndrome, benign intracranial hypertension, and normal hydrocephalus. These patients are mainly headaches, which resembles tension headaches. Such diseases can be identified by lumbar puncture measurement of cranial pressure and brain CT examination.

Tension headache treatment

Drug treatment

Because the pathogenesis of tension-type headaches is unclear, mild non-narcotic analgesics are often used in drug selection to reduce symptoms, mainly non-steroidal anti-inflammatory drugs (NSAIDs). Other drugs include moderate muscle relaxants and light sedatives, and antidepressants are often used depending on the condition. It is usually administered orally and applied short-term to avoid causing toxic and side effects of the drug. Many of the medications for this disease are the same as those for migraine. Non-steroidal anti-inflammatory drugs such as acetaminophen, aspirin, and ergotamine or dihydroergotamine are also effective during acute attacks. For frequent and chronic tension-type headaches, preventive treatment should be used. Tricyclic antidepressants such as amitriptyline, doxepin, or selective serotonin reuptake inhibitors such as sertraline or fluorine should be used. Zetin, etc., or muscle relaxants such as eperisone hydrochloride, baclofen and the like. People with insomnia can be given benzodiazepines such as diazepam orally.

Analgesics for tension headache need to follow the principles: Use in full in the early stages of headache. For occasional tension-type headaches and frequent tension-type headaches that occur less than 15 days per month, analgesics can be used as appropriate during headache attacks. For chronic tension headaches that occur more than 15 days per month, pain medications are not recommended, and prophylactic drugs are used instead.

2. Non-drug treatment

Physical therapy can improve tension headaches. The treatment plan adopted by some scholars includes four parts:

(1) Training the correct posture of the neck and head when sitting, standing, sleeping and working.

(2) Practice at home to improve the head position and prone position, strengthen the muscles of the back of the neck, and place an ice pack at the back of the neck.

(3) Perform a mid-to-deep massage on the back and shoulders for 2 minutes.

(4) Passively stretch the trapezius muscle, the upper part of the trapezius muscle, the shoulder muscle and the pectoralis muscle for 5 minutes.