Join Now | Sign in

Headache Health Article

Marketplace

Licensed from

Page: < Back 1 2 3 4 5 6 7 8 9 10 11 12 Next >

Tension-type Headache

Tension-type headache is the most common headache type of all in western populations. The diagnostic criteria are shown in Box 160-4. Muscle contraction is not always the basis of this headache. Pressure on sensory nerves, interference with blood supply of muscles and other tissues, and alterations in the threshold to pain from changes in the central nociceptive system may also be relevant. The headache is described as a tight band around the head, a pressure or fullness, a feeling that the head is in a vise, or a feeling that the head will explode. The whole head and often the neck and upper shoulders are typically involved, as may be the temples, the face, and the region of the upper trapezius (Fig. 160-2).

Tension-type headaches are benign and hard to treat. The physician should look for evidence of neck injuries and of TMJ dysfunction (especially if the pain is unilateral) and search for clues in the history as to why a person may show the effects of physical, psychologic, or social stress in this way. There are no physical signs other than tenderness in the craniocervical muscles.

Physical and emotional pressures, including states of depression or anxiety, are often considered responsible for tension-type headaches, but if the headache is unilateral, TMJ dysfunction should be considered. Therapy (if no local cause is discovered) might include amitriptyline or nortriptyline, muscle relaxants, psychotherapy (seldom), or other approaches as described under treatments for migraine . Such headaches are sometimes treated successfully by physical measures, such as local heat and massage, ultrasonic stimulation, or acupuncture. Relaxation techniques provided by courses of instruction and aided by tapes and biofeedback are often useful.

Combined Headache

Combined or mixed headache is thought to be related to both vascular and muscle contraction mechanisms. It presents as a constant tightness and pressure, with an added pulsatile component, and at times with nausea and vomiting. The treatment is the same as for migraines. It is common for someone who has had migraine headaches for many years to evolve to a headache that has features of both tension and migraine.