What is it about ?
The most common headache is tension headache. The mechanism involved is not clear. Physical or psychological tension plays a role in the persistence of complaints, but this is not always what causes the headache. In some cases, the tension headache may appear at the same time as the migraine.
Tension headaches come in 2 forms
- An “episodic” form: less than 15 days of headaches per month;
- A “chronic” form: more than 15 days of headaches per month.
How to recognize it?
In tension headache, the headache is “crushing” (like a vice) and its intensity increases in the evening. You usually feel the headache around the temples, at the back of the head (at the level of the occiput) and in the skull. Pain usually occurs on both sides of the head, but it may only be on one side. The pain can be unbearable at head level. Throbbing pain is also possible.
Numbness in the arms appears from time to time at night. It happens to be taken from dizziness when sitting down or standing up. Normally, the tension headache is not accompanied by nausea or vomiting. However, you may have trouble sleeping.
How is the diagnosis made?
The doctor will usually make the diagnosis based on specific questions about your complaints and giving you a physical exam. Above all, he will try to rule out other forms of headache by paying attention to the following warning symptoms:
- Sharp increase in headaches;
- Repeated vomiting and associated with headaches;
- Neurological examination abnormal in case of headache;
- Headache that only occurs when coughing or straining;
- An episode of loss of consciousness associated with headaches;
- Persistent headache after trauma to the skull.
The doctor will do a neurological exam and take your blood pressure. He may perform a physical examination of the neck and shoulder area, but often the condition of muscle tone is not commensurate with the headaches complained of. The doctor may ask you to keep a headache diary to get a better idea of your complaints.
Additional tests, such as imaging tests, are rarely necessary. But if the doctor has doubts about the diagnosis, he will give you a CT scan or MRI or he will refer you to a specialist (neurologist).
What can you do ?
Exercising and stretching can relieve headaches. You may take a pain reliever, for example paracetamol (1st choice) or ibuprofen, but do not take it for more than 5 days in a row. Prolonged use of painkillers can make headaches worse.
Adopt a correct (ergonomic) posture while working. Try to reduce stressors and engage in activities that relax you, such as walking, yoga, or a sauna.
What can your doctor do?
For episodic tension headaches, the focus is on stretching exercises and (temporary) pain relievers.
In case of chronic tension headaches, the doctor will give you advice on taking medication. The excessive use of painkillers is gradually reduced and, ideally, we try to stop them. He will try to determine the stressors that contribute to the headaches and, if necessary, he will refer you to a physiotherapist for manual therapy. Relaxation techniques or massages can also be recommended.
If treatment without medication is not sufficient, preventive treatment with antidepressants (eg amitriptyline or nortriptyline) can be started.
Want to know more?
- Physical activity – Eat Move – Health question
- Move at any age… After 50 too! – Eat Move – Health Question
- Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
- Ibuprofen – CBIP – Belgian Center for Pharmacotherapeutic Information
- Amitriptyline – CBIP – Belgian Center for Pharmacotherapeutic Information
- Nortriptyline – CBIP – Belgian Center for Pharmacotherapeutic Information
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