Tension Headaches

Written by Mathilde Opsvik
A problem frequently encountered in the clinic is headaches associated with pain and restriction of the neck and shoulders. We call these ‘tension headaches’. Tension headaches can be caused by tightness in the muscles at the back of the neck and over the scalp. The underlying causes include anything which makes those muscles tense, including poor posture, stress, clenching your teeth, or sleeping in a bad position. With that said, tension headaches can also be caused by tiredness, anxiety or dehydration. Still, I have found that many people are not aware of the link between pain and restriction in the neck and shoulders, and tension headaches.
Tension headaches are usually felt as a band across the forehead, and can last from a few hours to a few days. They are usually felt on both sides of the head – most often the front. Typically, the pain is like a tightness around the hat-band area. Some people feel a squeezing or pressure on their head.
Tension-type headaches tend to come on during the day and get worse as the day goes on, but do not usually disturb sleep and are often less noticeable in the morning. (Except if the headache is triggered by sleeping in an awkward position causing a sore neck, or an ache in the face and jaw due to tooth grinding.)
In my opinion, the healthiest way to conquer tension headaches is to change the factors that trigger the headache instead of taking medication to ease the pain. For symptomatic relief, manual therapy to correct the painful and restricted tissues often gives great relief. Using heat therapy such as a hot water bottle or a warm bath can often work as a natural analgesic and soften tight musculature. Some cardiovascular exercise can also be an excellent way of ridding the tension. If you find that the headache comes on when you are hungry or dehydrated then make sure you drink more water and eat regularly. Other ways to avoid tension headaches are by having plenty of sleep and avoiding excessive noise.
Painkillers often work well to ease a tension-type headache. But note: you should not take painkillers for headache for more than a couple of days at a time. Also, on average, do not take them for more than two days in any week for headaches. See a doctor if you need painkillers for headaches more often than this. If you take them more often, you may develop medication-induced headache. Do not take painkillers to prevent headaches. Take each day as it comes. Painkillers that are used include paracetamol or anti-inflammatory painkillers such as ibuprofen. It is best to take a full dose as soon as a headache starts. This may ward off the headache better than treating it after it has fully developed. You can take a second dose after four hours if necessary (Treatment – Tension Head Ache, Patient.co.uk, 2014).
Prevention is the better than cure. As with so many other health problems getting enough exercise and avoiding stressful situations can make a big difference. It may also help to keep a diary if you have frequent headaches. This can help you discover the pattern of the headache so that you can avoid the potential trigger.
Diagnosis and management of headache in adults; Scottish Intercollegiate Guidelines Network – SIGN (November 2008)
Diagnosis and Management of Migraine, Tension-Type, Cluster and Medication-Overuse Headache; British Association for the Study of Headache (BASH) Guidelines, (2010 – reviewed 2014)
Guideline on the treatment of tension-type headache; European Federation of Neurological Societies (2010)
Headaches: diagnosis and management of headaches in young people and adults; NICE Clinical Guideline (September 2012)
Headache – tension-type; NICE CKS, November 2012 (UK access only)