What to do with a ‘normal’ headache or tension headache?

Headache tips and advice to combat headaches. Tension headache is the most common type of headache in adults and occurs slightly more often in women than in men. Tension headaches are often referred to as ‘normal headaches’ and sometimes as ‘non-specific headaches’. Below are tips and advice to cope with tension headaches and relieve the complaints.

Headache tips and advice

• What is tension headache?
• What are the triggers of tension headaches?
• Headache tips: how can you best deal with tension headaches?

• Headache tip 1: Keep a headache diary
• Headache tip 2: Medication to treat headaches
• Headache tip 3: Medication to prevent headaches
• Headache tip 4: Physiotherapy, exercise therapy and manual therapy
• Headache tip 5: Psychological interventions
• Headache tip 6: General advice to prevent headaches
• Headache tip 7: Ginger for (emerging) headache

More women than men suffer from tension headaches / Source: Istock.com/JackF

What is tension headache?

Tension headaches, often referred to as ‘regular headaches’ and sometimes as ‘non-specific headaches’, are the most common type of headache in adults. It occurs slightly more often in women than in men. Tension headaches often start at a young age and their occurrence decreases with age. A distinction is made between so-called episodic tension headache (headache complaints < 15 days per month) and chronic tension headache (headache > 15 days per month). Episodic tension headaches have the following characteristics:

• you experience a pressing, pinching or clamping headache, comparable to a tight band around the head;
• the headache may last from a few minutes to many days;
• (sometimes) nausea without vomiting (as is often the case with migraine);
• you do not suffer from phonophobia (hypersensitivity to bright noise) or photophobia (hypersensitivity to bright light) is absent, or you suffer from only one of the two complaints;
• the headache is mild to moderate, bilateral and the muscles of the shoulders, neck and skull are often extra sensitive;
• shoulders (and sometimes the neck) are stiff and painful;
• with normal physical exertion, such as cycling or climbing stairs, the pain does not get worse;
• Often (but not always) you can continue with your activities with this form of headache.

Although tension headaches and migraines are two different entities, both types of headaches often occur in the same person and work hand-in-hand. Tension headaches are not serious, but they are an annoying condition.

What are the triggers of tension headaches?

Little is known about the precise origins of tension headaches. Tension and muscle tension are not primary causes, although both factors can provoke or worsen the headache, just like over-fatigue or a ‘wrong (body) posture’, or cold, damp and fever. Possible luxating or triggering factors of muscle tension headache include:

• persistent tension or stress (psychological tension), which causes you to unconsciously contract the muscles of the jaw, forehead, neck and…
• shoulders tense;
• insufficient rest and/or insufficient sleep (overtiredness);
• physical exertion, for example heavy lifting, running, bending or frequent climbing of stairs;
• mental exertion: when you are extremely concentrated, the neck, shoulder and head muscles are often unconsciously tense, which can trigger a headache;
• anxiety and depression;
• incorrect posture of shoulders, neck and head can lead to muscle overload and thus trigger headaches;
• a dental or jaw abnormality;
• eye strain when reading or looking at a television or computer screen for a long time, as well as long-sightedness;
• climatic conditions, such as a change in weather, a change in climate or a change in air pressure, and cold, moisture and drafts can stiffen the neck muscles and trigger muscle tension headaches;
• hormonal fluctuations that occur during menstruation, ovulation or menopause, as well as pregnancy or pill use;
• sinus infections, flu, cold or allergy;
• fever;

Peanuts / Source: Istock.com/etiennevoss

• Overload of the chewing muscles due to crooked placement of the lower or upper teeth, nail biting, frequent teeth grinding or chewing gum;
• nutrition: a number of nutrients can have a negative influence on the headache (caffeine, alcohol, aspartame, peanuts and certain types of cheeses); and
• Too low a blood sugar level can trigger a tension headache.

Heredity may also play a role in the development of tension headaches. Tension headaches in children can sometimes be explained by the child’s daily life, for example tensions at school or in the family.

Headache tips: how can you best deal with tension headaches?

What is the best way to deal with tension headaches? Below are tips and advice:

Headache tip 1: Keep a headache diary

Keeping a headache diary can help identify individual triggers and triggers. Then you can take this into account in the future and influence your headache yourself, for example by adjusting your working position if you have an incorrect posture or by creating more balance between effort and relaxation. Of course, you cannot avoid all triggering factors, for example, weather changes, certain emotional events or hormonal changes. But sometimes you can prepare better for it. For example, hormones can be a trigger, and if you know that your headache always starts three days before your period, you can take this into account in your planning. You can buy a handy headache diary for next to nothing from the Dutch Association of Headache Patients (www.hoofdpijnpatienten.nl).

Paracetamol for regular headaches / Source: Martin Sulman

Headache tip 2: Medication to treat headaches

For pain relief during attack treatment, the first choice are regular painkillers that are available without a prescription from a drugstore or pharmacy, such as paracetamol, aspirin or an NSAID (for example ibuprofen). These agents have a beneficial effect on the duration and intensity of the complaints. According to one study, caffeine enhances the analgesic effect of ibuprofen.[1] Be aware that long-term and/or excessive medication use can lead to a so-called medication-dependent headache (MAH). A rule of thumb for safe and responsible medication use is: two days of medication, seven days of nothing at all.

Headache tip 3: Medication to prevent headaches

Keep in mind that treatment with medication to prevent tension headaches often comes last. The effect of this is often minor. In addition, following therapy or lifestyle adjustments often yields more benefits. The medicines that can help prevent tension headaches or reduce the severity of the complaints have not been specifically developed for this purpose, but their effect on tension headaches has been discovered by chance. The most common drug for the prophylactic treatment of muscle tension headaches is amitriptyline , originally an antidepressant. The drug can reduce the frequency and intensity of headaches. It should be taken every day for a longer period of time, with the dosage being increased gradually. This remedy is only prescribed if other solutions do not provide sufficient relief and there are many headache days per month. It must also be ruled out that medication-related headaches are present. A beneficial effect of the use of amitriptyline is mainly found in older studies, but the effect is not consistent.[2] SSRIs (serotonin reuptake inhibitors, the modern antidepressants) have not proven effective in the treatment of tension headaches.[3]

Headache tip 4: Physiotherapy, exercise therapy and manual therapy

For tension headaches that are mainly triggered by incorrect posture or incorrect movements, physiotherapy and exercise therapy may provide a solution. The physiotherapist can ensure better blood circulation and relaxation by massaging and stretching tense neck and shoulder muscles. Exercise therapy, such as Mensendieck or Caesar therapy, can help to correct and improve your posture. You can also learn to relax the muscles with exercise therapy.

Manual therapy appears to be an effective treatment for people suffering from chronic muscle tension headaches. Manual therapy not only reduces the frequency of headaches, but it also improves daily functioning and reduces absenteeism from work. The positive effect of this form of therapy can mainly be attributed to the increase in muscle strength of the neck muscles, research shows.[4]

Headache tip 5: Psychological interventions

When mental exertion and/or stress are triggering factors of tension headaches, cognitive behavioral therapy (CGT), possibly combined with stress management and relaxation exercises, can provide a solution. The treatment will focus on reducing muscle tension, thus preventing headaches as much as possible. This can possibly be combined with medication to prevent headaches (see above). Discuss this with your doctor.

Headache tip 6: General advice to prevent headaches

The following advice can help reduce or prevent headache complaints:

• Find a good balance between physical and mental exertion and relaxation.
• Many people do not dare to talk about their problems out of shame or fear of being considered ‘crazy’. However, it is important to share and discuss problems with others. The advice is to prevent problems immediately and avoid worrying.
• Prevent overload of various muscles by ensuring a good (working) posture. Sometimes this requires adjustments at work, such as a different chair or a different desk. It can also be useful to make good agreements at work about the division of tasks and to adjust them if necessary and if possible.
• Make sure you have sufficient ‘computer breaks’ not only at work but also at home. During such a break, relax your arms, shoulders and neck muscles and do some physical exercises to relax your muscles.

Moving is healthy! / Source: Istock.com/monkeybusinessimages

• Don’t sit at your desk during your lunch break, but go for a walk. Good for body and soul!
• If you already work on the computer quite a bit during the day, try to limit it in the evenings and on weekends.
• Leave the car at home more often and walk or cycle to work (if possible).
• Make sure you get enough exercise every day. The advice is that half an hour of moderate-intensity exercise per day is healthy.
• Take a short walk in the evening before you go to sleep and put your phone aside and leave the television off.
• Provide regularity and structure. Go to bed on time and get up on time.
• A warm shower or bath can sometimes provide relief from a headache.
• Provide fresh air (ventilate your house well).
• Have your neck and shoulder muscles massaged or do relaxation exercises.
• If you regularly suffer from (tension) headaches, you can also contact the Dutch Association of Headache Patients for information and support.

Tea with fresh ginger / Source: Istock.com/ChamilleWhite

Headache tip 7: Ginger for (emerging) headache

Ginger can help combat headaches and migraines. As soon as you feel a headache coming on, take two capsules with plenty of water. Or cut some fresh ginger root into slices and warm it with some water and then make tea from it. After drinking the tea, you should also eat the ginger slices. After about 20 minutes, the emerging headache is significantly slowed down. The anti-migraine effect is due to the substance shogoal present in ginger.

Notes:

1. Knuistingh Neven A, Eekhof JAH. Tension headache. Minor ailments. Huisarts Wet 2003;46:238-30.
2. Knuistingh Neven A. Tension headache. In; Minor ailments in general practice. Fifth completely revised edition, second edition, Elsevier Healthcare, Amsterdam, 2010, p.501-504.
3. Moja PL, Cusi C, Sterzi RR, Canepari C. Selective serotonin re-uptake inhibitors (SSRIs) for preventing migraine and tension-type headaches. Cochrane Database System Rev. 2005;3:CD002919.
4. VUMC. Manual therapy works well for chronic muscle tension headaches (press release). www.vumc.nl/departments/over-vumc/nieuws/7765486 (last consulted on 07-12-2014)

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