“Tension Headache” How Should it be Prevented and Treated

It is among the most common forms of primary headache (i.e. not caused by any disease), with a spread in the population between 46% and 78%, slightly greater among women….

To diagnose tension-type Headache , the criteria listed in the International Headache Classification must be respected. The first is the presence of at least 10 attacks with headaches of variable duration (from 30 minutes to 7 days), with at least two of the following characteristics: bilateral location; non-throbbing pain; mild or medium intensity; no worsening during routine physical activities. Also, there should be no nausea or vomiting, but there may be discomfort in light or sound, never both. Different subtypes of tension headache are then described according to the frequency of monthly attacks and the contracting association of pericranial muscles (i.e. the forehead, temples, neck, shoulders), appreciable on palpation: Episodic infrequent Ctt, present for less than 12 days a year; frequent episodic tension-type headache, from 1 to 14 days of headache per month; chronic CTT, 15 days or more of headache per month for more than three months.

The tension-type headache

Greater among in the females It occurs at all ages, but more frequently before the age of 40. The causes are unclear, but they are thought to be different and involve genetic and environmental aspects. Factors such as stress, psychological or performance, particular life events, even positive, play an important role in promoting      a tension-type headache as well as certain postures that keep the muscles of the neck or cervical spine or shoulders taut for many hours. But it is above all a bad quality of the night’s sleep that facilitates its appearance.

Lack of sleep
A very recent study has shown that 26-72% of subjects identify the main trigger of a tension headache attack as a sleep alteration and lack of sleep for only two consecutive days would suffice to promote the risk of onset. The “bidirectional” relationship between the two disorders should be underlined: headache can cause sleep disturbance and sleep disturbance can precede or trigger headache. The difficulty in falling asleep, a fragmented sleep, an early awakening are related to an increased frequency and intensity of attacks and create a vicious circle that can lead not only to the chronicity of the headache (0.5-1%), but to tiredness during the day, difficulties in facing commitments, which in turn are responsible for greater stress and the appearance of anxiety (9.5%) and depression (14.2%). The connection of the tension headache with these emotional, psychological and neurophysiological triggers can be related to the common malfunction of the brain structures that control emotionality, sleep and the threshold for pain and the decrease in some neurotransmitters (serotonin, melatonin).

The advices
For this we recommend: rest, suspension of work-study activity, even for short periods, relaxation and meditation techniques. In addition, travel, weather changes and cold weather can worsen the symptoms of a Cct. If the identification of “personal” triggers is fundamental, a correct diagnosis is equally important: if there has been only one attack, it must be excluded, through clinical history and neurological examination, that it is not another type of headache.

The cure
tension-type headache can be addressed with drugs that resolve symptoms in a few hours or with preventive treatment. In the first case, with Fans (ibuprofen, aspirin, naproxen, paracetamol) but also with muscle relaxants. For prophylaxis, indicated in very frequent or chronic forms, tricyclic antidepressants or other categories such as SSRIs, which block the re-uptake of serotonin, but with conflicting results. The pain of tension-type headache is not disabling and often those who suffer from it heal themselves with the risk of taking inappropriate drugs or using too many of them, causing the disease to worsen and become chronic. I recommend consulting with your family doctor and in severe cases an outpatient clinic or a headache center.

Lack of sleep
A very recent study has shown that 26-72% of subjects identify the main trigger of a tension headache attack as a sleep alteration and lack of sleep for only two consecutive days would suffice to promote the risk of onset. The “bidirectional” relationship between the two disorders should be underlined: headache can cause sleep disturbance and sleep disturbance can precede or trigger headache. The difficulty in falling asleep, a fragmented sleep, an early awakening are related to an increased frequency and intensity of attacks and create a vicious circle that can lead not only to the chronicity of the headache (0.5-1%), but to tiredness during the day, difficulties in facing commitments, which in turn are responsible for greater stress and the appearance of anxiety (9.5%) and depression (14.2%). The connection of the tension headache with these emotional, psychological and neurophysiological triggers can be related to the common malfunction of the brain structures that control emotionality, sleep and the threshold for pain and the decrease in some neurotransmitters (serotonin, melatonin).

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"Tension Headache" How Should it be Prevented and Treated

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