Headache

Complications

Because tension headaches are so common, their effect on job productivity and overall quality of life is considerable, particularly if they're chronic. The frequent pain may render you unable to attend activities. You might need to stay home from work, or if you do go to your job, your ability to function is impaired.

Test and Diagnosis

If you have chronic or recurrent headaches, your doctor may conduct physical and neurological exams, then try to pinpoint the type and cause of your headaches using these approaches:

Your pain description

• Pain characteristics. Does your pain pulsate ? Or is it constant and dull ? Sharp or stabbing ?
• Pain intensity. A good indicator of the severity of your headache is how much you're able to function while you have it. Are you able to work? Do your headaches wake you or prevent you from sleeping?
• Pain location. Do you feel pain all over your head, on only one side of your head, or just on your forehead or behind your eyes?

Imaging tests

If you have unusual or complicated headaches, your doctor may order tests to rule out serious causes of head pain, such as a tumor. Two common tests used to image your brain include:

• Computerized tomography (CT). A CT scan is a diagnostic imaging procedure that uses a series of computer-directed X-rays to provide a comprehensive view of your brain.
• Magnetic resonance imaging (MRI). An MRI scan combines a magnetic field, radio waves and computer technology to produce clear images.

Some people with tension headaches don't seek medical attention and try to treat the pain on their own. Unfortunately, repeated use of over-the-counter (OTC) pain relievers can actually cause overuse headaches.

Treatment and Medication:

A variety of medications, both OTC and prescription, are available to reduce the pain of a headache, including:

• Pain relievers. Simple OTC pain relievers are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Prescription medications include naproxen (Naprosyn), indomethacin (Indocin) and ketorolac (Ketorolac Tromethamine).
• Combination medications. Aspirin or acetaminophen or both are often combined with caffeine or a sedative drug in a single medication. Combination drugs may be more effective than are single-ingredient pain relievers. Many combination drugs are available OTC.
• Triptans and narcotics. For people who experience both migraines and episodic tension headaches, a triptan can effectively relieve the pain of both headaches. Opiates, or narcotics, are rarely used because of their side effects and potential for dependency.

Preventive medications

Your doctor may prescribe medications to reduce the frequency and severity of attacks, especially if you have frequent or chronic headaches that aren't relieved by pain medication and other therapies.

Preventive medications may include:

• Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and nortriptyline (Pamelor), are the most commonly used medications to prevent tension headache. Side effects of these medications may include weight gain, drowsiness and dry mouth.
• Other antidepressants. There also is some evidence to support the use of the antidepressants venlafaxine (Effexor XR) and mirtazapine (Remeron) in people who don't also have depression.
• Anticonvulsants and muscle relaxants. Other medications that may prevent tension headache include anticonvulsants, such as topiramate (Topamax). More study is needed.

Preventive medications may require several weeks or more to build up in your system before they take effect. So don't get frustrated if you haven't seen improvements shortly after you begin taking the drug.

Your doctor will monitor your treatment to see how the preventive medication is working. In the meantime, overuse of pain relievers for your headaches may interfere with the effects of the preventive drugs.

Lifestyle and home remedies

Rest, ice packs or a long, hot shower may be all you need to relieve a tension headache. A variety of strategies can help reduce the severity and frequency of chronic tension headaches without using medicine. Try some of the following:

• Manage your stress level. One way to help reduce stress is by planning ahead and organizing your day. Another way is to allow more time to relax. And if you're caught in a stressful situation, consider stepping back.
• Go hot or cold. Applying heat or ice - whichever you prefer - to sore muscles, may ease a tension headache. For heat, use a heating pad set on low, a hot-water bottle, a warm compress or a hot towel. A hot bath or shower also may help. For cold, wrap ice, an ice pack or frozen vegetables in a cloth to protect your skin.
• Perfect your posture. Good posture can help keep your muscles from tensing. When standing, hold your shoulders back and your head level. Pull in your abdomen and buttocks. When sitting, make sure your thighs are parallel to the ground and your head isn't slumped forward.
• Deep breathing, biofeedback and behavior therapies. A variety of relaxation therapies are useful in coping with tension headache, including deep breathing and biofeedback.

Coping and support

Living with chronic pain can be difficult. Chronic pain can make you anxious or depressed and affect your relationships, your productivity and the quality of your life.

Here are some suggestions:

• Talk to a counselor or therapist. Talk therapy may help you cope with the effects of chronic pain.
• Join a support group. Support groups can be good sources of information. Group members often know about the latest treatments. Your doctor may be able to recommend a group in your area.

Prevention:

In addition to regular exercise, techniques such as biofeedback training and relaxation therapy can help reduce stress.

• Biofeedback training. This technique teaches you to control certain body responses that help reduce pain. During a biofeedback session, you're connected to devices that monitor and give you feedback on body functions such as muscle tension, heart rate and blood pressure. You then learn how to reduce muscle tension and slow your heart rate and breathing yourself.
• Cognitive behavioral therapy. This type of talk therapy may help you learn to manage stress and may help reduce the frequency and severity of your headaches.
• Other relaxation techniques. Anything that helps you relax, including deep breathing, yoga, meditation and progressive muscle relaxation, may help your headaches. You can learn relaxation techniques in classes or at home using books or tapes.

Using medications in conjunction with stress management techniques may be more effective than is either treatment alone in reducing your tension headaches.

Additionally, living a healthy lifestyle may help prevent headaches:

• Get enough, but not too much sleep.
• Don't smoke.
• Exercise regularly.
• Eat regular, balanced meals.
• Drink plenty of water.
• Limit alcohol, caffeine and sugar.