What is Muscle Contraction Tension Headache (Tension Headache)?
Tension-type headaches, often referred to as muscle contraction headaches, stress headaches, or psychomyogenic headaches, are the most common type of primary headaches. These headaches can occur repeatedly and are split into two main types: episodic (which can be frequent or infrequent) and chronic. The main difference between these types lies in how often the headaches occur.
To distinguish tension-type headaches from other types, healthcare professionals use the definition and diagnostic criteria provided by the International Headache Society (IHS). A tension-type headache can last anywhere from half an hour to a week, often feels like a tight band across the head, and can range in pain intensity from mild to moderate. Importantly, this type of headache doesn’t get worse with light activity, like walking. The specific IHS criteria for diagnosing tension-type headaches can be found in the evaluation section.
What Causes Muscle Contraction Tension Headache (Tension Headache)?
The exact cause of tension-type headaches (TTH) isn’t completely clear, but it seems to be linked to nutrition, muscle issues, environment, and genetics.
Research often points to vitamin deficiencies as factors relating to TTH. One study focused on Turkish kids found that almost one in four of the children aged 11 to 15 in the study had headaches and low B-12 levels. Some had what scientists called a serious B-12 deficiency. When the children were given vitamin supplements, their headaches disappeared. Data also showed a connection between low levels of Vitamin D and TTH. In a comparative study, 70% of people with chronic TTH had a Vitamin D deficiency. In contrast, a quarter of the control group, the healthy participants, had the same deficiency.
Stress and poor body posture are also considered possible causes for tension headaches. However, the exact process that occurs within the body is not completely understood. For instance, when someone hunches their neck while playing video games or using a computer, there’s added pressure on the joint connecting the upper neck bones. The shoulders try to make up for this by rolling forward to reduce the stress. This can cause muscle imbalances and lead to areas tightening, creating the tension headache.
Risk Factors and Frequency for Muscle Contraction Tension Headache (Tension Headache)
Tension-type headache (TTH) is a common type of headache that affects about one-fifth of the world population. It’s so prevalent that a study from Denmark suggests that about 78% of adults have experienced at least one episode in their lives. These headaches are more likely to affect women than men, with a ratio of about 3:1. In addition, it’s the most common type of headache in children. Even so, it typically strikes people between the ages of 25 and 30. A Danish study also reported that for every 1,000 people each year, about 14.2 experience frequent episodic TTH.
Signs and Symptoms of Muscle Contraction Tension Headache (Tension Headache)
When examining a patient’s headache history, doctors often try to identify if it’s a single occurrence or a recurring issue. Recurring headaches, known as primary headaches, might indicate a disorder. However, if a new headache severely differs from past episodes, it could signify a more serious issue requiring investigation, like different migratory patterns during migraines and could warrant further evaluation.
Tension-type headaches (TTHs) are a common type of primary headache. Patients experiencing these are advised to keep a diary, logging each episode’s duration, severity, and any factors that seem to make it worse or better. For diagnosis, at least ten such episodes must occur. These headaches typically last anywhere from 30 minutes to 7 days, but usually average around 4 to 6 hours. They’re often characterized as dull, pressing or having a band-like tightening effect on both sides of the head. They tend to be of mild or moderate intensity and don’t worsen with physical activities, which is why patients with TTHs continue their daily routine, unlike migraine patients. TTHs often improve in the morning and worsen in the evening.
Patients may complain of tightness in their neck or shoulder muscles, and sleep disturbances. They usually do not exhibit symptoms like nausea, vomiting, and sensitivity to light or sound, which commonly occur with migraines. Sometimes TTH and migraines have similar symptoms, making accurate diagnosis difficult and may require time. It’s important to also learn about the patient’s medication history, including the type and frequency of painkillers used.
Physical examinations of those with TTHs usually find no issues. But identifying other causes for the headache, like certain brain issues or pressure in the skull, is crucial. In these cases, physical symptoms like a stiff neck or changes in vision can be observed.
During medical history taking and physical examination, doctors should always look for certain “red flags” that could indicate a secondary, more serious issue. These include:
- Sudden onset of headache
- Onset of headache after 50 years of age
- Very severe headache
- New onset of headache with an existing medical condition
- Headache accompanied by systemic illness
- Focal neurological signs or symptoms
- Changes in vision (papilledema)
- History of head trauma
Doctors can also use the “SNOOP4” acronym to help evaluate secondary headache disorders:
- “S” for systemic symptoms like fever, chills, and muscle pain, and weight loss
- “N” for neurological symptoms, especially focal neurological deficits
- The first “O” for older age of onset, namely 50 years or over
- The second “O” for sudden onset, as in a severe blow to the head
- “P1” for papilledema – changes in vision
- “P2” for positional headaches – headaches that worsen or improve in certain positions
- “P3” for headaches precipitated by strain or exertion
- “P4” for progressive headaches or a significant change in headache pattern
Testing for Muscle Contraction Tension Headache (Tension Headache)
If doctors suspect tension-type headache (TTH), they generally make the diagnosis based on specific criteria set by the International Headache Society, instead of relying on lab tests or imaging studies. This way of diagnosing is efficient in many cases. However, if certain concerning symptoms, known as ‘red flags’, are present, additional tests might be necessary. These can include brain imaging to make sure that the headaches aren’t due to another, more severe cause. In these cases, an MRI scan with a special dye (gadolinium contrast) is the recommended imaging study.
The International Headache Society’s guidelines for diagnosing TTH state that a person must have experienced at least ten episodes of headache that last anywhere from 30 minutes to seven days. These headaches must have at least two of the following characteristics: they affect both sides of the head, feel like a pressing or tightening sensation (but not pulsating), range from mild to moderate in intensity, and aren’t made worse by everyday physical activities such as walking or climbing stairs. A person diagnosed with TTH doesn’t experience nausea or vomiting and has no more than one of either light sensitivity or sound sensitivity. Furthermore, the symptoms should not match those of any other type of headache disorder as described in the International Headache Society guidelines.
However, there might be cases where all the features mentioned above for TTH may not necessarily apply, and the symptoms don’t align with any other headache disorder either. In such cases, the person might receive a diagnosis of ‘probable’ TTH. It’s crucial for these individuals to regularly get checked over a period of time, and most often, they are eventually diagnosed with TTH. Some people experience TTHs less frequently, while others might have them very often. This frequency factor leads to three subtypes of TTH: infrequent episodic (headache occurring less than once a month), frequent episodic (headache occurring between one to fourteen days a month), and chronic (headache occurring 15 or more days a month).
Treatment Options for Muscle Contraction Tension Headache (Tension Headache)
To tackle episodes of tension-type headaches (TTH), the main treatment involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Recent research has shown that ibuprofen (400 mg dose) and acetaminophen (1000 mg dose) are the best medical options for these headaches. Combining these two medicines seems to work better than using ibuprofen alone. Despite being frequently used, a 500 mg dose of acetylsalicylic acid (ASA) was found to be as ineffective as a placebo. Other NSAIDs, like naproxen, ketoprofen, and diclofenac, can be more effective than a placebo in dealing with acute TTH. It’s important, though, to not overuse pain-relieving drugs as they could ironically lead to headaches caused by medication overuse. Muscle relaxants have weak evidence backing their effectiveness for TTH and may pose the risk of habituation or dependence.
For chronic TTH, the goal is to reduce the frequency of headaches using preventive medicines. The drug amitriptyline is one of the most effective and widely studied for managing chronic TTH. The dose should be started low (10 to 25 mg daily) and gradually increased until a suitable response is achieved or side effects appear. The typical response time is 3 to 4 weeks. If beneficial, amitriptyline is usually continued for at least six months. If headaches recur after stopping the drug, it may be continued long-term. Keep in mind this medication may cause side effects like dry mouth, drowsiness, urinary retention, heart irregularities, and glaucoma. Selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) were found less effective than amitriptyline.
There’s mixed evidence on the use of a drug called botulinum toxin type A to prevent chronic TTH. It’s usually not recommended as first-line treatment, but might be used in cases where other treatments don’t work.
Non-drug-based treatments can also be helpful for chronic TTH. Physical therapy, biofeedback, and cognitive-behavioral therapy are particularly effective. Other beneficial practices include relaxation, regular exercise, and improved posture. Other treatments like massage, manipulation, acupuncture, and osteopathic manipulative medicine may also improve symptoms, including increasing the range of head movement.
What else can Muscle Contraction Tension Headache (Tension Headache) be?
When trying to determine if someone has tension-type headaches (TTH), doctors also need to consider other types of headaches that have similar symptoms.
- Migraine headaches are a frequent type of headache that could be mistaken for TTH. They differ in key ways though. Migraines are typically moderate to severe, last between 4 to 72 hours, and may only affect one side of the head. People with migraines often describe the pain as pulsating or throbbing. Migraines can get worse with physical activity and also cause nausea, sensitivity to light and sound, and vomiting. Some people may also see or feel a “warning sign,” known as an aura, before the migraine starts.
- Medication overuse headaches are another type to consider. These can happen when someone takes pain-relief medicines too often, at least 10 to 15 days a month. Patients may experience a temporary relief from these headaches with medication, but the pain returns once the effect of the drug fades. People with these headaches can also seem nervous, easily upset, and restless. For treating these headaches, it’s crucial that the patient stops taking the overused medicines.
- A type of headache that is less common but important to recognize is the hypnic headache. These types of headaches only occur during sleep and will usually wake the patient up. They are more common in people over 50 who generally have a higher risk of secondary headaches. It is key for doctors to distinguish whether a headache is primary (a condition in itself) or secondary (a symptom of another medical issue).
In all patients, especially those at increased risk of secondary headaches, doctors need to assess for so-called “red flags,” or signs that could point to a more serious underlying cause of their headaches. Some causes could include giant cell arteritis, sleep apnea, heart-related headaches, neck-related headaches, and many others. However, a detailed discussion of these types of headaches is beyond the scope of this task.
What to expect with Muscle Contraction Tension Headache (Tension Headache)
The outlook for Tension-Type Headache (TTH) is generally positive, with most people responding well to treatment. In a study conducted in Denmark involving 549 people, around half of the individuals suffering from occasional TTH saw their symptoms disappear. However, about 15% developed a chronic form of TTH.
Possible Complications When Diagnosed with Muscle Contraction Tension Headache (Tension Headache)
Tension-type headache (TTH) may not be a severe illness, but it has a substantial impact on a person’s life. Regular episodes or chronic TTH can lead to missed days at work and decreased productivity. It can also lead to heightened stress levels and mood disorders.
Preventing Muscle Contraction Tension Headache (Tension Headache)
It’s important that patients understand their condition and what might cause it. They should pay special attention to good sleep habits, relaxation techniques, and maintaining the right posture. If you’re dealing with primary headache disorders, keeping a headache journal can be really helpful. In this diary, you should note down each headache you experience, how long it lasts, how severe it is, what might have caused it, and what makes it worse or better. Having a good relationship with your doctor makes a big difference, too. Most patients see better outcomes when they stick with the same doctor over a long period of time.
