Headache, Nonmigraine Tension Type
• Gradual onset of a mild, steady, or dull aching in the head
• Pain often described as vise-like squeezing or heavy pressure around head
• Constant headache (does not throb)
Although a headache may be associated with a serious medical condition, most headaches are not serious. Headaches can be caused by a wide variety of factors, but the overwhelming majority that require medical attention are either tension or migraine headaches. A quick way to differentiate between the two is the nature of the pain. Tension headaches usually have a steady, constant, dull pain that starts at the back of the head or in the forehead and spreads over the entire head, giving the sensation of pressure or a feeling that a vise grip has been applied to the skull. In contrast, migraine headaches are vascular headaches characterized by a throbbing or pounding sharp pain. For more information on migraines, see the chapter “Migraine Headache.”
Causes
A tension headache is usually caused by tightening in the muscles of the face, neck, or scalp as a result of stress or poor posture. The other most important causes are drug reactions and magnesium insufficiency. The tightening of the muscles results in pinching of the nerve or its blood supply, which results in the sensation of pain and pressure. Relaxation of the muscles usually brings about immediate relief. Often the headache can be worsened (or improved) by applying hand pressure to trigger points on neck muscles. A trigger point is the central area of tension in the muscle. A tension headache only rarely mimics other types of headaches of a more serious nature, such as those associated with a stroke or brain tumor. Consult a physician immediately if a headache feels different from a tension headache or migraine, or if the headache is unrelenting.
Therapeutic Considerations
Modern drug treatment of headache, whether migraine or tension, is ultimately doomed because it fails to address the underlying cause and as a result produces significant risk for side effects. Rather than focusing on identifying and eliminating the precipitating factor, the goal with headache medications is simply to provide symptomatic relief. Particularly interesting are several clinical studies estimating that approximately 70% of patients with chronic headaches suffer from drug-induced headaches, a result of the medications they are taking to suppress the symptoms of headache. In other words, the headache medications are giving them headaches, and if they quit taking the drugs their headaches go away. In one study of 200 patients suffering from analgesic rebound headache, discontinuation of these medications resulted in a 52% improvement in the total headache index. Specific improvements occurred in headache frequency and severity, general well-being, and sleep patterns, and there were also reductions in irritability, depression, and lethargy.1
Tension headaches have been shown to respond to a number of natural therapies. Particularly helpful are physical treatments such as massage, chiropractic, and other forms of bodywork (discussed later in this chapter). Bodywork is the term often used to describe healing techniques that work with the structure of the body. Most of these therapies involve hands-on work, such as massage. Virtually all bodywork techniques may be helpful in the treatment of both acute and chronic tension headaches. However, rather than simply getting a massage whenever a headache appears, we recommend seeking out physical therapies that teach people to become aware of body tension and posture.
Chiropractic care can be quite helpful when misalignment of the spine creates muscular tension in the neck. In 1996, the RAND Corporation analyzed all of the scientific evidence from 1966 to 1996 on chiropractic treatment of tension headaches.2 Their conclusion was that chiropractic care probably provides at least short-term benefits for some patients with neck pain and headaches. A follow-up analysis provided additional support for the value of chiropractic care.3 Our feeling is that it is definitely worth a try. However, if you do not get relief within a few sessions, either this is not what you need or you should find another practitioner. We also do not agree with some chiropractors’ recommendation that treatments be continued indefinitely. The best chiropractors not only adjust your neck or other areas of the spine needing attention but also provide you with postural and muscle exercises to correct the causes of the underlying imbalance.
An alternative to chiropractic care involves getting a referral to a conventional physical therapist from your primary care doctor. Clinical studies have shown that conventional physical therapy (consisting of education for posture at home and in the workplace, home exercise, massage, and stretching of the cervical spine muscles) can reduce the frequency and severity of tension headaches.4,5 For example, in one study 20 patients with a diagnosis of tension headache were treated for pain relief in a physical therapy clinic once a week for six weeks.4 The previous three-week period of no treatment served as a control period during which patients recorded their headache frequency, duration, and intensity using a numeric pain scale. Results indicated that the frequency of headaches and activity scores were significantly improved over the course of treatment. These benefits were maintained after 12 months. Given the problems associated with chronic use of aspirin and other pain relievers, this study provides evidence that addressing the cause rather than suppressing symptoms is clearly the better approach.
The next goal is to learn how to relax the tight muscles by alternating tension and then relaxation in the muscle. See the exercise for progressive relaxation in the chapter “Stress Management.” Learning how to relax has been shown in clinical studies to provide exceptional benefits without side effects. One of the more interesting studies compared the effectiveness of school-based, nurse-administered relaxation training vs. no treatment for chronic tension headache in children (10 to 15 years old).6,7 After six weeks and at the six-month follow-up, 69% and 73%, respectively, of the students who received relaxation training had achieved at least a 50% reduction in headaches as compared with 8% and 27%, respectively, of those in the control group. So teaching children with chronic tension headaches how to relax can be quite effective, and it is without side effects. What we really like about this therapy is that the children get a better message: rather than seeking relief from a drug, they learn how to control the headache themselves.
If these treatments are not effective, the next step is to follow the recommendations given in the chapter “Migraine Headache.” Those recommendations are also appropriate in the treatment of chronic tension headaches, which share the following features with migraine headaches:
• Both can be the result of chronic use of aspirin and other pain relievers.
• Tension and migraine headaches are often triggered by food allergies.
• Magnesium supplementation can help both.
• 5-hydroxytryptophan (5-HTP) has been shown to help both.
Finally, occasional use of aspirin (or willow bark extracts standardized for salicin, the natural form of aspirin) or acetaminophen is safe and effective in the treatment of an acute headache. The key is not to rely too heavily on these medications. After all, a headache is not caused by a lack of aspirin or acetaminophen. But chronic headaches may be due to low magnesium. A study in Italy showed just how effective magnesium supplementation can be for children with chronic or episodic tension-type headaches.8,9 Supplementation with 180 mg magnesium twice per day produced a symptom reduction of 87.5%, with 100% of the patients experiencing at least a 50% reduction in symptoms. Analgesic consumption also decreased a remarkable 65.4%.
QUICK REVIEW
• A tension headache is usually caused by tightening in the muscles of the face, neck, or scalp as a result of stress or poor posture.
• The first therapeutic goal in treating the chronic tension headache sufferer is to address any structural problem that may trigger a tension headache.
• Regularly taking drugs for acute headaches often causes chronic headaches.
• Learning how to relax and defuse tension goes a long way in the treatment and prevention of tension headache.
• Migraine and tension headaches share many features.
• Magnesium insufficiency is common in tension headaches.
The primary therapy should be addressing the factors that trigger tension in the neck muscles. Since the neck is an area of the body that often holds tension produced by psychological stress, it is especially important to learn to relax neck muscles through techniques such as progressive relaxation. In addition, it is important to address any structural factors that may be triggering tension headaches. Chiropractic care, physical therapy, and bodywork are important treatments.
• A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures”
• Key individual nutrients:
Vitamin B6: 25 to 50 mg three times per day
Magnesium (bound to aspartate, citrate, fumarate, malate, or succinate): 150 to 250 mg two to three times per day
Vitamin D3: 2,000 to 4,000 IU per day (ideally, measure blood levels and adjust dosage accordingly)
• Fish oils: 1,000 mg EPA + DHA per day
• One of the following:
Grape seed extract (>95% procyanidolic oligomers): 100 to 300 mg per day
Pine bark extract (>95% procyanidolic oligomers): 100 to 300 mg per day
Some other flavonoid-rich extract with a similar flavonoid content, super greens formula, or another plant-based antioxidant that can provide an oxygen radical absorption capacity (ORAC) of 3,000 to 6,000 units or more per day