THE CLINICAL SYNDROME

• The tension-type headache, which used to be referred to as the muscle contraction headache, is the most common kind of headache that affects people.

• It is possible for it to be either episodic or chronic, and it may or may not be connected to the contraction of muscles. There is typically a significant amount of sleep disruption.

• Patients who suffer from tension-type headaches are frequently described as having multiple unresolved conflicts relating to work, marriage, and other social relationships, as well as psychosexual challenges.

• Large groups of patients who suffered from tension-type headaches were given the Minnesota Multiphasic Personality Inventory to complete, and the results showed that not only did they suffer from borderline depression, but also somatization.

• In some patients, this somatization manifests itself as abnormal muscle contractions, while in others, it manifests itself as a straightforward headache. This is the consensus among researchers.

SIGNS AND SYMPTOMS

• Tension headaches usually affect both sides of the head, but sometimes only one. Frontal, temporal, and occipital headaches are common.

• After several hours or days, a tension headache will usually stay the same. This disorder causes sleep disruption but no aura.

  • Due to this disruption, you may have problems going asleep, wake up often at night, or wake up sooner than usual.

  • These headaches usually occur between 4 and 8 in the morning and evening.

  • Although both sexes are affected, most cases are female.

• Tension headaches may run in families because children mimic their parents' pain responses, but there is no genetic link.

• Stress—physical or mental—always causes a severe tension headache. This could be a conflict with a coworker or spouse or a hefty task. A long automobile ride, neck strain, whiplash, or cathode ray tube glare might create a headache.

• Cervical spondylosis might worsen, causing a tension-type headache.

• Tension-type headaches can cause temporomandibular joint dysfunction (TMJ).

TESTING

• There is currently no diagnostic test that can specifically identify tension headaches.

  • The primary goal of the testing is to discover a hidden pathologic process or another disease that may present symptoms similar to those of tension-type headaches.

• Magnetic resonance imaging (MRI) of the brain and, if significant occipital or nuchal symptoms are present, magnetic resonance imaging (MRI) of the cervical spine should be performed on all patients who have recently experienced the beginning of a headache that is presumed to be of the tension type.

• In patients who have previously been stable on their treatment for tension-type headaches but who have recently noticed a change in their symptoms, an MRI should also be conducted.

• If a diagnosis of tension-type headache is uncertain, a screening battery of laboratory tests including a complete blood count, erythrocyte sedimentation rate, and automated blood chemistry should be carried out.

DIFFERENTIAL DIAGNOSIS

• In clinical practice, the diagnosis of tension-type headache is typically made by gathering specific information about the patient's headache history. Despite the obvious distinctions between the two types of headaches, tension headaches are frequently misdiagnosed as migraine headaches.

• A mistake like this can lead to treatment strategies that don't make much sense and poor symptom management for headache sufferers.

• A tension-type headache may also be a symptom of a disease affecting the cervical spine or the soft tissues that surround it.

• Arnold-Chiari malformations may present itself clinically as tension-type headaches; however, it is simple to spot these malformations on pictures of the posterior fossa and cervical spine.

TREATMENT

Abortive Therapy

• The doctor must examine the frequency and intensity of the headaches, their impact on the patient's lifestyle, the success of past treatments, and any drug usage or abuse when choosing a treatment.

• Teaching the patient to lessen stress can often control tension-type headaches that occur once or twice a month.

• Analgesics or NSAIDs can relieve acute symptoms. Headache patients should not receive combination analgesics with barbiturates or opioids. Abuse and dependence outweigh theoretical benefits. In drug abusers, the doctor should avoid abortive treatment. Abusing mild analgesics and NSAIDs can have major side effects.

Prophylactic Therapy

• If the headaches occur more frequently than once every one or two months or if they are so severe that the patient repeatedly misses work or social engagements, then prophylactic therapy is indicated.

• Prophylactic therapy is indicated when the headaches occur more frequently than once every one or two months.

Antidepressants

• Antidepressants are typically considered to be the most effective medications for the preventative treatment of tension-type headaches. Not only can the use of these medications assist reduce the frequency and severity of headaches, but they can also restore sleep patterns and treat any underlying depression that may be present.

• Patients should be made aware of the potential adverse effects of this class of medications, which may include drowsiness, dry mouth, impaired vision, constipation, and urine retention, among other symptoms.

• Patients need to be informed that finding relief from their headache discomfort typically takes between three and four weeks. On the other hand, a return to normal sleep patterns takes effect right away, and this alone may be sufficient to bring about a discernible reduction in the intensity of headache symptoms.

Biofeedback

• Patients who suffer from tension-type headaches and are sufficiently motivated may find that monitored relaxation training combined with patient education about coping methods and stress-reduction measures is beneficial for their condition.

• If one want to obtain favorable outcomes, careful selection of patients is of the utmost significance.

• Before attempting biofeedback on a patient who suffers from substantial depression, it may be good to address the patient's depression first.

• If the patient uses biofeedback, they may be able to regulate their headaches without having to resort to pharmaceuticals that come with unwanted side effects.

Cervical Epidural Nerve Block

• Multiple studies have shown that a cervical epidural nerve block combined with steroid medication is effective in providing patients with tension-type headaches with long-term relief from their symptoms, even when other treatment techniques have been tried and found to be ineffective.

  • This medication can also be employed as a stopgap measure while the patient waits for the antidepressant ingredients to take action.

  • Depending on the patient's clinical symptoms, a cervical epidural nerve block can be done anywhere from once per day to once per week.

COMPLICATIONS AND PITFALLS

• Some tension-type headache sufferers have uncontrolled depression or anxiety and a pharmaceutical dependency on opioid analgesics, barbiturates, moderate tranquilizers, or alcohol.

  • The repeated failures of outpatient treatment are depressing and frustrating. Inpatient treatment in a psychiatric or headache unit can speed up recovery and treat headaches simultaneously.

• Monoamine oxidase inhibitors reduce tension-type headache frequency and intensity in this population. Phenelzine 15 mg three times a day works well.

  • After two to three weeks, the dosage is gradually dropped to an optimal maintenance level of five to ten milligrams three times a day.

  • If specific dietary limitations are not followed or if monoamine oxidase inhibitors are taken with certain prescription or over-the-counter medications, they might trigger life-threatening hypertensive crises. Thus, only reliable, compliant patients should use them.

  • The doctors prescribing these potentially dangerous drugs should know how to use them safely.