Headaches: Tension - Managing Tension-Type Headaches

Diagnosis

Diagnosing the cause of persistent daily headache can be difficult. People who visit the emergency room with disabling headache may be misdiagnosed as tension-type headaches instead of migraines. It is important to choose a doctor who is sensitive to the needs of headache sufferers and is aware of the latest advances in treatment.

According to the International Headache Society, a diagnosis of tension-type headache is suggested by the following symptoms:

• Pressing or tightening (but non-pulsating) feeling
• Mild-to-moderate pain on both sides of the head
• Not aggravated by routine physical activity (such as walking or climbing stairs)

---

---

In episodic tension-type headaches:

• No nausea or vomiting
• Photophobia (intolerance of light) or phonophobia (intolerance of sound) may be absent or one of these symptoms (but not both) may be present

In chronic tension-type headaches:

• No vomiting
• No moderate or severe nausea
• No more than one of the following symptoms: Mild nausea, photophobia, or phonophobia
• Some types of chronic tension headache may include tenderness upon manual palpitation of the head (pericranial tenderness).

Differentiating Medication-Overuse (Rebound) Headache from Tension-Type Headache.

About a third of persistent headaches are the result of the rebound effect caused by the overuse of headache medications.

Usually in such cases, medications have been taken on an ongoing basis for more than 3 days each week. If patients stop taking these drugs, the headaches come back. The patient then starts taking the drugs again. Eventually the headache simply persists and medications are no longer effective. Even after successful medication withdrawal, relapse is common, particularly with drugs that contain caffeine, so doctors should check for this type of headache even in patients who have previously been treated.

Medications implicated in medication-overuse headache include barbiturates, sedatives, narcotics, and migraine medications, particularly those that also contain caffeine. (Heavy caffeine use can also cause this condition.) Simple painkillers, such as aspirin or ibuprofen, are less likely causes of medication-overuse headaches.