Tension headache is the most common type of headache.
When muscles in the head, neck, or shoulders are shortened (contracted), blood vessels are constricted, and the brain’s circulation is affected.
The neck is the gateway to the head, and if this gate is partially closed, the results are dull headaches, woolly thinking, dizziness and irritability.
Many sufferers from this type of headache are unaware of the extent of the congestion in their muscles until firm pressure around the base of the skull, the back of the neck or the shoulders causes them to howl in protest.
When the blood circulates freely, the waste products of metabolism (the burning of the food we eat) are rinsed away and excreted.
When the muscles are tight, the waste products are trapped and form crystals.
It is when these are pressed on to the bones that the pain is felt.
If you are tender in these muscles and your headache is relieved by a head and shoulder massage, you can be reasonably sure it is a tight-muscle or tension headache.
Alcohol is a powerful muscle relaxant, so if a drink improves your symptoms, this could confirm the diagnosis.
Causes of Tension Headaches
Emotional triggers which cause muscles in the head and neck to react blushing when you are embarrassed and turning pale when you are afraid.
You might ask why the muscles respond with pain when the trigger is emotional distress.
The answer is that the muscles .of the head and neck (and indeed other muscles) cannot differentiate between emotional and physical strain, as a bane out of alignment, a strained pasture, fear, a bad marriage, overwork, depression or a large gas bill could all prompt the protective ‘splinting’ reaction.
Perhaps if we were animals, we would retreat into our shells or stick our heads in the sand.
- Injury: explained above.
- Posture: holding the body in strained positions: standing badly, sitting unsupported, unbalancing the head, for example.
- Bedtime television watching: the head propped forward while you peer at the screen.
- Looking down while reading: putting a strain the neck.
- Painting a ceiling, or working in awkward situations such as under a car or the kitchen sink.
- Facial mannerisms: frowning, squinting, jaw-clenching.
- Dental tension: prolonged chewing (gum), abnormal chewing to avoid sensitive teeth, jaw problems, teeth-grinding.
- Infections: swelling.
- Eye strain: fatigue in the muscles surrounding the eye.
- Spectacle problems: pulling the head back to look through half glasses or bifocals.
Neck problems and headaches
Muscle-contraction headaches can accompany arthritis of the neck (cervical sodalities).
Patients often say their pain is due to this condition in a resigned way that suggests they are doomed to headaches far the rest of their life.
This is not necessarily the case. It puzzles me that this diagnosis is so often made without any physical examination or X-ray.
Is it perhaps that in persons over 45 wear and tear in the neck joints is sometimes assumed when it is not actually present?
It would seem difficult ta differentiate in the absence of a history of arthritis and at least a physical examination, between cervical sandlots and muscle spasm in the neck muscles from an emotional or physical trigger.
Arthritis is an inflammation .of the joints. Any joint in the body can be affected.
There are several types, but the most common ones are osteoarthritis and rheumatoid arthritis.
Osteoarthritis is by far the most common and the incidence increases with age – wear-and-tear arthritis.
Rheumatoid arthritis can develop in young people and is by far the more serious condition. It can cause severe pain and deformity, leading to disability.
When there is osteoarthritis in the neck, there is an increased likelihood .of developing muscle-contraction headaches.
This could be another ‘splinting’ reaction and also a response to the pain.
Portions of the damaged bone can press on nerves and pinch them.
The nerves react with compression, irritation and eventually inflammation. This can also happen with a slipped disc.
The shock absorber or cushion between the vertebrae presses on the nerve, causing pain.
Both osteoarthritis and a slipped disc can cause neurological symptoms such as numbness, weakness and tingling.
When the cervical spine is involved, this will be felt in the arms.
As has been said, a person who has a painful physical focus is also more likely to be affected by emotional triggers – fear of the pain, low mood, frustration.
This adds to the tension in the neck and thus causes more headaches.
Symptoms Of tension Headache
Visual disturbances: these are not as dramatic as in migraine sufferers, but they can occur in tension headaches, usually in the form of blurred vision or, if it is severe, there can be altered perception.
In a hallucination, the person sees something that is not there – for example, a pink elephant.
In altered perception, the person sees what is there – for example, a flower on a curtain may appear like a face.
- Pain in the neck, shoulders and back.
- Bloating of the stomach or bowel and wind. Often the passing of wind is the first sign that the headache is abating.
- Nausea and loss of appetite are often part of the symptom picture or craving for foods not usually a part of the sufferer’s diet.
- Shakiness and lack of muscular coordination: difficulty gripping a pen or clumsiness and regularly dropping things. ‘
- Fatigue and lack of interest in things normally enjoyed.
- Wobbly legs: feelings of not quite knowing where the ground is or of walking on eggshells.
- Dizziness, especially when turning the head.
- Irritability, anxiety, depression and feeling of unreality; for example, walking into the kitchen and it being unfamiliar; or depersonalization – when a person looks into the mirror and they know intellectually it IS their image they see but somehow they look different, rather ‘like a distorted image in a mirror at a funfair.
- Difficulty in breathing through the nose – mild hyperventilation.
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Some of these symptoms might seem relatively remote from the site of pain, but because they happen with such monotonous regularity.
Most people are very accurate about their symptom picture; and the same symptoms crop up again and again in large numbers of people.
The pain is less disabling than migraine.
Most sufferers continue working through these headaches and rarely retreat to bed during the day.
Many people accept their headaches almost as a way of life.
Facts about Tension Headache
Distribution of pain
The pain is usually dull on the top of the head, extending from the forehead like a tight band and can go down the back of the head, behind the ear, into the jaw and across the face.
The muscles at the base of the skull are often very tender on pressure. The pain can extend further, to the neck, shoulders and upper back.
When does the pain start?
It can come at any time of the day but rarely starts in the night.
It usually affects both sides and can produce a weight on the top of the head or a tight band around the head accompanied by a ‘spicy’ feeling.
Sufferers can go to bed with a headache and wake up with the same headache.
This is more common in people who are anxious and depressed.
Their subconscious works away all night trying to help resolve their emotional conflicts and the result is that they awake as tense as when they retired to bed.
However, it is more usual for the pain to start in the morning and gradually worsen as the day progresses, with sleep bringing some measure of relief.
How long does the tension headache last?
It can last hours, days or even weeks if nothing is done about it. It is easy to understand why these headaches can be protracted.
When the muscles are habitually over stimulated, they become so contracted that merely switching off by reading, watching television or sleeping is not enough to allow them to rest in their lengthened state.
The muscles need practical help in stretching, massage, acupressure or other hands-on treatment, or the person might resort to painkillers, muscle relaxants or alcohol. The drawbacks of using drugs and alcohol are discussed later.
Who suffers from this type of headache ?
Both sexes (in about equal proportions) and all ages.
They usually start in early adult life, although 10-20 per cent of sufferers have their first attacks in childhood (Saper and Magee, 1978).
Children and tension headache
One might imagine that children would escape tension in the head, neck, and shoulders because they were supple and active and don’t have adult life responsibilities. This is not so; life is different but just as difficult for them.
The neuroses of later life are incubated during the early years. Children often find.
It is challenging to express emotional pain, and the adults around them can miss this.
It is impossible to have all our needs met even if we are born into loving, stable families – the world is a scary place.
We react to this fear by tightening our muscles or ‘unmooring’.
This practical mechanism allows us to hold in our fear, frustration, anger, grief, Sadness or any other hurtful emotion.
Thus the foundation stone of neurosis is! laid.
In children, physical triggers causing muscle tension include the persistent cough which keeps the shoulders raised, poorly placed desks and pushing the head forward to peer at the blackboard.
Sleeping on the stomach can put a strain on the neck, as can be carried on the mother’s hip and having to turn the head in one direction to see the world.
Sadly, also, children often spend long hours in front of badly positioned TV sets or lying on the floor, lifting the head to play computer games.
The appearance of a persons with a tension headache
They are usually very pale because of the blood vessels’ constriction, the face lacks expression, and the eyes look dull.
The sufferer often looks detached, as though they are not entirely with you.
If there are sinus problems and the tension headache, there can be dull red patches over the cheek-bones and fluid retention around the eyes.
Sometimes the face can look puffy.
This is probably because of congestion due to the tight muscles impeding the lymph drainage from the head. Furrowing of the brow can also be a feature