Neurological Disorders: Tension Headache

Tension headache is very frequent, and along with migraine headache they encompass most cases of headache seen by a neurologist.

It is an example for a primary headache condition because no structural, systemic or any other known causes are identifiable as a cause for this type of headache and if such causes are identified then the headache is more appropriately called as secondary headache.

Women are more frequently affected than men. There is no racial or ethnic predilection. Adults are affected more than the people belonging to the extreme age groups.

The exact cause of this headache is not yet clear however stressful situations take a contributory role. The incidence of this headache is definitely more in patients having stress, psychiatric and emotional dysfunction, but very little is known as to what kind of neurochemicals in the brain mediate this condition.

The headache typically is of long duration and may go on and on for weeks to months. Patient typically complains to the doctor about a daily headache. The severity generally is not high, on a 1 to 10 scale (10 is the worst) patients generally complain of 4 or 5 but it is the perpetuity what annoys the patient. The nature is usually dull and aching sensation. Severe sharp, shooting or stabbing type are uncommon.

Headache is felt as diffuse or all over the head. Patients may complain of a tight feeling in their scalp muscles. Neck tightness is common too.

Light bothering (photophobia), sound bothering (phonophobia) are not expected with this condition. If such symptoms are present then migraine headache needs to be suspected or a combination of both migraine and tension types. Presence of nausea, vomiting, aura etc also should point towards migraine headache or certain other types of headache.

Diagnosis is mostly clinical however when patient presents initially with this type of headache it should not be straightaway attributed to tension type of headache rather relevant investigations are to be accomplished.

A head CT or more preferably an MRI of the brain helps in ruling out any structural problems. The above tests are usually recommended as with and without contrast.

Blood tests like thyroid function tests, liver tests, ESR/CRP, antiphospholipid antibodies etc may be required on case to case basis.

There is no curative treatment for this kind of headache.

Various anti headache medications are tried and examples include;

• Non steroidal anti inflammatory drugs like naproxen
• Muscle relaxants like tizanidine, baclofen
• Anti anxiety agents like benzodiazepines (e.g. diazepam)
• Anti depressant like amitriptyline
• Anti psychotics like quetiapine
• Nerve-pain pills like gabapentin etc

Often this type of headache is refractory and doesn’t respond to any medications. Psychotherapy/counseling may be required too. Patients need reassurance that no underlying serious pathologies are identified to explain the headache.

A neurologist is frequently involved in the care of patients with tension headache.