Muscle Tension Headaches

Until Recently headaches were largely considered a nuisance by the medical community and many other health care providers. But patients who suffer from headaches consider their problem nothing less than a painful and sometimes disabling. Several studies have shown headaches to be significant public health problem.(2,4,5) A study from the United States reported that 27.3% of females and 13.9% of males suffer from severe headaches.(6) Another study found that in one year headaches in the U.S. resulted in 74.2 million days of restricted work activity, costing an estimated $1.4 billion in lost productivity.(3) Headaches are one of the most common reasons that people seek both medical and chiropractic treatment.(8)

Headaches - Types and Causes

Of the two broad categories of chronic recurrent headaches (migraine and tension-type), tension headaches are more common, accounting for about 85.5% of full headaches. Muscle tension headache, muscle contraction headache and tension headache describe the same thing. The pain of tension headaches is usually described as between mild and moderate, and happen two or three times more frequently than migraine headaches. Upper back and neck pain and stiffness are also associated with tension headaches.

There are many possible causes of tension headache. Some studies have found that both migraine and tension headache sufferers have lower than normal blood levels of serotonin, a chemical in the central nervous system that suppresses pain. It is believed that because there is less serotonin, what you would not normally consider painful becomes painful - resulting in headache.(28,29)

Still other studies have found that problems in the cervical spine can cause pain similar to headache.(7,24,25) Clinical tests on headache patients have found changes in electrical muscle activity, reduced range of motion, palpable muscle spasm and palpable tenderness along the cervical spine. Many problems in the neck resulting from injury, recurring work strain, stress, and possibly joint degeneration can lead to head pain.(26,27)

Treatment of Tension Headache

The most important aspect of treatment for tension headache sufferers is to relieve or improve the problem that causes the pain as quickly as possible with few, if any, side effects. In order to provide a through evaluation of treatment for tension headaches, many of the common options will be discussed. These include spinal manipulation, medication, psychological interventions, physical therapies, exercise, and occupational and lifestyle changes.

Spinal Manipulation

A large study on tension headache yielded strong evidence for the effectiveness of spinal manipulation. This study showed significant decreases in the headache frequency, total headache pain, and over-the-counter medication use, with increase ability to function.(1) In this study, patients who had at least one tension headache a week for at least three months were randomly assigned to receive either spinal manipulation treatment or Amitriptyline, a standard headache medication. Those in the spinal manipulation group were treated two times a week for six weeks; those in the Amitriptyline group were prescribed a six week course of the medication.

Patients in both groups improved during the treatment phase of this study, but four weeks after the treatment ended, the patients who had taken Amitriptyline went back to their pre-treatment headache status, while most of those treated with spinal manipulation maintained their improvements. Two other studies have tested the effects of spinal manipulation for treating tension headaches. While both showed benefits in the spinal manipulation groups, sample sizes were too small to demonstrate any statistically significant differences.(2,9,10,11,12,13,14,15)

Spinal manipulation, which is basic to chiropractic treatment, is not generally used to treat each episode of tension headache but is used during a specific length of treatment time to control mechanical factors that lead to headaches. The length of treatment will vary depending on the patient's symptoms and the causes of the pain.

Medication

Drugs used to treat headache are classified as either abortive or prophylactic. Abortive medications relieve a headache that has already started; prophylactic medications are taken daily to prevent a headache. The most common abortive medications for headache are over-the-counter (OTC) analgesics, such as acetaminophen, aspirin, ibuprofen, and naproxen sodium. Occasionally, in more severe cases, these drugs are prescribed in higher doses or in combination with other drugs. The long term use of OTC medications is associated with serious side effects including liver damage (acetaminophen), stomach damage (aspirin, ibuprofen, naproxen sodium), and kidney damage (ibuprofen, naproxen sodium).(16,17,18) Abortive drugs do not always address the cause of a headache and they do not prevent headaches from occurring, which means that the headache sufferer who relies on them for pain relief can end up taking large amounts of the drug over a period of years - increasing the likelihood of serious side effects. A study on tension headache by Boline et al., found more than one case of a patient consuming between 10-20 acetaminophen tablets per day with tests showing early signs of liver damage.(1)

The most commonly prescribed and thoroughly studied prophylactic headache medication is Amitriptyline, a tricyclic antidepressant that is proven effective . It works for treating headaches by allowing the body to build up levels of serotonin.(19,20,21,22,23) Though this medication relieves pain, it does not address the cause of headaches.

The overuse of medications can also result in a rebound headache. This type of headache is triggered when the person is taking so much medication that a drop in the blood level of the drug results in a headache. (Essentially, the body develops a dependency of the medication.) The person is then required to maintain a constant level of medication in the blood stream to avoid a headache. When one takes into consideration the many possible side effects of drugs, their prolonged use becomes a serious public health problem.

Psychological Interventions

A number of Psychological therapies can be used to treat tension headaches. These therapies include cognitive therapy (changing behavior), muscle relaxation techniques, and hypnotherapy. These have all been studied and shown to provide an effective reduction in head pain and headache frequency.(27)

There are many relaxation techniques that can be used to treat tension headaches, and many of them are quite simple and can be done nearly anywhere. For example, lie down (if possible), close your eyes, and breathe deeply while slowly tensing and relaxing your muscles. Start with your feet, and then work your way up, doing all of the major muscle groups along the way. Another simple relaxation technique involves closing your eyes and imagining yourself in a pleasant place. Many people choose the beach and imagine the warmth of the sun on their skin.

Also proven effective in treating tension headaches is biofeedback. This technique involves a trained professional who teaches you to control bodily functions not generally considered controllable, such as blood pressure, temperature, and brain activity. No particular health care profession claims biofeedback as its own, but some psychologists, medical doctors, dentists, physical therapists, and Doctors of Chiropractic practice it.(30)

Exercise

Exercise in an important aspect of treating tension headaches. Appropriate stretching exercises, which are best used in the morning and during and after a stressful work day, can be provided by a qualified health care professional. If you have neck or upper back pain or stiffness, do not try any exercise without prior approval from a doctor.

Another important element to include in an exercise program is a form of cardiovascular exercise done two or three times a week. Probably the easiest to start and the most economical to continue is a walking program. Walking and other cardiovascular exercises have been found to reduce and/or alleviate chronic pain problems, including a tension headache. As with any exercise, if you have not done so for awhile, begin gradually. Start walking short distances and gradually increase both time and distance until you are walking for at least 20 or 30 minutes.

Lifestyle Improvements

Lifestyle changes to include in a management program of tension headaches should begin with an evaluation of the work place. Since most workers today sit or stand for prolonged periods, the work station should have adequate lighting (eye strain can cause headache) and care should be taken to put as little strain on the spine as possible, especially the cervical spine. When working, keep your work station as close to your center of gravity as possible and avoid holding your head in bent or twisted positions for too long.

It will also be helpful to incorporate breaks into your work day - take a break every 45 to 60 minutes. The break need only be a minute or two long, just getting up and/or changing positions is important in reducing stress to the neck and upper back. Brief, moderate stretching of the neck, arms and upper back are helpful.

Physical Therapies

For the occasional headache, you may find that applying either ice or heat to the area of your head that hurts may help. You may also find that massage,(31) acupressure,(32) or other physical therapy may work for relieving your headache.

Treating the Whole Patient

There are a number of possible treatments for tension headaches besides taking a pill. Although a medication may mask the pain, the cause of the pain is not usually addressed and you are subject to having more headaches, requiring more pills. A headache is a biological sign that something is wrong, so find a health care professional who is interested in finding the cause and then stopping the headaches. As with any treatment program, both you and your doctor must become partners in your care. Without this partnership, the long-term benefits of the treatment will not be realized and the problem will continue.

References:

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