Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
The key to making the diagnosis of any headache is the history given by the
patient. The health care practitioner will ask questions to understand when
the headache began, learn about the quality, quantity, and duration of the pain,
and ask about any associated symptoms. The history of tension headache will
include pain that is mild to moderate, located on both sides of the head,
described as a tightness that is not throbbing, and not made worse with activity.
There will be no associated symptoms like nausea, vomiting, or light sensitivity.
The physical examination, particularly the neurologic portion of the
examination, is important in tension headaches because it should
be normal to make the diagnosis. The only exception is that there may be some
tenderness of the scalp or neck muscles. If the health care practitioner finds an
abnormality, then the diagnosis of tension headache would not be considered
until the potential for other types of headaches have been investigated.
How are tension headaches treated?
Tension headaches are painful, and patients may be upset that the
diagnosis is "only" a tension headache. Even though it is not life-threatening, a
tension headache can affect the activities of daily life.
Most people successfully treat themselves with over-the–counter (OTC) pain
medications to control tension headaches. The following work well for most
people:
If these fail,
other supportive treatments are available. Recurrent headaches should be a
signal to seek medical help. Massage, biofeedback, and stress management can all
be used as adjuncts to help with control of tension headaches.
It is important to remember that OTC medications, while safe, are medications
and may have side effects and potential interactions with prescription
medications. It always is wise to ask your health care practitioner or pharmacist if you
have questions about OTC medications and their use. This is especially important
with OTC pain medications, because patients use them so frequently.
It is important to read the listing of ingredients in OTC pain medications. Often
an OTC medication is a combination of ingredients, and the second or third
ingredient may have the potential for drug interaction or contraindication with
medications a patient is currently taking. For example:
Some OTC medications
include caffeine, which may trigger rapid heartbeats in some patients.
In night
time preparations, diphenhydramine (Benadryl) may be added. This may cause
drowsiness, and driving or using heavy machinery may not be appropriate when
taking the medication.
Other examples where caution should be used include the following:
Aspirin should not be used in children and teenagers because of the risk of
Reye's Syndrome, a disease where
coma, brain damage, and death can occur
if there is a
viral like illness when the and aspirin is used.
Aspirin and ibuprofen are irritating to the stomach and may cause bleeding.
They should be used with caution in patients who have
peptic ulcer disease or
who take blood thinners like warfarin (Coumadin) and
clopidogrel bisulfate
(Plavix).
Acetaminophen, if used in large amounts, can cause
liver damage or failure.
It should be used with caution in patients who drink significant amounts of
alcohol or who have liver disease.
One cause of chronic tension headaches is overuse of medications for pain.
When pain medications are used for a prolonged period of time, headaches can recur as the
effects of the medication wear off. Thus, the headache becomes a symptom of
the withdrawal of medication (rebound headache).
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Sinus infection (sinusitis) signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
A brain tumor can be either benign (non cancerous) or malignant (cancerous), primary, or secondary. Causes and risk factors include age, gender, family history, and exposure to chemicals. Symptoms range from headaches, leg and feet numbness to seizures. Treatment is dependant upon the type and location of the brain tumor.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
MRSA (methicillin resistant Staphylococcus aureus) bacteria causes skin infections with the following signs and symptoms: cellulitis, abscesses, carbuncles, impetigo, styes, and boils. Normal skin tissue doesn't usually allow MRSA infection to develop. Individuals with depressed immune systems and people with cuts, abrasions, or chronic skin disease are more susceptible to MRSA infection.
Allergic rhinitis symptoms include an itchy, runny nose, sneezing, itchy ears, eyes, and throat. Seasonal allergic rhinitis (also called hay fever) is usually caused by pollen in the air. Perennial allergic rhinitis is a type of chronic rhinitis and is a year–round problem, often caused by indoor allergens, such as dust, animal dander, and pollens that may exist at the time. Treatment of chronic rhinitis and post nasal drip are dependant upon the type of rhinitis condition.
Menstrual cramps (pain in the belly and pelvic area) are experienced by women as a result of menses. Menstrual cramps are not the same as premenstrual syndrome (PMS). Menstrual cramps are common, and may be accompanied by headache, nausea, vomiting, constipation, or diarrhea. Severity of menstrual cramp pain varies from woman to woman. Treatment includes OTC or prescription pain relief medication.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Lyme disease is a bacterial illness, which is spread by ticks when they bite the skin. Initially the disease affects the skin causing a reddish rash associated with flu-like symptoms. It takes weeks to months after the initial redness of the skin for its effects to spread throughout the body. Lyme disease can be treated with antibiotics. Lyme disease can be prevented by using tick avoidance techniques.
An upper respiratory infection is a contagious infection of the structures of the upper respiratory tract, which includes the sinuses, nasal passages, pharynx, and larynx. Common causes of an upper respiratory infection include bacteria and viruses such as rhinoviruses, group A streptococci, influenza, respiratory syncytial, whooping cough, diphtheria, and Epstein-Barre. Examples of symptoms of upper respiratory infection include sneezing, sore throat, cough, fever, and nasal congestion. Treatment of upper respiratory infection are generally with OTC medication and home remedies.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Dengue fever is contracted from the bite of a striped Aedes aegypti mosquito. Symptoms of dengue include headache, fever, exhaustion, severe joint and muscle pain, rash, and swollen glands. Since dengue is caused by a virus, there is no specific medicine to treat it. Treatment instead focuses on relieving the symptoms.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Temporomandibular joint disorder, or TMJ, is a disorder of the temporomandibular joint(s) that causes signs and symptoms including ear pain, bite problems, headaches, dizziness, clicking sounds in the jaw, tinnitus and/or locked jaws. Behaviors or conditions that can lead to TMJ include teeth grinding or clenching, fingernail biting, habitual gum chewing, trauma to the jaw, stress, and occupational hazards. Treatment for TMJ may include heat, ice, a soft diet, antiinflammatory medications, physical therapy, stress management, occlusal therapy, correction of bite abnormalities, and surgery.
Norovirus infection causes stomach flu, or gastroenteritis. It's a very contagious illness with symptoms that include nausea and vomiting, diarrhea, stomach cramps, fever, headache, chills, and muscle aches. Norovirus infection cannot be treated with antibiotics, so treatment focuses on maintaining proper hydration.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
The common cold (viral upper respiratory tract infection) is a contagious illness that may be caused by various viruses. Symptoms include a stuffy nose, headache, cough, sore throat, and maybe a fever. Antibiotics have no effect upon the common cold, and there is no evidence that zinc and vitamin C are effective treatments.
Glaucoma is a common eye condition in which the fluid pressure inside the eye rises because of slowed fluid drainage from the eye. If untreated, glaucoma may damage the optic nerve and other parts of the eye, causing the loss of vision or even blindness.
Typhoid fever is an illness caused by the Salmonella typhi bacteria. The illness is contracted by ingesting the bacteria in contaminated water or food. Symptoms include headaches, fever, diarrhea, lethargy, aches and pains, and poor appetite. Treatment focuses on killing the Salmonella bacteria with antibiotics.
Brain aneurysm (cerebral aneurysm) is caused by microscopic damage to artery walls, infections of the artery walls, tumors, trauma, drug abuse. Symptoms include headache, numbness of the face, dilated pupils, changes in vision, the "worst headache of your life," or a painful stiff neck. Immediate treatment for a brain aneurysm is crucial for patient survival.
Pregnancy symptoms vary from woman to woman. There are some symptoms that are more frequent in some women. These symptoms include a missed period, nausea, vomiting, bloating, weight gain, headaches, food cravings, and mood changes.
Coxsackie viruses may be divided into two groups. Type A causes hand, foot, and mouth disease and conjunctivitis, while type B causes pleurodynia. Both types sometimes cause meningitis, myocarditis, and pericarditis. There is no specific treatment for this disease.
Leptospirosis is an infectious disease caused by bacteria. The illness progresses in two phases. Symptoms in the first phase include headache, muscle aches, eye pain with bright lights, chills, and fever. Symptoms in the second phase begin after a few days of feeling well and include fever, aches, and a stiff neck. Some people develop meningitis and abdominal pain.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
A tension headache is a headache previously thought to be caused by contraction of the muscles in the back of the neck, on the scalp, and sometimes in the jaw. The term tension-type headache is now preferred, reflecting the fact that research has shown that these headaches may not be related to muscle tension.
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