Headache (cont.)
How are tension headaches diagnosed?
The key to making the diagnosis of any headache is the history given by the
patient. The health care practitioner will ask the appropriate 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 is important in tension headaches because it has to
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.
How are tension headaches treated?
Tension headaches are painful, and often patients are upset that the
diagnosis is "only" a tension headache. Though it is not life-threatening, a
tension headache can affect daily life activities.
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 headache control.
It is important to remember that OTC medications, while safe, are medications
and may have side effects and potential interactions with prescription
medications. It is always 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 ingredient listing of 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 the 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 were 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 with a
viral like illness and aspirin use.
- 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 time, headaches can recur as the
effects of the medication wear off. Thus, the headache is a symptom of
medication withdrawal (rebound headache).
Next: What causes cluster headaches? »
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