Tension headache


The tension headache is the most common type of headache. It can be roughly differentiated from cluster headache, migraine headache and drug headache.

About 90% of people experience tension headaches over the course of their lives - women are a little more likely to be affected. It mainly manifests itself as a dull, pressing pain in the area of ​​the forehead (often in the temple area) or the neck.

Typically it occurs on both sides. A fundamental distinction is made between a frequently occurring episodic form (a maximum of 14 days a month over a period of 3 months) and a rarely occurring chronic form. A transition between the individual forms is possible.

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Causes of tension headaches

The origin of tension headaches is not fully understood. There are numerous factors that can trigger or worsen the headache. These factors can also mutually reinforce each other and, in total, lead to the development of headaches.

Tension in the head, neck and shoulder muscles is considered the most common cause of headaches. These often develop through long static postures. Bad posture can lead to tense muscles, especially when working with the computer or on long car journeys, which can lead to headaches.

The emergence of the headache can be exacerbated by other factors. Above all, this includes psychosomatic causes in which psychological problems are expressed in physical complaints. In addition to permanent stress or conflict situations, disturbed sleep can also contribute to the development of headaches. Last but not least, the influence of febrile infections on the development of headaches is also discussed.

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Tension headaches from tension

As mentioned earlier, muscle tension is the number one cause of tension headaches. Many different muscle groups in the head, neck or shoulders can be affected.

Tense neck muscles are often the cause. This is due to poor posture, such as those that occur when working continuously at the computer. In rare cases, distant, tense muscles can also contribute to the development of headaches. This is due to the fact that the muscles of the back are connected to one another and the tension in one muscle triggers a pull on the other muscles.

The permanently tense muscles activate pain receptors. As a result, these lead to headaches for the patient. At the same time, the threshold above which the patient feels pain is lowered (central awareness) - as a result, the headache intensifies if the muscles remain tense. This often creates a vicious circle, as the bad posture is exacerbated by the headache.

In addition to tense muscles, muscle weakness can also lead to these symptoms.

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Tension headache through the jaw

Another cause of tension headaches is orthodontic problems in the temporomandibular joint.

Nocturnal teeth grinding can lead to tension in the jaw muscles. At the same time, the temporomandibular joints are damaged. The pain can spread to neighboring parts of the body - among other things, it can irritate the meninges and cause headaches.

These disorders in the temporomandibular joint can have different causes.

In addition to the nocturnal teeth grinding, which is associated with psychological risk factors, incorrectly placed tooth fillings, crowns, bridges or defective dentures can also lead to these symptoms.

The symptoms often only appear very late after orthodontic surgery, as the muscles and ligaments can compensate for them for a long time.

Diagnosis of tension headaches

A tension headache is diagnosed by excluding the other types of headache (cluster headache, migraine headache, drug headache). In addition, in rare cases, depending on the patient's symptoms (neurological abnormalities?), Clarification of brain tumors and meningitis is urgently required.

The individual types of headache can be differentiated based on their intensity, their duration, their localization and the accompanying symptoms. In the case of tension headache, the patient often reports a dull and pressing pain or, in rare cases, pulling pain.

At the beginning, this occurs mainly in the area of ​​the temples and neck, before it spreads over the entire head.

The intensity of the pain is seldom so strong that the person concerned is restricted in some way at work. The duration varies greatly from patient to patient and ranges from an hour to a week. The pain is typically bilateral. At the same time there is no nausea and no vomiting. Light and noise sensitivity can occur in rare cases, but are not possible at the same time.

A headache diary is also helpful when looking for the cause and for diagnosis. Over a certain period of time, among other things, it is documented under which circumstances the headache occurs and how severe it is.

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Accompanying symptoms of tension headaches

In the context of the occurrence of tension headaches, accompanying symptoms only occur in rare cases. Instead, symptoms that are typical for migraine headache and are crucial for making a diagnosis appear.

Patients with tension headaches often report that the pain feels like wearing a hat that is way too tight. This feeling of pressure is strongest in the forehead and neck area.

In rare cases, eye involvement can also occur. Similar to the headache, the patient feels a feeling of pressure in the area of ​​the eyes. In addition, a slight sensitivity to light or noise is possible. In contrast to migraine headache, however, this cannot occur at the same time.

The accompanying symptoms can also be more pronounced, especially in the chronic course of tension headaches. In some cases, depression, sleep disorders or anxiety disorders are also possible. Drug abuse is also possible in the untreated form of chronic tension headaches.

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Eye pain as an accompanying symptom

In rare cases, the headache can also spread to the eye area. The patient feels a feeling of pressure in the area of ​​the eyes or the eye socket without being able to localize it exactly. Visual disturbances as well as lightning and lighting phenomena do not usually occur with tension headaches.

Conversely, complaints around the eyes can also lead to headaches. For example, with narrow-angle glaucoma, the intraocular pressure can rise significantly, which irritates pain receptors and causes headaches.

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Therapy of tension headaches

There are many different therapy options available for treating tension headaches. It is important to identify and avoid what triggers the headache.

This therapy of the causes is preferred to drug therapy. This includes, among other things, regular muscle training as part of physiotherapy to strengthen the muscles.

In addition, sporting activity (light endurance training) and various relaxation exercises can help improve symptoms. Training to avoid bad posture (for example at the workplace) can also alleviate tension headaches. It makes sense to keep a headache diary.

This causal treatment can be specifically supported by medication. The use of painkillers should be discussed with the attending physician.

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Drugs used to treat tension headaches

The choice of medication to treat tension headache depends on the type of headache.

Episodic headaches (less than 14 days per month over a period of 3 months) can be treated with the widely used pain relievers. In addition to aspirin and ibuprofen, these also include paracetamol.

However, it should be noted that long-term use of these drugs can also lead to headaches (drug headache) and can make them worse. For this reason, regular therapy should always be discussed with a doctor.

Chronic headaches are often treated with tricyclic antidepressants. The drug of choice is amitriptyline. The active ingredient influences the perception of pain by raising the reduced pain threshold.

However, due to the wide range of side effects, this therapy must be checked regularly by a doctor. Depending on the patient and accompanying symptoms, individual additional treatment may be necessary.

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Home remedies for the therapy of tension headaches

Tension headaches can often be alleviated with various home remedies. Basically, to avoid headaches, a sufficient amount of water (1.5 to 2 liters per day) is recommended. In addition, applying and massaging peppermint oil on the temples and neck typically leads to an improvement in symptoms. In addition, vanilla extracts are said to have a headache relieving effect.

By cooling the temples or neck, the pain signals that lead to the headache can be masked. At the same time, heat pillows can relieve tension in the muscles by increasing the blood flow. Alternatively, a warm full bath and regular sauna sessions are also suitable.

Acupuncture can often quickly lead to an improvement in the headache symptoms. The pain stimulus can be suppressed by stimulating various channels in the human body. However, the effectiveness varies from patient to patient.

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Homeopathy for the treatment of tension headaches

There are also numerous homeopathic remedies available for treating headaches. The effectiveness of these active ingredients is very different and controversial from patient to patient. If the pain persists, therapy should be discussed with the attending physician.

For strong knocking and hammering headaches, products with deadly nightshade extracts (Belladonna) recommended. Homeopathic products made from yellow jasmine are suitable for the treatment of neck headaches that are increasingly spreading to the forehead (Gelsemium).

A strong feeling of pressure in the head can be treated with iris extracts (Iris versicolor). Products containing bloodroot (Sanguinaria), are suitable for the treatment of headaches that increase in strength during the day.

For severe unilateral headaches, products with wormwort extracts (Spigelia) recommended.

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Massage for the therapy of tension headaches

A massage is ideal for releasing the tense muscles in the neck and shoulders. The individual muscles are moved and relaxed.In addition, the patient can reduce the discomfort with a light circular massage movement of the temples or neck.

Accompanying relaxation therapy and stress management training are recommended. The progressive muscle relaxation according to Jacobsen often takes place.

Application in which the different muscle groups in the body are deliberately tensed and relaxed one after the other, whereby a state of deep relaxation is to be achieved.

Sport for the therapy of tension headaches

Regular physical activity counteracts the development of tension headaches. Light endurance training (jogging, swimming, cycling) in particular can prevent the development of pain as a prophylactic measure. At the same time, physical movement counteracts tension.

In addition, through targeted training of the muscles in the head and neck area (for example as part of physiotherapy), the muscles can be strengthened in such a way that possible incorrect posture can be compensated.

How long do tension headaches last?

The duration of tension headaches differs fundamentally depending on the type of headache (episodic / chronic). In addition, there are clear differences between the individual patients.

An episodic tension headache is when the headache lasts less than 14 days a month over a period of three months.

Usually the headache will subside within a few days after starting treatment.

Headaches that occur more than 14 days a month and over a longer period of time are referred to as chronic headaches. These are difficult to treat and can take a long time depending on the patient and therapy.

Prognosis of tension headaches

The typical tension headache usually goes on well. With accompanying therapy and the avoidance of triggering factors, the headache disappears in most cases within a few days. Sometimes there is an improvement without starting treatment.

Nevertheless, a transition into the chronic form of tension headache is possible. This chronic course often results from the simultaneous occurrence of aggravating factors (stress, sleep disorders, depression). Targeted therapy can also treat this type of headache well.

Forehead headache

Since tension headaches often first manifest themselves in the area of ​​the forehead and temples, one also speaks of frontal headaches.

In addition to the tense muscles that typically trigger, pain in the forehead area can also have many other causes.

Sinus inflammation, flu infection, or nerve inflammation in the face are possible. Migraine headaches and various eye diseases in the forehead area can also manifest themselves.

To clarify the cause of headaches in the forehead area, it is essential to consult a doctor.

What should you do if you have tension headaches during pregnancy?

Due to the hormonal changes in the course of pregnancy, women often complain of headaches and body aches. These mainly occur in the first few months of pregnancy. At the same time, if possible, you should avoid taking medication during this period. In some cases, it makes sense to replace it with herbal products.

Paracetamol and ibuprofen are the first choice for the treatment of severe headaches and body aches during pregnancy.

A disruption of the baby's development could not be proven in any of the numerous studies carried out. Nevertheless, it should always be taken in consultation with the attending physician. In addition, it should be noted that ibuprofen and aspirin should not be taken after the 28th week of pregnancy, as this can lead to complications during childbirth.

In the case of mild and moderate headaches, an improvement in the symptoms may also be achieved without taking medication. Pregnant women should ensure that they sleep regularly, exercise lightly, drink a lot and eat a balanced diet. In addition, cold compresses on the forehead or temples as well as massages are useful.

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How do I tell the difference between migraines and tension headaches?

Tension headaches are usually much less severe than migraine headaches. They occur on both sides and after a short time affect the entire head. Patients report a dull and pressing pain.

Accompanying symptoms during the headache are rare. In a few patients, there is a slightly increased sensitivity to light and noise. Tension headaches are not made worse by physical activity - on the contrary, exercise can relieve this type of headache.

In comparison, migraine headaches often only occur on one side. The pain is preferably localized on the forehead, the temples or behind the eyes.

The patient feels a pulsating and sometimes pounding pain. The intensity of the pain is often very high, which severely restricts the patient's work, among other things. In addition to the headache, typical accompanying symptoms appear for migraines, which are referred to as aura. These are visual and speech disorders, some of which are very pronounced. Nausea and vomiting can also occur. In contrast to tension headaches, migraine headaches worsen with physical activity.

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