Tension headaches are typically diffuse, mild to moderate in intensity, and are often described as feeling like a “tight band” around the head. Tension headache (TTH) is the most common type of headache, yet the causes of this type of headache are still not well understood.
Treatment for tension headaches is quite effective. Management of tension-type headaches is often a balance between a healthy lifestyle, the use of non-drug treatments, and adequate drug treatment.
Symptoms
Symptoms of tension headaches include:
- Dull, aching headache
- A feeling of “tightness” or pressure in the forehead or sides of the head and at the back of the head
- Soreness of the scalp, neck and shoulder muscles
Tension headaches fall into two main categories - episodic and chronic.
Episodic tension headaches
Episodic tension headaches can last from 30 minutes to a week. Episodic tension headaches occur on fewer than 15 days per month for at least three months. Frequent episodic tension headaches can become chronic.
Chronic tension headaches
This type of tension headache lasts several hours and may be continuous. If headaches occur 15 or more days per month for at least three months, they are considered chronic.
Tension headaches and migraines
Tension headaches can sometimes be difficult to distinguish from migraines. Additionally, if a patient has frequent episodic tension-type headaches, they may also have migraines.
Unlike some forms of migraine, tension headaches are usually not accompanied by blurred vision, nausea, or vomiting. And if during migraines physical activity increases the intensity of the headache, then during headaches stress loads do not have such an effect. Increased sensitivity to any light or sound can sometimes occur with tension headaches, but these symptoms are uncommon.
Types of headaches after exercise
Doctors distinguish two types of headaches after exercise.
1. Pain that occurs as a reaction to intense exercise.
They are called primary pain, and they can appear in absolutely healthy people. “Primary headaches are usually harmless, not associated with diseases, and they can be dealt with simply by taking medication or changing the intensity of exercise,” comments Fedor Mikhnevich, family doctor at GMS Clinic .
This type of headache often feels throbbing and occurs during or after vigorous exercise. This is usually bilateral pain - for example, a pounding sensation in your temples after an intense run.
“Most often, this symptom occurs from high-intensity running, cardio or plyometric exercises (these are exercises that simultaneously increase muscle strength, overall endurance and burn the maximum amount of fat),” says Grigory Zhezha, doctor of exercise therapy and sports medicine at the SportMedica clinic. .
2. Pain that is associated with chronic diseases.
They are called secondary. “They are caused by health problems: related to the brain (bleeding, tumor), or extra-cerebral (for example, diseases of the arteries of the heart). Secondary headaches may require emergency medical care,” notes Fedor Mikhnevich.
Secondary headaches feel similar to primary ones, but are often accompanied by other symptoms: vomiting, loss of consciousness, double vision, excessive tension in the back of the neck muscles. “Initial headaches can occur within five minutes of starting a workout, but do not last particularly long. Secondary ones will torment you for at least a day, and sometimes for several days after the load,” comments Fedor Mikhnevich.
“The reasons why headaches develop after physical exercise can be different,” explains Konstantin Makhinov, a neurologist at the European Medical Center (EMC) . — These can be both life-threatening conditions (subarachnoid hemorrhage) and attacks of existing pain syndromes (migraine). More often, as a rule, attacks of benign pain develop, but you shouldn’t let your guard down either.”
Causes
The causes of tension headaches are not known. Medical experts believed that tension headaches occur due to problems in the muscles of the face, neck and scalp, which in turn are caused by strong emotions, excess exertion or stress. But research shows that muscle spasm is not the cause of this type of headache.
The most common theories hold that there is an increased sensitivity to pain in people who have tension headaches and perhaps have an increased sensitivity to stress. Increased muscle soreness, a common symptom of tension headaches, may be a result of increased overall pain sensitivity.
Triggers
Stress is the most common trigger that causes tension headaches.
Risk factors
Risk factors for tension headaches include:
- Gender. Women are more likely to get this type of headache. One study found that nearly 90 percent of women and 70 percent of men experience tension headaches during their lifetime.
- Average age of the patient. The incidence of tension-type headaches peaks around age 40, although these headaches can develop at any age.
Complications
Due to the fact that headaches can be quite common, they can significantly affect work productivity and overall quality of life, especially if they become chronic. Frequent pain can disrupt your usual lifestyle and overall performance.
Preventing headaches after exercise
Proper training is the key to good health. Don't want to get a headache after class? Follow these doctor's recommendations:
- Avoid exercising in hot, humid or high altitudes if you are prone to exercise-related headaches.
- Add aerobic exercise. “I recommend cardio training, which is aimed at strengthening the heart muscle. With such exercises, blood pressure does not increase much, the pulse remains within normal limits and does not cause hypertrophy of the heart muscle. Thus, if a person feels bad after a workout, it means that the load is high for him, and he needs cardio training. To test their effectiveness, there are stress tests, for example, the Martinet-Kushelewski test is an assessment test that determines the ability of the cardiovascular system to tolerate stress and recover from exercise. It shows whether the training has positive dynamics,” says Grigory Zhezha.
- Breathe correctly: at a calm pace, without delay. Make the main effort while exhaling.
- Don't skip your warm-up. “It stimulates the heart rate and gives time to the blood vessels to prepare for further activity,” says Fedor Mikhnevich.
- Drink more liquid! “Drink at least 200ml of water before and after a run or workout to stay hydrated. Water helps saturate the body’s cells with oxygen,” adds Fedor Mikhnevich.
- Prepare properly for class. “Before a fitness class, follow the general rules: do not eat heavy food less than 2 hours before training. Ideally, you should approach the lesson after sufficient sleep and in good health,” sums up Julia Hazime.
By following these recommendations, you will reduce your risk of post-workout headaches.
Diagnostics
The diagnosis of tension-type headache is primarily based on medical history and symptoms and neurological examination.
The doctor may be interested in answers to the following questions:
- When did the symptoms begin?
- Has the patient noticed any triggers, such as stress or hunger?
- Were the symptoms continuous or episodic?
- How severe are the symptoms?
- How often do headaches occur?
- How long did you last have a headache?
- What does the patient believe reduces symptoms and what increases symptoms?
In addition, the doctor is also interested in the following details:
- Characteristics of pain. Is the pain throbbing? Is the pain dull, constant or sharp?
- Pain intensity. A good indicator of headache severity is the amount of time a patient can work during a headache attack. Can the patient work? Are there any episodes where the headache led to awakening from sleep or sleep disturbance?
- Localization of pain. Does the patient feel pain throughout the entire head, only on one side of the head, or just in the forehead or eye sockets?
Instrumental examination methods
If a patient has unusual or intense headaches, the doctor may order additional testing to rule out more serious causes of the headaches.
The two most commonly used diagnostic methods are CT (computed tomography) and MRI, which allow visualization of organs and tissues and detection of morphological changes.
Treatment
Some patients with tension headaches do not see a doctor and try to treat the pain on their own. Unfortunately, repeated self-use of painkillers can itself cause severe headaches.
Drug treatment
There are a wide variety of medications, including over-the-counter ones, that can help relieve pain, including:
- Painkillers. Simple over-the-counter pain relievers are usually the first line of treatment for headaches. These include aspirin, ibuprofen (Advil, Motrin IB, others), and naproxen (Aleve). Prescription medications include naproxen (Naprosyn), indomethacin (Indocin), and ketorolac (ketorolac tromethamine).
- Combined drugs. Aspirin or acetaminophen or both, often combined with caffeine or a sedative in one medicine. Combination medications may be more effective than medications with a single active ingredient.
- Triptans and drugs. For people who have both migraines and tension-type headaches, triptans can provide effective headache relief. Opiates, or narcotics, are rarely used due to their side effects and high risk of addiction.
How to get rid of pain
If you experience headaches while doing physical work, sports, or simple household activities, you should consult a specialist and undergo a thorough examination to eliminate the risk of brain hemorrhages and not miss the development of tumors. If the culprit is frequent spasms and disruptions in the autonomic regulation of brain vessels, you can learn to cope with the problem without medications. Center M.S. Norbekova suggests taking health restoration courses, which teach special gymnastic exercises and figurative practices that help normalize vascular tone.
Prophylactic drugs
Other medications may be prescribed to reduce the frequency and severity of attacks, especially if the patient has frequent or chronic headaches that are not relieved by pain medications.
Preventive medications may include:
- Tricyclic antidepressants. Tricyclic antidepressants, including amitriptyline and nortriptyline (Pamelor), are the most commonly used medications to prevent the development of tension headaches. Side effects of these drugs may include weight gain, drowsiness, and dry mouth.
- Other antidepressants. There is evidence that antidepressants such as venlafaxine (Effexor XR) and mirtazapine (Remeron) are effective in patients who are not depressed.
- Anticonvulsants and muscle relaxants. Other medications that may prevent tension headaches from developing include anticonvulsants such as topiramate (Topamax) and muscle relaxants.
Lifestyle adjustments and home remedies
Rest, ice packs, or long, hot showers can often reduce the intensity of headaches.
Non-drug treatment
- Acupuncture. Acupuncture may provide temporary relief from chronic tension headaches.
- Massage. Massage can help reduce stress and relieve tension. It is especially effective for relieving muscle spasms in the back of the head, neck and shoulders.
- Deep breathing, biofeedback and behavioral therapy. A variety of relaxation treatments are very helpful in treating tension headaches, including deep breathing and biofeedback.