Tension headaches (TTH) are the most common type of headache. According to various sources, 30-78% of people worldwide suffer from them, while the more well-known migraines are observed only in 8-20%. They are most often observed in women over 20 years of age, although they are often found even in schoolchildren. But it is extremely rare for the first time that HDN occurs after 50 years of age.
Tension headaches are the primary forms of headaches or cephalgia and are not caused by organic changes in the brain and blood vessels. But, despite the benign origin, pain in the head significantly limits a person, reduces his performance and quality of life in general. Therefore, no less than other types of cephalgia, it requires consultation with a neurologist and competent treatment.
Previously, tension-type headaches were considered a psychogenic disorder and were called muscle tension pain or stress cephalalgia. But studies have shown that they still have a neurobiological origin.
Causes of painful symptoms
If a patient complains that he has a neck pain and nausea, and also feels dizzy (when walking or at rest), doctors first need to understand the causes of the condition and make the correct diagnosis.
Osteochondrosis of the cervical spine
The most common cause of dizziness, accompanied by nausea and pain, is osteochondrosis of the cervical spine. During his life, a person constantly makes various movements, which means his body is almost constantly under stress. The spine absorbs the load, and over the years this leads to the fact that its individual elements wear out and gradually begin to lose their function. The cartilaginous structures (intervertebral discs) that are present in the cervical and other parts of the spine gradually lose moisture and become fragile and thin. This is called osteochondrosis. The vertebrae and intervertebral discs altered by osteochondrosis begin to irritate the paired vertebral artery, which supplies the brain, hence dizziness (together with nausea). Neck pain is caused by the fact that the distance between the spinal disc and the vertebral body becomes smaller, and they gradually begin to compress the spinal nerves.
Vascular diseases
If your neck hurts and nausea appears, these symptoms may be associated with problems of the vascular system. A general disruption of the functioning of blood vessels leads to the fact that blood moves through them at a reduced speed, and in some segments the blood even stagnates. Consequently, normal nutrition of all organs and systems of the human body ceases. For poor blood supply to the brain, dizziness and nausea, headaches that radiate to the cervical region are quite typical.
Metabolic diseases
Neck pain and nausea are symptoms that can occur due to a general metabolic disorder in the human body. Such diseases include diabetes mellitus, hypertension, atherosclerosis and other pathologies that lead to the gradual accumulation of harmful substances in the human body.
Traumatic disorders of the spine and head
The cause of neck pain, instability in movement or at rest can also be a spinal injury. If the structure of the vertebrae is damaged (especially the most fragile ones, which are located in the cervical region), every movement of a person can be accompanied by pain. Dizziness occurs due to the fact that damaged vertebral structures interfere with normal blood supply to the brain.
Vegetative-dystonic syndrome
A separate group of causes that provoke dizziness and neck pain includes vegetative-vascular dystonia.
. This is a complex disease that is associated with a violation of the vascular tone of the autonomic nervous system. Dizziness and neck pain are symptoms that appear along with irregular heartbeat, pressure surges, pale face, fainting, etc.
How do tension headaches manifest?
With tension-type headache, the head hurts on both sides in the temples, back of the head, and crown area. The pain itself is pressing or squeezing in nature, but not pulsating. They rarely become strong and painful. Most often, the pain is mild or moderate in intensity. Patients often describe their sensations as “squeezing the head with a hoop,” “girdle pain around the temples,” “pressing pain, like a helmet or helmet.” They may occur:
- in the morning immediately or shortly after waking up, persist throughout the day, often alternately weakening and gaining intensity;
- in the afternoon, especially after suffering stress, anxiety or performing particularly strenuous work, a long stay in a forced uncomfortable position that provokes overstrain of the muscles of the neck and head (most often when working at a computer, machine tool, driving a car, etc.).
The attack begins gradually, although with serious emotional shock it can develop abruptly. It may be accompanied by:
- decreased appetite;
- deterioration of health when staying in a noisy and crowded room;
- a feeling of pressure in the eyes;
- a feeling of stiffness of the head and movements with it;
- unpleasant sensations when combing hair or wearing a hat;
- sleep disturbance, insomnia due to pain in the head that persists even at night.
But HDN does not completely deprive a person of working capacity, although it has a negative effect on it. Also a characteristic feature of tension headaches is an improvement in the condition when experiencing positive emotions, during pleasant activities, rest, and relaxation. In some cases, even switching attention from one task to another, more pleasant one, leads to a decrease in the severity of pain in the head.
When a headache occurs, some patients notice transient or permanent discomfort, a feeling of tension in the back of the head, the back of the neck and the shoulders. Sometimes the muscles in these areas are so tense that outright pain occurs. This is called “coat hanger” syndrome and is mainly caused by prolonged stay in a static position with a bowed head. The severity of muscle tension increases as the intensity and frequency of headache attacks increases.
Tension headaches differ from migraines in the absence of a sensation of pulsation, the bilaterality of the process, as well as the absence of nausea, vomiting, severe photophobia and intolerance to loud sounds. Although sometimes it is still possible to experience slight increased sensitivity to light and sounds.
Chronic tension headaches are somewhat more severe. Although the attacks occur with the same symptoms, their high frequency exhausts the person. This affects not only his ability to perform daily duties, but also affects his psychological state, causing irritation, increased anxiety, sleep disturbances, melancholy, and depressive disorders. All this together significantly reduces the patient’s quality of life.
TTH needs to be differentiated from headaches due to vegetative-vascular dystonia (VSD). In the latter case, in addition to a headache, patients note dizziness, a feeling of palpitations, increased sweating of the palms, trembling hands, tingling in the chest, difficulty breathing, or only some of these symptoms. With VSD, presyncope or even loss of consciousness is often observed.
Diagnostics
Since the causes of dizziness are varied, the methods for diagnosing the disease may also vary. First of all, to exclude or confirm metabolic diseases, the patient is prescribed a blood test (general, clinical, sugar, or other), as well as other standard tests that every person has taken at least once in the clinic. If there are injuries, an X-ray of the area of the spine where the injury is located must be taken. MRI may also be prescribed to study the internal bone structures and soft tissue structures of the cervical spine.
or
ultrasound
.
During the initial examination, the doctor (this may be a therapist
,
neurologist
,
surgeon
,
traumatologist
or other specialist) conducts a visual examination and palpation to understand whether the pain intensifies when pressing on the affected area.
What causes dizziness
If we separately consider such a symptom as dizziness, we can distinguish two main causes. The first is a disruption of brain function. The second is a disruption of the vestibular apparatus. The mechanism of dizziness can be described as follows:
- information about the location of the body in space enters the brain from the vestibular apparatus through the nerve endings of the peripheral nervous system;
- this information is processed and transferred to the balance center, which is located in the temporal lobes of the brain.
If the process of transmitting information about the location of the body in space is disrupted at any stage, the person is likely to feel dizzy. A violation can occur for any of the reasons listed above - vascular malfunction, injury, metabolic disorder, and so on.
How to treat headaches and neck pain
The treatment method for neck pain and dizziness directly depends on what caused the appearance of such symptoms. Doctors may prescribe painkillers, anti-inflammatory drugs (tablets or gels for topical use). Medicines are also prescribed to restore blood flow, blood pressure, and metabolism. In some cases, physiotherapeutic procedures, massage, and exercise therapy are effective. Any treatment must be under the supervision of a physician. Sometimes, if there is no effect, it can be adjusted or supplemented. To get help from a qualified doctor, contact the Energo clinic. This is where specialists work who have extensive experience in treating spinal injuries, vascular, metabolic and other disorders of the human body.
Treatment of tension headaches
Treatment tactics for tension-type headache are determined individually by a neurologist. The doctor takes into account the frequency of attacks, their strength, the presence of concomitant disorders, and the psychological state of the patient. With frequent episodic and chronic tension-type headaches, an integrated approach is always required, designed to break the links in the vicious circle of pain development and normalize both the psycho-emotional state of the patient and eliminate excessive muscle tension and the pain itself.
When developing treatment tactics, the neurologist is guided by the following fundamental principles:
- treatment and prevention of emotional and personal disorders, which include not only depressive disorders, but also increased anxiety, various phobias, somatoform diseases, etc.;
- treatment and prevention of muscle tension;
- eliminating or preventing the occurrence of drug abuse.
Therefore, patients with tension headaches are recommended not only drug therapy, but also non-drug methods, in particular psychotherapy, therapeutic massage and manual therapy, physical activity, especially visiting the pool, yoga, etc.
When prescribing treatment, the patient must be explained the nature of headache attacks and focus on the role of emotional factors, as well as excessive tension in the muscles of the head and neck. Therefore, it is very important to learn to avoid such undesirable influences, that is, try not to enter into conflicts, react more calmly to various life circumstances, and also take regular breaks from work, and if it involves a long stay in a static tense position.
If a patient notices a decrease in visual acuity, eye strain while working at a computer, reading, etc., he needs to consult an ophthalmologist. If indicated, glasses are prescribed, which must be worn to avoid visual strain.
Drug therapy
Pharmacotherapy for tension-type headache includes not only painkillers, which should be taken to relieve an attack, but also a number of other drugs aimed at eliminating muscle spasms and normalizing the psycho-emotional state. All of them are selected strictly individually, taking into account concomitant pathologies and other features. Most often, patients are prescribed:
- sedatives - help calm, eliminate anxiety, some increase drowsiness, which allows you to normalize sleep with their help, but limits use in the morning and during the day;
- antidepressants – used to treat depression, help improve mood, eliminate anxiety, irritability, emotional stress, improve sleep quality;
- neuroleptics - indicated for severe forms of mental disorders, mania, phobias, as they suppress psychomotor agitation and emotions;
- muscle relaxants - indicated when signs of overstrain of the pericranial muscles and their soreness are detected, including those that arise or increase with palpation;
- anticonvulsants – help to deeply eliminate muscle spasms and stabilize the emotional state;
- botulinum toxin injections - used in some cases with severe overstrain of the pericranial muscles.
The duration of treatment for tension headaches is at least 3 months. In most cases, the course takes 4 months, less often it is extended to 6 months. If you stop therapy earlier, the likelihood of attacks returning with the same intensity increases sharply.
If tension headaches are combined with migraines, β-blockers, calcium channel blockers, etc. are additionally prescribed.
To relieve an attack, it is recommended to take painkillers, in particular NSAIDs and combination drugs. This:
- paracetamol (Panadol, Efferalgan);
- ibuprofen (Nurofen, Imet, Mig);
- nimesulide (Nimesil, Nise);
- diclofenac (Voltaren, Diclak, Ortofen);
- ketoprofen (Artrum, Ketonal, Flamax, Flexen);
- ketorolac (Dolak, Ketanov, Ketocam, Ketolac);
- combined (Spazmalgon, Sedalgin-neo, Solpadeine).
But the main rule for using analgesics is to use them no more than 10 times a month! This is necessary to avoid the development of drug abuse and resulting headaches. But such drugs should be used with great caution in the presence of diseases of the gastrointestinal tract, in particular gastritis, gastric and duodenal ulcers. Oral drugs from the NSAID group have an irritating effect on the mucous membranes of the gastrointestinal tract, i.e. they have an ulcerogenic effect. This can provoke an exacerbation of chronic gastroenterological pathologies and cause abdominal pain of varying degrees of intensity.
Even with rare attacks of tension headaches, patients with gastrointestinal diseases should consult a doctor for an individual selection of an anesthetic drug.
The following also help reduce pain:
- resting with a damp towel over your eyes in silence in a dark room;
- warm shower or bath;
- massage of the neck and temples.
Psychotherapy
Since tension-type headaches are very often associated with disorders and instability of psychological state, it is recommended to consult a psychotherapist and follow his recommendations. Individually selected psychotherapeutic techniques help eliminate the main trigger for the development of attacks or reduce its impact on a person’s well-being.
In particular, cognitive behavioral therapy has proven itself to be effective for tension headaches. It is based on the principles of cognitive and behavioral therapy and allows you to learn to detect, objectively evaluate and respond more correctly not only to external stimuli, but also to your own thoughts. As a result of regular practices, a person develops new, more advanced ways of behavior, which are subsequently transformed into full-fledged behavioral models and no longer require such careful self-control and self-analysis.
Massotherapy
Massage therapy is an effective and safe way to relax and treat tension headaches. It has virtually no contraindications and can be performed even during pregnancy and children.
During therapeutic massage, a specialist acts on the muscles of the back and neck, which leads to increased blood circulation, accelerated metabolism, and also helps to improve the functioning of the nervous system and eliminate stagnant processes. A qualified doctor can achieve complete relaxation of overstrained muscles of the collar zone, and the positive emotions experienced by the patient during the session lead to the release of endorphins and the elimination of psychological stress.
At the same time, competent impact on the pericranial muscles allows you to speed up the process of their recovery and increase the elasticity of the fibers, which allows you to eliminate chronic spasm and quickly achieve improved well-being. This also makes it possible to eliminate irritation of the nerves by compressed muscles and avoid chronic headaches. Additional positive properties of therapeutic massage are increased performance and improved sleep quality.
In his work, the specialist uses various methods of influence, including stroking, rubbing, kneading and vibration. Their use in an individually determined order and force allows you to obtain a pronounced effect, noticeable after the first session.
Manual therapy
Therapeutic massage and manual therapy are not the same thing, and the main difference between these methods is the depth of impact and the techniques used. For HDN, both methods can be used both together and separately.
Manual therapy involves deep work on muscles, joints and ligaments, in particular the spinal column. It is indicated even in the absence of spinal pathologies, and if they are present, it is irreplaceable. Such a high importance of manual therapy is explained by the fact that the work of all organs depends on the condition of the spinal cord and the spinal roots extending from it, which are protected by the spine. Therefore, influencing it and restoring the correct position of the vertebrae, intervertebral discs, eliminating the slightest deformations with additional training of the muscles of the back and neck helps to improve the functioning of all organs, well-being, mood and reduce anxiety.
Manual therapy of the back and neck is especially important when diagnosing osteochondrosis that accompanies tension-type headaches or is the cause of their occurrence. It also allows you to overcome muscle-tonic syndrome and completely break the vicious circle of pain.
In other cases, post-isometric relaxation (PIR) and so-called craniosacral manual therapy are recommended. PIR is a method of soft, gentle influence. Thanks to its use, it is possible to achieve maximum relaxation and stretching of the muscles in the affected area, increasing their elasticity and, accordingly, eliminating pain.
Craniosacral therapy involves influencing the bones of the skull and working on the vertebrae of the cervical spine. As a result of competent and extremely careful actions of a specialist, it is possible to improve or even completely normalize the blood supply to the brain, which is especially important in case of vertebral artery syndrome. But, more importantly for patients suffering from headaches, craniosacral therapy makes it possible to eliminate attacks, including migraines, and also improve a person’s cognitive abilities. All this has an extremely positive effect on the patient’s performance and psychological state, which is the key to a progressive reduction in the frequency of attacks and their intensity.
Moreover, manual therapy can be performed even on pregnant women and children.