Benjamin Wedro, MD, FACEP, FAAEM
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.
In this Article
- Headache facts
- What is a headache?
- How are headaches classified?
- What are primary headaches?
- What are secondary headaches?
- What are cranial neuralgias, facial pain, and other headaches?
- What causes tension headaches?
- What are the symptoms of tension headaches?
- How are tension headaches diagnosed?
- How are tension headaches treated?
- What causes cluster headaches?
- What are the symptoms of cluster headaches?
- How are cluster headaches diagnosed?
- How are cluster headaches treated?
- Can cluster headaches be prevented?
- What diseases cause secondary headaches?
- How are secondary headaches diagnosed?
- What are the exams and tests for secondary headaches?
- When should I seek medical care for a headache?
- Headache & Migraine Triggers - Slideshow
- A Visual Guide to Migraine Headaches - Slideshow
- Take the Headaches Quiz!
- Headaches FAQs
- Find a local Neurologist in your town
How are tension headaches diagnosed?
The key to making the diagnosis of any headache is the history given by the patient. The health care professional will ask questions about the headache to try to help make the diagnosis. Those questions may include learning about the quality, quantity, and duration of the pain, and asking about any associated symptoms. The person with a tension headache will usually complain of 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 to make the diagnosis, it should be normal. However, there may be some tenderness of the scalp or neck muscles. If the health care professional finds an abnormality on neurologic exam, then the diagnosis of tension headache should be put on hold while the potential for other causes of headaches has 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 make daily activities more difficult to accomplish. Most people successfully treat themselves with over-the–counter (OTC) pain medications to control tension headaches. The following work well for most people:
- ibuprofen (Motrin, Advil),
- acetaminophen (Tylenol), and
- naproxen (Aleve).
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 a health care professional or pharmacist if one has questions about OTC medications and their use. This is especially important with OTC pain medications, because they are used 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 listed ingredient may have the potential for drug interaction or contraindication based upon a patient's other medical issues 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 sedation, and driving or using heavy machinery may not be appropriate when taking a sedative 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 life threatening complication that may occur when a viral infection is present and aspirin is taken.
- Aspirin, ibuprofen, and naproxen are irritating to the stomach and may cause intestinal bleeding. They should be used with caution in patients who have peptic ulcer disease or who take blood thinners like warfarin (Coumadin), dabigatran (Pradaxa), clopidogrel bisulfate (Plavix), and prasugrel (Effient).
- Overuse of aspirin, ibuprofen, and naproxen also may cause kidney damage.
- 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 (This is classified as a secondary headache when the pain is due to the withdrawal of a medication [rebound headache].).
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