It's 5:00 p.m. and your boss has just asked you to
prepare a 20-page briefing paper. Due date: tomorrow.
You're angry and tired and the more you think about
the assignment, the tenser you become. Your teeth
clench, your brow wrinkles, and soon you have a
splitting tension headache.
Tension headache is named not only for the role
of stress in triggering the pain, but also for the
contraction of neck, face, and scalp muscles brought
on by stressful events. Tension headache is a severe
but temporary form of muscle-contraction headache.
The pain is mild to moderate and feels like pressure
is being applied to the head or neck. The headache
usually disappears after the period of stress is
over. Ninety percent of all headaches are classified
as tension/muscle contraction headaches.
By contrast, chronic muscle-contraction headaches
can last for weeks, months, and sometimes years. The
pain of these headaches is often described as a
tight band around the head or a feeling that the
head and neck are in a cast. "It feels like somebody
is tightening a giant vise around my head," says one
patient. The pain is steady, and is usually felt on
both sides of the head. Chronic muscle-contraction
headaches can cause sore scalps - even combing one's
hair can be painful.
In the past, many scientists believed that the
primary cause of the pain of muscle-contraction
headache was sustained muscle tension. However, a
growing number of authorities now believe that a far
more complex mechanism is responsible.
Occasionally, muscle-contraction headaches will
be accompanied by nausea, vomiting, and blurred
vision, but there is no preheadache syndrome as with
migraine. Muscle-contraction headaches have not been
linked to hormones or foods, as has migraine, nor is
there a strong hereditary connection.
Research has shown that for many people, chronic
muscle-contraction headaches are caused by
depression and anxiety. These people tend to get
their headaches in the early morning or evening when
conflicts in the office or home are anticipated.
Emotional factors are not the only triggers of
muscle-contraction headaches. Certain physical
postures that tense head and neck muscles - such as
holding one's chin down while reading - can lead to
head and neck pain. So can prolonged writing under
poor light, or holding a phone between the shoulder
and ear, or even gum-chewing.
More serious problems that can cause
muscle-contraction headaches include degenerative
arthritis of the neck and temporomandibular joint
dysfunction, or TMD. TMD is a disorder of the joint
between the temporal bone (above the ear) and the
mandible or lower jaw bone. The disorder results
from poor bite and jaw clenching.
Treatment for muscle-contraction headache varies.
The first consideration is to treat any specific
disorder or disease that may be causing the
headache. For example, arthritis of the neck is
treated with anti-inflammatory medication and TMD
may be helped by corrective devices for the mouth
and jaw.
Acute tension headaches not associated with a
disease are treated with analgesics like aspirin and
acetaminophen. Stronger analgesics, such as
propoxyphene and codeine, are sometimes prescribed.
As prolonged use of these drugs can lead to
dependence, patients taking them should have
periodic medical checkups and follow their
physicians' instructions carefully.
Nondrug therapy for chronic muscle-contraction
headaches includes biofeedback, relaxation training,
and counseling. A technique called cognitive
restructuring teaches people to change their
attitudes and responses to stress. Patients might be
encouraged, for example, to imagine that they are
coping successfully with a stressful situation. In
progressive relaxation therapy, patients are
taught to first tense and then relax individual
muscle groups. Finally, the patient tries to relax
his or her whole body. Many people imagine a
peaceful scene - such as lying on the beach or by a
beautiful lake. Passive relaxation does not
involve tensing of muscles. Instead, patients are
encouraged to focus on different muscles, suggesting
that they relax. Some people might think to
themselves, Relax or My muscles feel warm.
People with chronic muscle-contraction headaches
my also be helped by taking antidepressants or MAO
inhibitors. Mixed muscle-contraction and migraine
headaches are sometimes treated with barbiturate
compounds, which slow down nerve function in the
brain and spinal cord.
People who suffer infrequent muscle-contraction
headaches may benefit from a hot shower or moist
heat applied to the back of the neck. Cervical
collars are sometimes recommended as an aid to good
posture. Physical therapy, massage, and gentle
exercise of the neck may also be helpful.
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