Tension Type Headache
What is Tension-Type Headache?
Tension-Type Headache is the world’s most prevalent headache, according to the International Headache society, and research suggests it can be prevalent in 60-86% of the population [1, 2]. WHO reports suggest that Tension-Type Headaches affect a large proportion of the population episodically, however 20-30% of sufferers experience more chronic episodes [1].
Characterised by a sensation of tightening, squeezing or pressing around the head, Tension-Type Headaches affect both sides of the head at the same time. This sensation has led to the misconception that Tension-Type Headache is caused by the tightening of the muscles around the head and face. These headaches are often mild-moderate in severity, and can vary in both the length of attacks, as well as their frequency.
As opposed to migraines, nausea and vomiting are not a feature of Tension-Type Headaches, but it is possible for patients to experience sensitivity to light or sound.
What are the different types of Tension-Type Headache?
Episodic Tension-Type Headache
Episodic Tension-Type Headaches are defined by the frequency of attacks a person experiences, per month. Typically, a person who has attacks on fewer than 15 days per month, is experiencing Episodic Tension-Type Headaches [3]. These headaches tend to peak in the fourth decade of life (30-39 years) in both males and females, with a prevalence of 42% for men and 46% for women of this age. Women, on average, are most likely to experience these types of headache [3].
Chronic Tension-Type Headache
Chronic Tension-Type Headaches are when attacks are experienced more frequently. A patient is suffering from Chronic Tension-Type Headaches if they experience attacks on more than 15 days per month, for longer than a three-month period [1, 3]. As these headaches are more persistent, they can be very disabling to a person’s life. Sometimes these people can have these headaches for between 10-30 years, and they can become resistant to pain killers.
How are these different from migraines?
People who suffer from Tension-Type Headaches are often wrongly diagnosed as suffering from migraines. The key difference between the two is that Tension-Type headaches are described as a bilateral, tightening or pressing sensation around the head, whereas migraines are described as a unilateral, pulsating pain in the head or face. Tension-Type Headaches are often mild-moderate in terms of intensity, and migraines are often more severe.
Also, Tension-Type headaches will generally not get worse with normal activities and exercise, whereas these will aggravate a migraine.
So, what causes Tension-Type Headaches?
With more modern research, we now know that Tension-Type Headaches are not actually caused by a tightening of muscles around the head. In fact, EMG studies have shown that there is no increase in muscle activity in the head or face in these people at all. More recent studies are starting to identify that people who experience Tension-Type Headaches have some increased sensitisation of pain pathways in the central nervous system and brain stem [2].
Modern headache research suggests that Tension-Type Headaches arise from problems in the upper cervical spine (C1-3). These patients have been shown to have an ‘up-regulated’ Trigemino-cervical Nucleus (TCN) as part of a sensitised brain stem [3]. This sensitised brainstem then interprets information coming from nerves in the neck incorrectly, sending symptoms around the head. This pain, referred from a sensitised brainstem, is what sufferers of Tension-Type Headache patients are experiencing.
I’ve done it all, is there anything else that can help me?
It isn’t uncommon for Tension-Type Headache sufferers to have tried most treatments or therapies available, often with very limited success. A big reason why this is the case, is because most practitioners don’t attempt to identify the cause of your headaches. At The Headache & Migraine Clinic, we use the experience that we have gathered from seeing countless similar patients with Tension-Type Headache, and we utilize the most current and up-to-date research to assess, treat and correctly diagnose your headaches. By assessing the joints in your upper cervical spine and the using techniques to determine the level of sensitivity in your brainstem, we can determine if this is the cause of your Tension-Type Headache.
If this is the case, then we can start treatment right then and there. Our treatment technique doesn’t involve any medication or surgery and is completely non-invasive. We expect that 90% of the time, improvement will occur in the first 5 sessions, and our clinic’s results speak for themselves.
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What are Cluster Headaches?
Cluster Headaches are a rare type of headaches that affect around 0.1% of the population, according to the International Headache Society. While they are rare, it does affect males 3-4 times more frequently than females [1].
Despite being uncommon, Cluster Headaches are regarded as being the most severe and debilitating type of headache. Research has shown Cluster Headaches frequently described as having the highest pain levels [2], out of all 300 different types of headache and migraine. Cluster Headache attacks occur in cycles, and will often wake sufferers during the night, or at regular times during the day. Attacks generally last between 15-180 minutes, and can happen multiple times per day, or once every couple of days [1, 2]. People who suffer from Cluster Headaches generally experience periods of attacks, or “cluster periods” that can last weeks or months. These periods are then followed by periods of remission lasting weeks, months or even years. The pain is often severe, on one-side of the head, and generally around the eye and/or temple region. Cluster Headaches have adopted the nickname, ‘suicide headaches’ due to their severe and debilitating nature [2].
What are the signs and symptoms?
Cluster Headaches are often severe enough that a sufferer cannot keep still during an attack. They may pace back and forth, have to take a shower, or even resort to banging their head in an attempt to reduce the pan.
Symptoms commonly associated with Cluster Headaches include [2]:
- Severe pain around one eye, that can radiate further around the face or neck
- Restlessness, shortness of breath and/or a sweaty face
- Watery/teary eyes or eye redness
- Swollen or droopy eyelids
- Runny or congested nose
- Pale or flushed skin
- Pain is unilateral, or affects only one side
What are the different types of Cluster Headache?
There are 2 types of cluster headache.
Episodic Cluster Headache
Cluster Headaches most commonly occur episodically. This is when sufferers experience bouts of “cluster periods” that can last for weeks or months, followed by an extended period in remission that can last up to years. They can occur seasonally or at set times each year. Episodic Cluster Headaches account for up to 80% of all Cluster Headaches [1, 2].
Chronic Cluster Headache
When Cluster Headaches occur without a prolonged period of remission, they are termed a Chronic Cluster headache. Sufferers often have “cluster periods” that will last over a year. While they may have days without attacks, the remissions will not last longer than a month.
What are the risk factors?
- Men are 5-6 times more likely to experience cluster headaches
- Sufferers are generally heavy smokers
- Higher alcohol consumption may be a factor
- Cluster Headaches most commonly affect people aged 20-50, but can occur at any age
- People with family members who are sufferers may be at a higher risk
What causes Cluster Headaches?
Historically, it was believed that cluster headaches, as well as migraines, were caused by the dilation of blood vessels in the head, causing pain. This was thought because medications, like triptans, are effective at relieving the pain if taking early enough in an attack. It was believed that triptans prevent this vessel dilation. However, recent research has shown that Cluster Headache and migraine sufferers do not experience blood vessel dilation at any different levels to people who do not suffer. So, how do these medications work?
Modern research has shown that Cluster Headaches and migraines arise from increased sensitivity in the central nervous system [2], more specifically, a sensitised brainstem which is located in the upper cervical spine (the upper neck). Faults in the upper neck can lead to this sensitised brainstem, which then can refer severe pain and associated symptoms into the head and face [3]. Triptan medication has also more recently been shown to de-sensitise the brainstem [4], as well as its original purpose of constricting blood vessels in the head. This would explain why they work, as well as identifying a sensitised brainstem and the cervical spine as a cause of cluster headaches.
I've tried it all, is there anything that can help me?
While Cluster Headaches are very uncommon, they are still experienced in the Gold Coast region. The severity of symptoms causes sufferers to try a range of therapies in an attempt to resolve them, with mixed results. Often, they have tried; medications, injection therapy, or even surgical interventions such as, nerve blocks or blood vessel cauterisation.
At The Headache and Migraine Clinic, we aim to use the most modern research to find the root cause of your cluster headaches. If we can determine that a sensitised brainstem is the cause of your headaches, then we can use world-leading treatment techniques to address the faults in your neck and de-sensitise the brainstem. We have seen plenty of Cluster Headache sufferers at our clinics, and have an 85-90% success rate with our treatment technique. The best part is that it is safe, non-invasive and medication-free.
