Pain: Tension-type headaches and migraines

We all have headaches at times, most commonly what are called ‘stress’ or ‘muscle contraction’ or ‘tension-type headaches’. 

These can last from 30 minutes to several days, and are often triggered by stress, anxiety, depression, neck strain, muscle spasms, eye strain, missed meals and inadequate sleep, says headache specialist Dr Elliot Shevel of The Headache Clinic in Johannesburg.

The pain is mild to moderate – a squeezing on the front, top and sides of the head. There’s no nausea or vomiting and these headaches don’t generally get worse with physical activity, but you may have sensitivity to bright light or noise. 

They are usually nothing to worry about, says Dr Shevel. But if they persist for more than 15 days a month for three months in a row, they are called ‘chronic tension-type headaches’ and can affect your quality of life, so see your health professional. Occasionally they may be a sign of an underlying disorder such as a tumour or thyroid disease.

Tension-type headaches can develop into migraines, which are more severe and can be triggered by the likes of hormone changes around the menstrual cycle in women, and certain foods, such as citrus or chocolate. The pain is pounding or throbbing, usually on one side of the head, accompanied by sensitivity to odours as well as noise and light, with nausea and vomiting. 

Migraines can be heralded by an ‘aura’, when you see spots or lines or have problems with speech or movement, and can last from four to 72 hours unless treated.

Treatment

Most tension-type headaches respond to over-the-counter pain relief from NSAIDS (non-steroidal anti-inflammatory drugs) like ibuprofen or naproxen sodium, from paracetamol, or from aspirin (though this should not be used by anyone under 18, as it may trigger rare but dangerous Reye’s syndrome).

It’s important to read directions and take them exactly as prescribed – overuse can cause stomach pain, bleeding, ulcers, liver damage and inflammatory bowel conditions. Taking them too often can also cause rebound headaches, as your body builds tolerance and you need stronger doses, in what can become a vicious cycle, says psychiatrist Dr Shaquir Salduker, director of the Durban Pain Clinic at St Augustine’s Hospital. If you reach for pain relievers more than twice a week, speak to your health professional or pharmacist, or see a headache or pain specialist.

Opioids such a codeine, and others like ‘Trama’ drugs and ‘Oxy’ drug opiate patches, should be avoided as they can become addictive if overused. “It’s known in pain management as ‘pseudo addiction’,” Dr Salduker says.

Opioids can cause mood changes when they wear off, anxiety, restlessness and irritability, and affect cognition, concentration and memory. They’re also quite sedating so they affect your reaction time. He reports that the incidence of opiate abuse is estimated to be higher than for cannabis and cocaine, and similar to alcohol abuse. 

“We detox patients and encourage non-medical interventions with physiotherapy to help relax muscles, and have a psychologist who teaches mindfulness and helps them reframe pain using cognitive behavioural therapy (CBT). We also use alternative medication which addresses the core root cause of the pain rather than the symptom,” says Dr Salduker.

Meditation, relaxation (with deep breathing), massage and gentle neck stretches may help relieve tension headaches without medication. So may warm or cold compresses, drinking water, improving sleep hygiene (avoiding caffeine and alcohol, keeping the room dark and free of electronic gadgets). Cognitive behavioural therapy can help also manage stress.  

Migraines may not respond to OTT medication, and prescription medications, such as triptans may be required. Some health professionals prescribe antidepressants (which also act as painkillers), anti-epileptics or beta blockers, but these have may not be effective and can have unpleasant side effects says Dr Shevel. 

“What’s needed is a multidisciplinary assessment of where the pain is coming from – for example, a neurologist will examine the brain and nervous system; a physiotherapist, the muscles; and a dentist, the teeth. The team can provide a co-ordinated treatment plan so all the contributing factors are addressed,” he says. 

Get medical help at once if:

- A headache is sudden and severe and unlike any you have experienced.
- It won’t go and gets worse quickly.
- You’ve had a fall or any injury to the head or illness.
- You’ve been engaged in physical activity (running, cycling, sex).
- You also have a fever, stiff neck, rash, double vision, weakness, numbness, confusion, difficulty speaking.

You may have a serious underlying condition such as a stroke or meningitis.

Also read: Stress management techniques

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