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
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.
Many scientists believe that the primary cause of the pain of
muscle-contraction headache is sustained muscle tension. Other
studies suggest that restricted blood flow may cause or contribute
to the pain.
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
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 muscle relaxants and 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
Nondrug therapy for chronic muscle-contraction headaches
includes biofeedback, relaxation training, and counseling. A
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
, 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.
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,
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.