This is the first post of a three-part series dealing with the most frequently asked questions about migraine and headache, based on the Karger publication “Migräne & Kopfschmerzen. Ein Fachbuch für Hausärzte, Fachärzte, Therapeuten und Betroffene” (“Migraine & Headache. A Reference Book for General Practitioners, Specialists, Therapists and Persons Concerned”).

This article provides answers to six frequently asked questions about tension headaches.


Migraine & Headaches (source: iStock)


Tension headache or migraine?

Tension headaches are usually dull and pressing; migraine headaches are usually strong and pulsating. There are exceptions in both cases, so the accompanying symptoms are the key differentiator.


How do tension-type headaches typically manifest themselves?

When it comes to the perception of tension-type headaches, the rule is that the pain is constant, moderately severe, and distributed over the entire head. However, pulsating and disabling pain also occurs. The most important distinguishing feature from migraine is the complete absence of accompanying symptoms such as nausea, vomiting, hypersensitivity to light, noise, and smell. Tension headache (also often referred to as tension-type headache) can be briefly summarized as “pure headache”. Tension headache is the most common type of headache of all and occurs as an attack headache, but also as a chronic, constant daily headache.


Are neck tensions the cause of tension headache?

Neck tension is rather rarely a cause of headache. Similar to migraine, it is often difficult to distinguish whether the neck tension is the cause of the headache or whether it is merely an accompanying pain in the neck. Tension headaches can be divided into those with and those without muscular tension in the head and neck region. However, this distinction does not seem to help in terms of cause or treatment.


When do we speak of chronic tension headaches?

The term “chronic” is ambiguous: On the one hand, it refers to the duration of the headache, i.e., at least three months; on the other hand, it is much more significant how many days per month a headache is present, i.e., at least 15 days per month.


What favors the development of tension headache?

In the foreground is an individual tendency to react to internal and external stimuli with headaches, migraines or tension headaches. These are often an expression of overload, self-inflicted as well as externally inflicted. Typically, tension headaches develop during the day, indicating increasing fatigue. This is aggravated by sleep problems, depressive moods and psychosocial problems. If sleep problems, alcohol consumption, medication overuse are suspected as causes, they are so-called secondary headaches.


How often may one take tablets for tension headaches?

“May” implies, on the one hand, medical limits in the use of tablets, but also, not insignificantly, socio-psychological rules and a kind of moral prescription. Medical limits for “may” would be, for example, that paracetamol should not exceed the daily total of four grams per day, because otherwise this exceeds the capacity of the liver to break down paracetamol. Frequently exceeding four grams per day can cause severe liver damage. Or, depending on individual predisposition,  acetylsalicylic acid can cause spontaneous bleeding and stomach problems. The triptans, however, know no such critical side effects. With “may” in the socio-psychological sense is also connected a kind of bad conscience and fear (e.g. of addiction and dependence).

Apart from side effects probably all attack medications can lead to medication overuse headache (MOH), if a certain number of takings per month occurs. One speaks of MOH with pain medicines and related medicines starting from 15 tablets or administrations per month, while with triptans already starting from 10 applications per month.


Information based on “Migräne & Kopfschmerzen. Ein Fachbuch für Hausärzte, Fachärzte, Therapeuten und Betroffene” (Karger, 2015).

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