How it feels
The picture is so typical that the diagnosis in most cases is made by questioning, without any research. The pain is described with the same words: squeezes, presses, pulls, “as if you were wearing a tight hat” or “pulled with a hoop.” The attack lasts from half an hour to several days, and the person usually continues to work, although with difficulty.
- Double-sided: covers the forehead, temples and back of the head, rather than just one half of the head
- Squeezing or pressing, but not pulsating
- Mild to moderate in strength - usually allows you to continue your usual activities
- Not aggravated by normal physical activity such as walking or climbing stairs
- No nausea or vomiting; There may be either increased sensitivity to light or sound, but not both
- Often accompanied by tension and soreness in the muscles of the neck, back of the head and shoulder girdles
- Duration - from 30 minutes to 7 days
There are two forms, and the difference between them is fundamental for treatment. Episodic form - attacks less than 15 days a month; here it is enough to deal with the provocateurs and, if necessary, take painkillers. Chronic form - headache 15 or more days a month for at least three months; it already requires preventive treatment, and it almost always involves excessive use of analgesics.
Migraine or tension headache: how to differentiate
These two conditions are constantly confused, and they are treated differently, so distinguishing between them is important from a practical point of view. Below is a comparison based on key characteristics. By answering these questions about his pain, a person in most cases determines the type on his own.
- Location: for migraines, most often one half of the head, for tension headaches - both sides, with a hoop
- Character: in case of migraine it is pulsating, in case of tension headache it is squeezing and pressing
- Strength: for migraines, moderate or severe, interfering with work; for tension headaches, mild or moderate
- Reaction to movement: migraine worsens from walking and climbing stairs, tension headache - no
- Nausea and vomiting: typical for migraine, no tension headache
- Light and sound: with migraines, both usually interfere, with tension headaches - no more than one thing
- Duration: migraine 4–72 hours, tension headache 30 minutes to a week
- Precursors: with migraines, about a third have an aura - visual flashes, zigzags, numbness; tension headaches do not have an aura
- Behavior: when you have a migraine, you want to lie down in the dark and quiet; when you have a tension headache, many feel better by walking and moving.
An important caveat: one person can have both types at the same time, and this is more common than people think. Typically, the background is a tension headache, and against its background, distinct migraine attacks periodically occur. It is also useful to distinguish between them: drugs for migraine relief for tension headaches work worse, and prevention in these two cases is structured differently.
Overuse headache: when medication becomes the cause
This is the most important part of the topic and at the same time the least known. Headache caused by excessive use of painkillers develops according to a simple mechanism: frequent use of analgesics changes the functioning of pain systems, the pain threshold decreases, and the headache begins to hurt more often. The person responds to this by increasing the frequency of reception, the circle closes. A daily background is formed, which is felt most strongly in the morning and is removed with another pill - not for long.
- Simple painkillers: risk occurs when taken 15 or more days per month
- Combination drugs, codeine drugs, triptans, ergot drugs: lower threshold - 10 or more days per month
- It’s the timing that’s critical: this regimen lasts for 3 months or longer.
- The days taken are counted, not the number of tablets: one tablet every day is more dangerous than five tablets once a week
- Typical picture: headache almost every day, worse in the morning, the nature of the pain blurs
- Combination drugs with caffeine and codeine create a problem especially quickly.
Treatment consists of stopping the drug that caused it, and here you need to be prepared for an unpleasant stage. In the first 1-2 weeks after withdrawal, the headache usually gets worse, nausea, irritability and sleep disturbances may appear. It is at this stage that most people return to pills, concluding that “you can’t live without them.” In fact, this is a natural period, after which the condition noticeably improves, and in a significant proportion of people the headache returns to its previous, rare form. The cancellation is planned together with the doctor: at the same time they prescribe preventive treatment and think about how to relieve pain during the transition period.
Neck, monitor and muscles
The connection to the neck in this type of headache is real, but it is commonly misunderstood. The culprit is not a “bad neck” or the notorious osteochondrosis, changes in which are found in almost all adults, regardless of the presence of a headache. The culprit is long-term static tension in the muscles of the neck, back of the head and shoulder girdle, which occurs in an uncomfortable position and does not go away for hours.
- The top third of the monitor should be at eye level: looking down at the laptop screen pushes the head forward and puts strain on the neck
- The head pushed forward greatly increases the load on the neck muscles - they work as a counterweight
- A smartphone on your lap and a “neck tilted down” - the same problem in an even more pronounced form
- Break every 45–60 minutes: stand up, make a few movements with your shoulders and neck, look into the distance
- Support for the forearms when working at a table relieves the load on the shoulders
- The pillow should support the neck, not elevate the head: too high increases morning pain
- Nighttime teeth clenching and chewing muscle tension are a common and overlooked source of temple pain.
- Regular aerobic exercise reduces the frequency of attacks better than local neck exercises
Massage, heat and stretching exercises do provide relief and should not be avoided. It is only important to understand their place: this is a way to relieve current tension, and not a treatment for the cause. A course of massage without changing the workplace and regime gives an effect for a couple of weeks, after which everything returns - not because the massage is bad, but because the conditions that create tension have not gone away.
What helps: attack treatment and prevention
Tactics depend on frequency. For rare attacks, one-time measures and working with provocateurs are sufficient. With frequent and chronic forms, preventive treatment plays the main role, and painkillers, on the contrary, have to be strictly limited by the number of days per month.
- При редком приступе: простое обезболивающее в адекватной дозе, принятое сразу, а не после нескольких часов терпения, — так требуется меньшая доза.
- Установить лимит: не более 10 дней приёма обезболивающих в месяц, и записывать эти дни в дневник.
- Убрать провокаторы: недосып, пропуски еды, обезвоживание, длительная неподвижная поза, избыток кофеина и его резкая отмена.
- Регулярная аэробная нагрузка не менее трёх раз в неделю — один of самых доказанных способов снизить частоту приступов.
- Работа со стрессом: техники релаксации, дыхательные упражнения, при возможности — когнитивно-поведенческая терапия, которая при хронической форме показала хорошие результаты.
- При хронической форме врач назначает профилактическую терапию курсом на несколько месяцев; эффект оценивают не раньше чем через 4–6 недель.
- Treatment сопутствующих тревоги и депрессии — при хронической головной боли они встречаются часто и поддерживают её.
It is worth adjusting in advance to the fact that preventive treatment does not work instantly. The goal is not the complete disappearance of pain from the first week, but a reduction in the number of pain days by approximately half, and it makes sense to evaluate the result based on the diary for a month, and not on the sensations in a couple of days. Premature cancellation “because it doesn’t help” is the most common reason for failure.
Are examinations necessary?
If the presentation is typical, neurological examination is normal and there are no warning signs, neither computed tomography nor magnetic resonance imaging is required. This is not saving money or refusing help: research in such a situation almost always turns out to be normal or reveals random findings that are not related to pain, but become a source of long-term anxiety and unnecessary procedures.
- A neurologist's examination and detailed questioning reveal more than any image
- Headache diary for 4 weeks - the most informative “research” for this complaint
- Measuring blood pressure: the connection between headaches and blood pressure is greatly exaggerated, but you need to check
- Complete blood count, if temporal arteritis is suspected in the elderly - indicators of inflammation
- TSH, hemoglobin and ferritin - anemia and thyroid disorders may contribute to headaches
- Vision testing and fundus examination if pain is associated with screen work
- Visualization - for any of the alarming signs, for changes in the usual nature of pain and for increasing pain
It is worth dispelling another persistent belief - that headaches are caused by “neck vessels” or changes in the cervical vertebrae found in the image. Almost every adult has such changes, including those who never have a headache, so by themselves they do not explain anything. Treatment built around them consumes time and money, but the frequency of attacks does not change.
