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Tension-type and medication-overuse headaches

Published by Bupa's health information team, April 2009.

This factsheet is for people who have tension-type or medication-overuse headaches, or who would like information about them.

Headaches are a common symptom of many conditions and almost everyone will experience headaches at some point in their lives. Usually these aren't serious and improve without any treatment.

About tension-type and medication-overuse headaches
Symptoms of tension-type and medication-overuse headaches
Causes of tension-type and medication-overuse headaches
Diagnosis of tension-type and medication-overuse headaches
Treatment of tension-type and medication-overuse headaches
Further information
Questions and answers
Related topics
Sources

About tension-type and medication-overuse headaches

Tension-type headaches used to be known as "tension headaches", but the accepted medical term is tension-type headaches because tension isn't always a clear cause. Tension-type headaches are the most common type of headache. Around three to eight out of 10 people will have tension-type headaches at some point in their life. They are twice as common in women as in men. 'Episodic' tension-type headaches can last from half an hour to a week.

You may have medication-overuse headaches if you already get frequent headaches and take painkillers regularly to control them. If you use painkillers too frequently you may reduce their effectiveness and cause further headaches. Medication-overuse headaches are sometimes also known as 'rebound' or 'withdrawal' headaches. Up to two in 100 people get medication-overuse headaches. Women are five times more likely than men to get them.

About four in 100 people develop chronic headaches. A chronic headache is where someone has a headache on 15 or more days per month. These may be chronic tension-type headaches, medication-overuse headaches or migraines. Chronic refers to how often you get headaches, not to how severe they are.

Symptoms of tension-type and medication-overuse headaches

Tension-type headaches

The symptoms of tension-type headaches include:

mild to moderate (not severe) pain on both sides of your head
a feeling of tightening or pressing around your head
muscle tenderness around your head and neck

The pain isn't pulsating and you don't usually feel sick, but you may be sensitive to light or noise. Your headache probably won't get worse when you're active, and you should be able to carry on with your everyday activities.

Medication-overuse headaches

A medication-overuse headache can develop after you have had migraines or tension-type headaches for several years and have been taking painkillers regularly. You might then start to get headaches if you don't take any painkillers for a day or so.

The headache:

is usually there when you wake in the morning and may be at its worst at this time
gets worse when you're active
may vary over time, sometimes getting worse and may move around your head
gets worse if you stop taking the painkillers

These symptoms may be caused by problems other than tension-type or medication-overuse headaches. You should visit your GP for advice.

Causes of tension-type and medication-overuse headaches

It's often not clear what causes tension-type headaches. If you're particularly stressed or anxious, this may cause your headache. If close members of your family have chronic tension-type headaches, you may be more likely to have them yourself. Lack of exercise and poor posture may also make it more likely that you will develop tension-type headaches.

You can get medication-overuse headaches if you regularly take:

paracetamol (especially when combined with codeine)
NSAID (non-steroidal anti-inflammatory drug) painkillers such as aspirin and ibuprofen
migraine treatments, including the medicines called triptans, such as zolmitriptan (Zomig), opioids (eg codeine) and ergotamine combinations (eg Migril)

Diagnosis of tension-type and medication-overuse headaches

Most people don't visit their GP when they get a headache. However, it's a good idea to see your GP if:

your headaches are frequent (on more than 15 days per month)
you get a sudden, severe headache unlike any you have had before
the pain is worst when you wake up

Also seek medical advice if your headache follows a head injury or if it's accompanied by any of the following symptoms:

stiff neck
fever (high temperature) and rash
confusion
paralysis
numbness
visual disturbances
slurred speech
behaviour changes

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may refer you to a neurologist (a doctor who specialises in conditions that affect the nervous system) if he or she is concerned that your headaches are caused by an underlying illness or injury.

Frequent mild headaches at the front of the head or in the eyes may be caused by a problem with your eyes such as short-sightedness.

Treatment of tension-type and medication-overuse headaches

Self-help

If you have tension-type headaches, they may get better without any treatment. But it's a good idea to look for any factors that may be causing your headaches to prevent them becoming chronic and to reduce the risk of developing medication-overuse headaches.

Staying active by doing 30 minutes of moderate physical activity, such as walking, jogging or swimming, on at least five days per week may help. Also, try to make sure you don't get too stressed. Yoga, meditation or other stress management techniques may be helpful.

If you have chronic tension-type headaches it may be helpful to keep a diary. You could note down when the headaches occur, how bad they are and how long they last. By doing this you may notice a pattern developing of when they occur or be able to identify things that trigger them, such as stress or poor posture.

Medicines

Tension-type headaches

Occasional tension-type headaches (less than twice a week) can be treated with over-the-counter painkillers. You shouldn't take medicines that contain opioids (eg codeine) as these are more likely to cause dependence and overuse.

If your GP thinks you have chronic tension-type headaches, he or she may prescribe a medicine called amitriptyline. This is an antidepressant medicine that has been shown to be effective for headaches when taken in small doses (lower than that used to treat depression) before going to bed every night. Alternatively, your GP may refer you to a pain clinic or a neurologist.

Medication-overuse headaches

If you have medication-overuse headaches, it's important that you stop taking the painkillers that are causing the problem, even if your headache gets worse at first. You may also feel sick, vomit and have problems sleeping. These withdrawal symptoms can last between one and four weeks depending on the type of medication you're overusing.

Your GP may suggest that you take an NSAID, such as ibuprofen, as long as this isn't the cause of your medication-overuse headaches. He or she may prescribe amitriptyline if your headaches are the result of overuse of NSAIDs.

If your GP prescribes you any medicines, it's important that you don't take any other over-the-counter painkillers. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice.

Talking and complementary treatments

If you have tension-type headaches, another option is a type of talking treatment called cognitive behavioural therapy (CBT) from a trained therapist. CBT can teach you stress management and relaxation techniques, which may help you to control your headaches.

Acupuncture may relieve some of the symptoms of your tension-type headache by helping to reduce tension in your muscles. There is little evidence that this works, but it may be worth trying as an alternative treatment.

If poor posture and muscle tension are contributing to your tension-type headache, physiotherapy may help to relieve these symptoms.

Further information

International Headache Society
www.i-h-s.org