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Tension-type and medication-overuse headaches

This factsheet is for people who would like information about tension-type and medication-overuse headaches. It does not discuss migraines or headaches that are caused by illness or injury. For more information, please see the separate BUPA factsheet, Migraine.

Headaches can be a common symptom of many conditions, and almost everyone will experience headaches at some point in their life. Usually these are not serious and will improve without any treatment.

• Tension-type headaches
• Causes
• Symptoms
• Chronic headaches
• Medication-overuse headaches
• Symptoms
• Diagnosing your headaches
• Treatment
• Further information
• Sources

Tension-type headaches

These used to be known as "tension headaches", but the accepted medical term is tension-type headaches because tension is not always a clear cause. Tension-type headaches are the most common type of headache, affecting around three-quarters of people in any one year.

Causes

It's often not clear what causes tension-type headaches. Anxiety and stress are often associated with these types of headaches, but do not necessarily cause them. Tension-type headaches are twice as common in women as in men. They are more common in people whose parents, brothers or sisters also have headaches. They are also more common in people who are not physically active. Sometimes poor posture can cause tension-type headaches.

Symptoms

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, including your scalp, jaw or neck

The pain is not pulsating and you don't usually feel sick, although you may be sensitive to light or noise. You might find everyday activities difficult but you can carry on. The headache will probably not get worse when you are active, for example when you walk up stairs. The headache can last from half an hour to a week. Doctors define occasional headaches of this type as episodic.

Chronic headaches

About 4 in 100 people suffer from chronic headaches. A chronic headache is where someone has the headache on 15 or more days per month. These may be chronic tension-type headaches.

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. You should have an eye examination at least every two years, unless you have been advised otherwise.

Sometimes, chronic headaches can be caused by taking medicines to treat other headaches (such as tension-type or migraine) too often. This is called a medication-overuse headache.

Medication-overuse headaches

People who get frequent headaches often regularly take painkillers, perhaps in an attempt to prevent a headache coming on. But the overuse of painkillers for headaches reduces their effectiveness and can cause further headaches, known as rebound or withdrawal headaches, or medication-overuse headaches. Up to 2 in 100 people get medication-overuse headaches. Women are five times more likely than men to get them.

Medication-overuse headaches can develop 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 (eg Naramig) and ergotamine (eg Migril)

Symptoms

A medication-overuse headache may develop after you have had migraines or tension-type headaches for several years and 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 then
• gets worse when you are active
• may vary over time, sometimes getting worse, and move around the head
• gets worse if you stop taking the painkillers
• probably won't make you feel sick

Diagnosing your headaches

Most people don't visit their doctor 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). Also seek medical advice if you get a sudden, severe headache, unlike any you've had before; if the pain is worst when you wake up; if your headache follows a head injury or if it's accompanied by any of the following symptoms:

• stiff neck
• fever and rash
• confusion
• paralysis
• numbness
• visual disturbances
• slurred speech
• behaviour changes

Your GP will diagnose your headache after listening to you describe your symptoms and doing a physical examination.

You will be referred to a specialist, such as a neurologist, if your GP is concerned that your headaches are caused by an underlying illness or injury.

Treatment

Treatment depends on the type of headaches you have.

Occasional tension-type headaches

For most people, tension-type headaches get better on their own, without any treatment. But it's a good idea to look at any factors that may be causing your tension-type headaches to prevent them becoming chronic and reduce the risk of developing medication-overuse headaches.

Staying active, with 30 minutes of moderate physical activity 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. For more information, please see the separate BUPA health factsheets, Stress and Stress in the workplace.

Occasional (less than twice a week) headaches can usually be treated with over-the-counter painkillers. Don't take medicines that contain codeine, as these are more likely to cause dependence and overuse. Ask your pharmacist for advice and always follow the instructions about dosage.

Chronic tension-type headaches

If your doctor thinks you have chronic tension-type headaches, he or she may prescribe a medicine called amitriptyline. This is an anti-depressant drug that's 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.

Another option is cognitive behavioural therapy (CBT) from a trained therapist. Alternatively, your GP may refer you to a pain clinic or a neurologist - a doctor specialising in conditions that affect the nervous system.

Medication-overuse headache

It is important that you stop taking the painkillers that are causing the problem, even though your headache will get worse at first. You may also feel sick, vomit and have problems sleeping. These withdrawal symptoms can last seven to 10 days.

Your GP may suggest that you take an NSAID such as ibuprofen, as long as this is not the cause of your medication-overuse headaches. He or she may prescribe a medicine called amitriptyline if your headaches are the result of overuse of anti-inflammatory painkillers.

During your treatment it's important that you don't take any other over-the-counter painkillers.

Further information

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

Sources

• Headache. Prodigy Guidance, 2005.
  www.prodigy.nhs.uk/headache
  accessed 14 December 2006
• Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalagia 2004; 24 Supplement 1
• Management of tension-type headache. British Association for the Study of Headaches, 2004
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd edition. Oxford University Press, 2006

Published by BUPA's health information team, healthinfo@bupa.com, February 2007.

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