Dear Doctor Garner,
Almost every day, around 4 p.m., I get a headache. It is not unbearable, but is getting to be pretty annoying. I have a very stressful job, working for the MTA, and my new boss is very difficult to work for, to say the least.

My wife says that I have tension headaches, which seems to make sense. Is there really such a thing as tension headaches? More importantly, is there anything that can be done to help stop them? My doctor has done many tests and they are all normal.

We love your column, and look forward to it each week. Please help!
Horrible Headaches in Hillcrest
 
Dear Horrible Headaches,
Most definitely there is an entity known as tension headaches. It is actually the most common type of headache there is. I was just talking about this subject with my very good friend, Mr. Jon Kelley, from The Prayer Channel.

The pain of a tension headache has been described as a tight band around the head. It also may cause discomfort in the back of the neck. People usually experience moderate pain not usually accompanied by nausea or vomiting.

The headaches can last from 30 minutes to several days.

The pain may start in the morning, perhaps in anticipation of a stressful day ahead, or later in the day, from either work stress, or conflict that is anticipated at home.

Some people experience fatigue and irritability, as well as loss of appetite and difficulty concentrating and sleeping.

Unlike migraine headaches, they are not usually accompanied by visual problems.

It was commonly believed until recently that the pain was caused by muscle contractions in the face, neck and scalp, due to tension or stress.

The most recent research exposes this as myth.

The tension headache is related to a change in chemicals in the brain. One of the effects of this imbalance is to tighten muscles, but the pain itself, is related to the chemical imbalance.

The change in chemistry activates pain pathways to the brain and interferes with the brain’s ability to suppress pain.
 
The following is a list of some things known to cause tension headaches:

1. Stress

2. Depression and anxiety

3. Skipping meals

4. Poor posture

5. Lack of physical activity

6. Medications for other conditions such as depression or high blood pressure.

7. Hormonal changes related to menstruation.

8. Lack of sleep

9. Jaw grinding

10. Whiplash, or other types of head trauma.
 
There are a variety of treatment options available. It is a good idea to see your doctor, if the tension headaches are so severe that they disrupt your life, if there is a new pattern in your headaches,  if it is new onset after age 50, or it is associated with any numbness, speaking difficulties or double vision.
 
The most basic treatment is with medications such as Tylenol and Motrin.
As these mask the problem, and don’t really get at the root, I suggest the following:

1. Put a heat pack or ice pack on your head or neck

2. Take a hot shower

3. Get enough rest or sleep

4. Take time away from things that are stressful

5. Get regular exercise daily

6. Yoga, massage and posture classes may be extremely helpful

7. Biofeedback training can teach you to deal with stress

8. Acupuncture has been very effective in eliminating pain.

 
Finally, last, but not least, I suggest you maintain a headache diary. Keep a book in which you record everything about your headaches. What time of day did it occur? What were you doing when it came on? What were your sleep patterns and the amount of sleep you received in the days leading up to the headache? What were you doing immediately before the headache? Finally, what made the headache go away?

This information can be very helpful to you and your doctor, in better understanding your headaches, and attacking the root cause, not merely covering it up with medicine.

The good news is that with a little detective work and help from your doctor, and some relaxation techniques, such as yoga, this problem can be controlled or even eliminated.

Remember, you are not alone. Tension headaches are extremely common and 90% of women and 70% of men will experience them in their lifetimes.

 Too much stress in general is not good for your body, and treating the cause of these headaches will improve your overall health.

Thank you very much for your question and nice comments about the column.
Have a great week and stay well.