"Sometimes I get so pumped up, I get a headache. I get woozy. I get dizzy. I like that feeling, I don't know why."
Torii Hunter  

       Tension headache account for 90% of headaches, knowing about symptom and management can keep you from overreacting to simple headache, in this blog I will explain the symptom, pathophysiology (mechanism) and how to manage tension headache.Moreover I will discuss alarming symptom which need urgent medical attention. 

  

Symptoms  

     Dull headache (not specific to certain area) not sharp, feels like band like mainly in frontal area, usually it is mild to moderate severity, it doesn’t affect regular activities. Often headache started at the end of the day and there is obvious precipitating factor.
The majority of people who suffer from tension headaches have recurrent episodes, around 1 or 2 times per month on average.

Pathophysiology (mechanism)
  Evidence support that it is muscular in origin due to sustain contraction of muscles of the cranium, in another words muscles of head and neck region, actually It used to called muscular contraction headache but The International Headache Society (IHS) renamed it as tension headache or tension-type headache.

                                    

Causes

  The most common cause is Emotional stress tress, patient usually developed headache at the end of the day (after work). Other common cause would be poor posture like taking a nap with more tension on your cranium muscles then you wake up with headache. Alcohol, eyes strain, dray eyes, cold\flue and upper respiratory tract infection like Sinusitis all can precipitate tension headache.
Depression generally associated with tension headache. But this doesn’t mean that we need to think about depression it anyone came with tension headache.
Some studies showed that patient with chronic tension headache have weak neck extension muscle which play major rule as a cause. 

Treatment

                   

     Better to treat according to severity. If headache is mild it is better to just relax, mussels tension will be relived in about hours. But if it is moderate over counter analgesic would be fine.
Symptomatic medication (to relive pain)
NSAID is superior to Paracetamol (Acetaminophen)
Ibuprofen: Drug Of Choice for mild to moderate headache
Naproxen: for moderate to severe headache
Aspirin and Other NSAID (ketoprofen, ketorolac,,,)can be used but chronic (long term) use of Analgesic can lead to Headache. What headache treatment can cause headache? Yes Medicine is complicated.
Medication overuse headaches: is known complication caused by chronic use of high dose Aspirin, NSAIN or Paracetamol.
NB: Pregnant women should only take medication under medical supervision, doctor should prescribe all medication even analgesic (Some NSAID can hurt the fetus).
 

Alternative Medicine
Relaxation techniques: like massage and meditation can improve chronic tension headache.
Acupuncture: might be useful for those who suffer chronic tension headache. 

                                                  

Alarming symptom:
This symptoms need immediate medical attention, Not always mean there is serious disease, it just need a doctor to evaluate.     

1 - Fever & headache always need to be investigated, do not hesitate giving some time and effort to see a doctor.
2 - Severe headache more in the morning and associated with Visual symptoms like decrease in visual equity or dark spot.
3 - Severe headache in one side and associated with awkward sensation before started (Aura) like distorted vision, though, food craving, feel stiff, yawing more than usual and other, if it is recurrent in same pattern usually suggest Migraine headache
4 - If headache associated with other Neurological symptoms, like weakness in arm or leg, numbness sensation or loss of sensation in any part of the body.
5- If it severe headache that disturb your simple ordinary activity or it is continued for another day you need to visit a doctor. 

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Senior medical resident at King Fahad specialist hospital
Bachelor in Medicine & surgery from University of El Imam El Mahdi
Diploma in Family medicine - Sudanese center for medical training ( SCMT ) 
Partial membership of royal collage of physician of United Kingdom (MRCPUK part1)
Partial membership of royal collage of physician of Ireland (MRCPI part1)
passed United States medical licencing examination - USMLE (passed step 2 CK)