By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
At one point or another, we’ve all had a tension headache, also known as a stress headache. Sometimes you can feel them building, and other times they hit you out of nowhere.
The fall season, in particular, can be a ripe time for them, when rapidly shortening days and holiday social events, shopping, and travel add an extra degree of difficulty to already strenuous schedules.
Here’s some advice on how to cope with them so you don’t miss a beat.
Tension Headache Symptoms
Often, patients will describe tension headaches as a band of pressure across the center of the forehead, and/or on both sides. If you’ve heard someone say (or have said yourself), “My head feels like it’s in a vise,” that’s a good way of describing stress headache pain.
Stress headaches also can be defined by what they’re not.
For example, tension headaches don’t affect just one side of the head, they don’t cause throbbing, and they aren’t associated with nausea, dizziness, or changes in vision. If you’re experiencing those symptoms, you’re more likely having a migraine headache or a cluster headache—not a stress headache.
(Sudden, significant pain on one side of the head may also be a sign of stroke. Be sure to check for other stroke symptoms before assuming it’s just a headache.)
What Causes Tension Headaches?
The specific mechanism of action behind tension headaches has yet to be pinpointed. At one time, we thought these headaches were the result of excess muscle tension in the head, neck, and shoulders. Evidence now points toward the extra-sensitization of certain pain pathways in the nervous system.
What we do know are some of the factors that can bring on a stress headache—poor posture, dehydration, lack of sleep, and of course, stressful situations. We also know that stress headaches tend to affect women more than men.
Are Stress Headaches Dangerous?
Occasional—or episodic—stress headaches are nothing to worry about. Chronic stress headaches (defined as more than 15 in a 30-day period), on the other hand, raise some red flags.
In addition to the lost work time and overall lower quality of life they cause, chronic stress headaches are a sign that that you may be pushing too hard and creating conditions in the body that lead to damaged arteries.
Even at low levels, the fight-or-flight response elevates blood pressure and causes the release of adrenaline, cortisol, and other stress hormones. Ongoing exposure to those hormones has an inflammatory effect in the blood and can lead to atherosclerosis and the advancement of cardiovascular disease.
A study published in the journal Neurological Sciences showed that people with untreated chronic stress headaches show higher levels of oxidative stress than people who had no headaches or whose headaches were treated.
Natural Ways to Relieve Stress Headaches
One of the best ways to get relief from headache pain is to simply take a break from whatever you’re doing. If you’re sitting at a desk and staring at a computer, then get up, go outside, and take a walk. If you’re constantly on your feet, sit down and rest. Once you’re feeling more relaxed, close your eyes and focus on your breath. Just a few minutes of quiet meditation can help ease tension.
Here are a few more tips for preventing stress headaches:
Check your diet.
Stress—particularly holiday stress—can make us sloppy with what we eat. Stay focused on healthy fats and antioxidant-rich fruits and vegetables, and steer clear of sugar. Foods rich in magnesium are helpful for stress headaches, since magnesium helps regulate the ability of our muscles and arteries to relax.
Yoga, tai chi, meditation, prayer, and other relaxation techniques.
There is some evidence that headache sufferers may have higher levels of anxiety than non-sufferers, and it’s even been suggested that antidepressant medication can be an effective treatment. I certainly don’t generally recommend going the route of an antidepressant, but this does point to a need to more consciously balance the mind and body. Find a routine for reducing stress that works for you, and make it a priority.
Chiropractic, massage, acupuncture, and other physical therapies.
A meta-analysis published in 2015 found that collectively, these treatments were just as effective as drugs at reducing the frequency, intensity, and duration of tension headaches over the long term. Chiropractic and massage/trigger point therapy, in particular, have been shown to be most effective when combined.
Improve your posture.
If you try a physical therapy, one thing your practitioner is likely to emphasize is posture. Studies have linked both forward head position and myofascial trigger points (points of unusual muscle tension) to stress and tension headaches. Whether standing, walking, or sitting, keep your shoulders back and chin tucked in.
Drink more water.
Even mild dehydration can cause headaches. Research shows that increasing your fluid intake by one liter a day can reduce the intensity and duration of headaches.
Get enough sleep.
Do you often wake up feeling tired? Or have trouble falling asleep or staying asleep? Studies suggest that disturbed sleep—including insomnia and obstructive sleep apnea—is a risk factor for developing tension and stress headaches. If you suspect this could be the source of your headaches, learn more about options for getting a better night’s sleep. You also might consider signing up for a sleep study.
Declare a moratorium on electronic devices.
Tablets, phones, laptops—put them away for 24 hours, if you can. Less screen time means less chance for eyestrain, which has been identified as a potential cause of headaches. If you’re sensitive to EMF, disconnecting also will help balance the body.
Grounding, or Earthing, helps regulate the autonomic nervous system, which helps turn off the fight or flight response. It also helps reduce inflammation that occurs as a result of stress. If you live in a warm climate, walk barefoot outside; if not, try sleeping grounded on a specially designed grounding sheet.
What Not to Do for Stress Headaches
It’s tempting to cope with headache pain by popping a few ibuprofen or other over-the-counter pain relievers. I have no problem with doing that so long as your headaches are infrequent. But if you’re having more than one a week, I’d recommend looking at other solutions.
Consistent use of NSAIDs, such as ibuprofen and naproxen (Advil, Motrin and Aleve), can cause gastric bleeding and increases the risk of liver damage. Moreover, Harvard University’s long-running Nurses Health Study has linked the daily use of both NSAIDs and acetaminophen (Tylenol) with an increased risk of developing high blood pressure.
Regular use of headache medications also can lead to a phenomenon called “rebound headache.” When you’ve adapted to having consistently high levels of a medication in your system and then you stop taking it, symptoms can recur—or “rebound”—more severely.
Finally, don’t be tempted to fix your headaches by drinking. One drink may relax you temporarily, but greater alcohol consumption—particularly the binge-type drinking that many people indulge in around the holidays—puts you at greater risk for holiday heart syndrome. Limit yourself to one beverage, and take care of your headache with other natural alternatives.
References and Resources:
- Bendtsen L, et al. Muscles and their role in episodic tension-type headache: implications for treatment. Eur J Pain. 2016 Feb;20(2):166–75.
- Chiu YC, et al. Tension-type headache associated with obstructive sleep apnea: a nationwide population-based study. J Headache Pain. 2015 Apr 21;16:34.
- Engstrøm M, et al. Sleep quality, arousal and pain thresholds in tension-type headache: a blinded controlled polysomnographic study. Cephalalgia. 2014 May;34(6):455–63.
- Espí-López GV, et al. Effect of manual therapy techniques on headache disability in patients with tension-type headache. Randomized controlled trial. Eur J Phys Rehabil Med. 2014 Dec;50(6):641–7.
- Espi-Lopez GV, et al. The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. a randomized controlled clinical trial. Eur J Phys Rehabil Med. 2016 Oct;52(5):606-617. Epub 2016 Mar 18.
- Fernández-de-Las-Peñas C, Cuadrado ML, and Pareja JA. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache. 2007 May;47(5):662–72.
- Gökçe Çokal B, et al. Serum oxidant and antioxidant status of patients with chronic tension-type headache: possible effects of medical treatment. Neurol Sci. 2015 Oct;36(10):1771–5.
- In This Issue of Archives of Internal Medicine. Frequency of Analgesic Use and Risk of Hypertension in Younger Women. Arch Intern Med. 2002;162(19):2160. doi:10.1001/archinte.162.19.2160
- Linde K, et al. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587.
- Mesa-Jiménez JA, et al. Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia. 2015 Dec;35(14):1323–32.
- Rains JC, Davis RE, and Smitherman TA. Tension-type headache and sleep. Curr Neurol Neurosci Rep. 2015;15(2):520.
- Schwartz BS, et al. Epidemiology of tension-type headache. JAMA. 1998 Feb 4;279(5):381–3.
- Spigt MG, et al. Increasing the daily water intake for the prophylactic treatment of headache: a pilot trial. Eur J Neurol. 2005 Sep;12(9):715–8.
© Stephen Sinatra, MD. All rights reserved.