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HeadWay, Issue #045 -- Tension-type Headache
April 21, 2007

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In this month's issue:

Headache classification - part 2

Gabapentin for migraine

Say what?! Horner's syndrome

Headache classification - part 2

Today we're going to talk about tension-type headache, the second in our series of headache classifications. But first, a few more words about classifying headaches.

Why do we classify headaches and migraines? For one thing, it gives us some common ground for conversation. We can be clear about what we're talking about - if we all use different terms for the same things we can get confused very quickly.

After the last newsletter, one reader wrote saying that he felt that the classification put the focus on the wrong things. If there are hundreds of headaches in the classification, are there really hundreds of causes?

One major purpose of the system is to find the best treatment as quickly as possible. No one is suggesting there are hundreds of causes. However, everyone reacts to treatment differently, and sometimes your symptoms can help us know which treatment will work for you.

Finally, remember that many of these types of headache are very rare. Most people get the same or similar types of headache, and so similar treatments actually may work for the vast majority. There are usually basic treatments you should try before getting into the more obscure ones.

Tension-type headache

Tension-type headache (TTH) has also commonly been called regular headache, tension headache, or stress headache. This is the most common headache - most people (not all) seem to get one in a lifetime. It can be very serious, and it has a large impact on society.

It was once believed that most of these headaches were a result of your emotional or mental state of mind. That may be true of some headaches, but there is mounting evidence that many have a neurobiological basis. Strangely enough, in spite of how common TTH is, it's the least studied type, and we really don't understand them very well.

A lot of the time, a headache is considered to be TTH in part because it doesn't fit anywhere else - it doesn't have a known cause, for example. But there are some specific symptoms that generally come with this type of headache:
  • Bilateral - it's not just on one side of the head
  • Pressing/tight pain - it's not a throbbing pain
  • Not aggravated by physical activity
  • Generally mild-moderate pain
  • Nausea is rare
  • Usually you're not sensitive to light or sound. Maybe one or the other bothers you, but not both

  • A TTH typically lasts anywhere from 30 minutes to a week. There are exceptions, such as in chronic tension-type headache, where, at worst, the pain may be continuous.

    Tension-type headaches are often closely related to the muscles in the head, neck and shoulders. Though we don't fully understand the cause of TTH, focusing on these muscles often leads to a good treatment.

    In spite of the familiar "Take two aspirins and call me in the morning" approach, drugs are not the first best treatment for TTH. There are a number of non-drug treatments and lifestyle adjustments that be even more effective in the short and long term.

    Read a summary of tension headache at the website.

    Check out the The International Classification of Headache Disorders here, courtesy of the Migraine Aura Foundation.

    Gabapentin for migraine

    Some of you have sent in success stories at the HeadWay MailRoom (you can leave your comments and ideas here too - your password is nomoache).  I read all your comments, even though I can't answer them all personally.  Thanks so much!

    Anyway, these stories often go like this:  I tried this drug and that drug and everything else too.  Then a doctor or someone got me to try [drug, natural supplement or treatment].  And finally, I've seen amazing improvement!

    This story has two morals.  (1) Keep trying!  There's always something to try, there's always hope.  (2) Just because you've tried a drug of a certain type doesn't mean no drugs of that type are going to work.  Sometimes something just slightly different can make all the difference.

    David from Canada recently wrote about Gabapentin:  I have had migraines for about the last 25 years.  Over that time, I have tried so many medicines, herbals, oils, meditations, name it, I've tried it ... About a year ago, my MD suggested a new medicine ... I am taking Gabapentin ... I think that they have eliminated about 75 - 80% of my migraines.

    David's not the only one who has found relief from Gabapentin.  Commonly known as Neurontin, this is an anticonvulsant.  Many anticonvulsants have been used as migraine preventatives - I've tried some, and you may have too.  I wrote briefly about Neurontin (commonly misspelled as Norontin) back in 2005, but here are a few more details...

    There is evidence that Gabapentin is effective for some migraineurs.  For example, this study published in 2001 showed a significant reduction in migraine attacks.  Common side effects include dizziness and sleepiness.  Some people find the side effects minor or non-existent, others will not be able to take the drug, or will need a reduced dose.

    Always take this drug under the supervision of a doctor.  There have been concerns about Neurotonin relating to depression and suicide.  People with liver or kidney disease also need to use special caution.

    Say what?!  Horner's syndrome

    Horner's syndrome is named after Swiss ophthalmologist Johann Friedrich Horner, who described the syndrome in 1869.  The result of Horner's syndrome is the drooping of the upper eyelid (ptosis) among other eye and facial symptoms.  Horner's syndrome has been related to cluster headache, where drooping eyelid is a common symptom.  Read more about Horner's syndrome here.
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