Headache caused by tension is ofthe commonest form. The pain is generally constant, tight, dull, a pressure or a feeling of band around the head or pressure at vertex. There is no definite periodicity marked but may continue for weeks or even months, without interruption. It is different from migraine and also carries no symptoms of photopobia/vomiting. The severity and intensity may vary from patient to patient. The symptoms arc far less severe when he is occupied with work (but not burdened) but when free, impact is likely to be felt more severely, though normal pattern of activity is not interfered with.
There may be local tenderness over the skull/in the occipit but factors, like trigeminal neuralgia and precipitation of (acute) pain by skin contact, should not be confused with tension headache. Hence, both the said factors, it’not discerned, may give a confused picture, thereby jumbling the symptoms. Both factors need to be carefully examined and distinguished so as to leave no room for any confusion.
It is best to take down the patient’s history carefully in details, not ignoring even minor points. lifestyle, family culture and atmosphere, financial constraints, marital relations, job-related burden and dissatisfaction are some of the reasons that could trigger tension, leading to tension headache. The patient needs to be taken into confidence and reassured that precipitant causes are fully manageable and need not cause any disturbance. A sympathetic and humane approach can go a long way in solving the prob-lem. The conciliatory and sympathetic approach, coupled with reassurance, would serve better purpose than any tranquiliser (sedative and analgesics). But crisis stage must be managed without any delay, even if medical aid is to be depended upon.
When causatives subside and disappear, normal condition, existing prior to onset of tension headache, will re-emerge much to the delight of the patient and his relatives.
Following points may be kept in mind, while distinguishing tension headache from other types of headache viz.
(i) Cause – Tension
(ii) Site – Generalised or Nuchal
(iii) Duration – Constant
(iv) Character of Pain – Tight / pressure/ Dull.
(v) Associated Symptoms – Anxiety / Depression, Tenderness (local)
Treatment
Try some analgesic (like Paracetamol, or analgin etc.) in combination with diazepam. Initially a 500 mg tablet of anyone of the analgesics along with 2.5/5 mg tablet of diazepam (T.D.S.) It will temporarily relieve pain but must not be used for more than 3-4 days whereafter, the dose may be reduced to half (in case of adults) but must not be used for infants, children, pregnant ladies, except when medically advised.
Resistance to symptoms is not found wanting. In some cases, obdurate and defiant attitude and behaviour prove detrimental and counter productive, as timely exercise on damage repair is all the more necessary.