Not Every Headache Is a Tension-Type Headache: When to See a Doctor
In my previous article I explained that tension-type headache is not hopeless. But that does not mean every headache is a tension-type headache.
Which headaches need a doctor without delay?
The line has to be drawn clearly here. It is not right to explain every new, unusual or steadily worsening headache as “tension.” Situations such as a headache that starts suddenly and that the person describes as the worst pain of their life; fever, a stiff neck or a change in consciousness; neurological signs such as loss of strength, difficulty speaking or loss of vision; pain that begins after a head injury; a new headache in a person with cancer or a suppressed immune system; or pain of a different character during pregnancy or after childbirth require a physician's evaluation without delay.
In frequently recurring headache, the correct diagnosis is just as important. Migraine, cluster headache, cervicogenic pain, temporomandibular problems and medication-overuse headache cannot be substituted for one another. Diagnosis comes before treatment.
A painkiller can sometimes be part of the cycle
There is nothing wrong with taking a painkiller when our head aches. Appropriate, occasional use helps many people. But taking medication too often can, in some people, contribute to headaches becoming more frequent and chronic.
The pain comes, a medication is taken, relief lasts a short while. Then the pain returns and the medication is taken again. After some time, the person may face not only the headache but a new cycle that the medication itself has entered.
For this reason, it matters that a person with frequent headaches tells the doctor not only which medication they use but also on how many days a month they use it. Suppressing the pain and understanding why it keeps coming back are not the same thing.
Treatment cannot be reduced to a single point
Treatment of tension-type headache begins with the correct diagnosis. When the pain began, how long it lasts, how many days a month it occurs, where it is felt, whether it is pressure or throbbing, accompanying findings, its relation to the neck and jaw, sleep, stress, the medications used and the rhythm of daily life must be assessed together.
Treatment also varies from person to person. Lifestyle adjustments, exercise, physical therapy and suitable manual medicine approaches, posture and ergonomic adjustments, a dental evaluation if there is a jaw problem, treatment of a sleep disorder and, when necessary, preventive medication can all be parts of the plan. The contribution of specialists in neurology, physical medicine and rehabilitation, dentistry, eye diseases or mental health may be necessary for some patients.
This does not mean sending the patient from one doctor to another. It means accepting that the human body can have a problem that involves more than one system at the same time.
What does regulation medicine look at?
When I evaluate a patient with tension-type headache, I do not look only at where the pain is. How is the movement and muscle tone of the neck? How much load does the shoulder girdle carry through the day? Is the jaw clenched? Is sleep truly restful? Is breathing shallow, and how is the function of the diaphragm? Does the person hold their breath without noticing while working? What kind of motor pattern does the body develop in response to stress? What are the screen and work setup like? How much movement is there? On how many days is a painkiller used?
None of these alone is the answer for every patient. The aim of regulation medicine is not to attribute everything to a single cause either. On the contrary, it tries to distinguish the relationships that sustain the pain and the loads that make it harder for the organism to regain balance.
The musculoskeletal system, nociceptive pathways, the autonomic nervous system, sleep, breathing and psychosocial load are not entirely independent of one another. Biological systems are in constant exchange of information. From a biophysical point of view, this is one of the important characteristics of life: a system sustains its existence not only through its structure but through its communication and its response to changing conditions.
A headache can sometimes describe the rhythm of life
The human body is not made of parts detached from one another. The neck speaks with the head, the jaw with the temples, sleep with the nervous system, stress with muscle tone. The brain processes all of these signals, and the mark of our way of life remains on this communication.
How long we sleep, how much we move during the day, how we sit in front of a screen, whether we clench our teeth, how we hold our body under stress and how we respond to pain when it comes all matter.
The body has a memory. This memory is not merely a poetic trace of past trauma; it can also show itself in repeated movements, muscle tone, pain sensitivity, sleep patterns and behavioral habits. A person can come to regard a load carried for a long time as normal. Pain sometimes becomes visible at the point where this silent adaptation is no longer enough.
For this reason, tension-type headache sometimes tells us something not only about our head. It also makes us wonder how long our body has been on alert.
Tension-type headache is not hopeless
People living with chronic headache may over time begin to say, “I have got used to living like this,” “It will never go away for me,” “All my tests are normal but my pain continues.” I have seen the weariness behind these sentences for years.
Normal test results do not mean the pain is not real. In some headaches no structural pathology can be seen, because the problem does not consist only of a structure that can be imaged. Function, the pain processing system, muscles, sleep, the jaw, the neck and the loads of life can meet in the same picture.
Good treatment is not merely silencing the pain. It means first ruling out dangerous causes and making the correct diagnosis; then understanding, as far as possible, the cycle that sustains the pain and opening a path specific to the person.
Sometimes the solution is not in a single medication. But that does not mean there is no solution.
Tension-type headache is not hopeless. With the correct diagnosis, the correct assessment and a treatment approach that does not see a person as only a head, it is possible to reduce the frequency of the pain and its burden on life.
Because the body often speaks. The responsibility of medicine is not merely to turn down the volume, but to try to hear what it is saying.
You can find neural therapy and Hüseyin Nazlıkul's other treatment methods here.
For more on stress, sleep and autonomic balance, see also Stress, Sleep and HRV.