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What is a tension headache?
The classic tension type headache is the intermittent headache where you feel like your head is in a vice. It is also described as a band of pain around the head like a “head band”. The pain should be even, NOT throbbing, NOT nauseating, and NOT causing excessive sensitivity to light or noise. It may interfere with your ability to function but not so bad that it prevents functioning - i.e. puts you to bed or is otherwise incapacitating.If the headache has qualities like these, it is more than likely a migraine not a tension headache.
Tension headaches in the past have been the most neglected type of primary headache. For a headache to be considered primary, there can be no other illness in the head or body causing the headache. A normal neurological examination and the absence of evidence of systemic disease, such as fever or stiff neck, is reassuring that a patient meeting these symptoms is having a primary headache. Naturally one cannot perform this examination on themselves.
Physicians in the past generally thought of tension headaches as extremely common (which they are) and virtually never disabling (which they sometimes are). Tension headaches were once called muscle contraction headaches but the medical community now feels they have essentially nothing to do with muscle contraction. They were also once called stress tension headaches implying that they were not truly a distinct entity but rather a psychologically driven condition, but that is also not true. Tension headaches, like all intrinsic neurologic diseases, can be made worse by being under stress but are not distinctly caused by it.
Prior to the headache classification system called the International Headache Society Classification system or I.H.S.{Cephalgia 2004;24 (Suppl 1)}, the studies on tension headaches included patients that varied widely. Tension type headaches were the least understood type of primary headache at the time of the development of the current I.H.S. classification system; it will undergo the most revision sometime during the next couple of years. Until then, the study of patients with chronic headache will be less than satisfactory as the current definition of chronic tension type headaches probably includes patients with different types of headaches.