Tension Headaches

Headaches are a major source of chronic pain. Although most people get an occasional headache, as many as 45 million Americans get them on a regular basis. Headache related lost work and medical expenses costs $50 billion per year in the U.S. alone. Over $4 billion a year is spent on over-the-counter headache relievers. Headaches are problematic in about 10 to 18 percent of the general population, and 10 percent of patients identified headache as the reason for their doctor visits.

Tension Headaches

Tension headaches account for about three quarters of all headaches. They cause moderate pain on both sides of, and across, the forehead, tend to both start and fade away gradually, and are the result of muscle tightness coming from the SCM (sterno-cleidomastoid) muscles in the neck. These muscles begin behind the bottom of the ear and come around the neck to the top of the collar bone (clavicle). They are the muscles that turn your head from side to side. With tension headaches you can often find a tender knot right in the middle of the muscle. This knot, called a “trigger point,” refers pain and tenderness to the sides of your forehead (the temple area), and then sends the pain across your forehead. Although putting a hot compress or the pain creams on the temples and across the forehead may help temporarily, they are more effective when placed over the tender knots in the muscles on both sides of the neck.
Occasionally, tension headaches are felt at the base of the skull, on the top of the head, and/or behind the eyes. For these headaches, the pain is often coming from the muscles where they attach to the base of the skull at the top of the back of your neck. If you push on those muscles (called the sub-occipital muscles) where they attach at the base of the skull during a headache, they will be very tender and can make the headache better or worse. When the pain is reproduced by pushing on the area, you know that these muscles are part of the source of that headache. If this is the case, use heat and the pain creams over those tender areas.

How Can I Make the Headaches Go Away and Stay Away?

Because tension headaches are muscular, the same treatments that cause your muscles to relax will often eliminate the recurrence of these headaches—permanently! These are nutritional support, hormonal support, getting at least eight hours of sleep at night, and treating underlying infections. Paying attention to structural factors and eliminating annoying stresses in your life can also help. I call the metabolic approaches to treating muscle tightness the “SHIN Protocol”. Here’s how to treat them.

1) Disordered sleep. Many people with headaches and muscle pain find that they are unable to get 7-8 hours of deep sleep a night without taking medications. For muscle pain to go away, it is critical that you get 8 to 9 hours sleep at night! Helpful medications include Ambien, Desyrel, Klonopin, Flexeril and/or Elavil. In addition, natural remedies can help sleep. An excellent one (which I developed -Revitalizing Sleep Formula by Enzymatic Therapy — 100 percent of my royalty for all products I develop is donated to charity) includes theanine, Jamaican Dogwood, wild lettuce, valerian, passionflower, and hops. These are also powerfully effective muscle relaxants as well. Other natural sleep aids include Calcium and Magnesium, 5-HTP (100-300mg), and melatonin (3/10-1mg). Some patients find that over-the-counter antihistamines such as doxylamine (Unisom for sleep) or Benadryl can also help.

2) Hormonal deficiencies. Blood tests for hormonal deficiencies are very unreliable. The normal range often the only picks up late stage deficiencies, and often is simply based on your not being on the lowest 2% of the population. Because of this (and for a number of other reasons) it is usually necessary, albeit controversial, to treat with thyroid, adrenal (very low dose cortef; DHEA), and ovarian and testicular hormones — despite normal blood tests! These hormones have been found to be reasonably safe when used in low doses.

3) Unusual infections. The most important ones to treat exude sinusitis and nasal congestion – which are usually caused by fungal infections. Although the concept is controversial, fungal infections are one of the most common causes of chronic sinusitis and spastic colon. Avoiding sweets (stevia is OK) and taking Acidophilus Pearls (healthy milk bacteria –2 pearls twice a day for 5 months) can be very helpful. We usually also add prescription antifungals as well if chronic sinusitis or spastic colon are present.

4) Nutritional supplementation. Because the western diet has been highly processed, nutritional deficiencies are a common problem. The most important nutrients include: a) vitamins — especially the B vitamins (most at 25-50 mg/day), vitamin B12 (50-3000mcg/day), and antioxidants (e.g. — vitamin C and E). b) Minerals — especially magnesium, zinc, and selenium and c) amino acids (proteins). To replace the 25 – 35 tablets that people needed to take, I developed a good tasting product that contains 50 key nutrients in 1 capsule and 1 scoop of a good tasting powder taken daily. It is called “Energy Revitalization System” by Enzymatic Therapy, and is available at health food stores or on my web site.

While you are treating the underlying causes of your muscle pain, many medications can also be used to prevent chronic tension headaches. Anti-depressants can help headache and other pains as well as depression. In one study comparing Elavil® 25 mg at bedtime with Remeron 30 mg at bedtime, both groups had less headaches but the Remeron® group had fewer side effects Both of these medications are likely to be more effective for tension headaches than Paxil 40 mg daily, which had only a mild effect. Overall though, I much prefer using the “SHIN protocol” to eliminate the underlying causes of your headaches.

What Can I Do for the Acute Pain?

Herbal remedies such as the End Pain formula, which contains willow bark, Boswellia, and cherry, can be very helpful for acute attacks as can the natural and prescription pain gels. Although the “End Pain” directions say to take 1-2 tablets, for acute pains 3-4 tablets at a time can be more helpful. Adding the muscle relaxant herbs found in the “Revitalizing Sleep Formula” can also be very helpful. A physical therapy technique called stretch and spray, which approximately 10 percent of physical therapists are familiar with, is also an excellent and pain free way to release your muscles and eliminate a tension headache. When the underlying metabolic (e.g. infections, sleep, nutritional and hormonal deficiencies) and structural factors have been treated, stretch and spray may result in permanent relief of the pain. In addition, there are, of course, the old standbys of chiropractic and body work. Unless the underlying metabolic causes are treated with the “SHIN protocol” and underlying structural problems are treated, relief from chiropractic and bodywork is likely to be short-lived – requiring repeated treatments. This is why I recommend combining metabolic and structural therapies. Over-the-counter remedies such as Tylenol® and Motrin®/Advil® can offer short-term relief. Other medications that can be quite helpful include Midrin® and Ultram®. I would begin with the natural therapies first, however, as I find that these are both more effective and much safer.

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Written by Dr Jacob Teitelbaum MD

Explore Wellness in 2021