‘A dull pain presses my entire head.’ Or, ‘It’s as if a much-too-tight steel band were wrapped around my head.’ This is how many people describe tension headaches.
‘Up to 70 per cent of Germans have these symptoms two or three times a month,’ noted Hans-Christoph Diener, spokesman for the German Neurology Society (DGN). Although episodic pains of this kind are unpleasant, they can usually be easily coped with.
Tension headaches, known medically as tension-type headaches, are a real problem if they become chronic, however. ‘As defined by specialists, this is when the pains occur 15 or more days a month for a least three consecutive months,’ explained Volker Limmroth, head physician at Cologne-Merheim Hospital’s neurological clinic.
Limmroth said the best way to determine whether the headaches were chronic was by noting each occurrence in a headache diary. Between two and three per cent of the German population suffer from chronic tension headaches, he pointed out.
Diener, who founded the West German Headache Centre at Essen University Hospital, said that people with frequent tension headaches should by all means see a neurologist or pain therapist.
‘There seems to be a time factor,’ he said. ‘If you catch a person on the way to chronification, it’s possible to ‘roll back’ the tension headaches with the help of multimodal therapy.’
But if the sufferer has been having headaches for three to five years already, he added, then lessening the severity of the pain is the most that can be done.
Multimodal therapy rests on four pillars. The first is long-term medicinal treatment. Painkilling drugs are unsuitable, though, because when taken over a long period they can not only have various side effects but also aggravate the headaches or cause them to become chronic.
‘Tricyclic antidepressants such as amitriptyline are usually prescribed instead,’ Diener said. They affect the metabolism of the neurotransmitter serotonin in the brain and make patients less sensitive to pain.
The second pillar is behaviour therapy. ‘Two methods are particularly effective against tension headaches: progressive muscle relaxation as developed by (American physician Edmund) Jacobson and autogenic training,’ remarked Susanne Grohs-von Reichenbach, a relaxation therapist in Munich.
Progressive muscle relaxation involves tensing and then relaxing certain muscle groups, which lessens the subjective intensity of the headaches. Autogenic training, on the other hand, is a concentrative self-relaxation technique. A basic training session of the latter is said to be specifically effective against headaches.
Both progressive muscle relaxation and autogenic training must be learned and then practiced for 10 to 15 minutes daily over a period of four to six weeks. ‘The brain has begun to be conditioned for relaxation by then, so the techniques can be applied in shorter sessions and when needed.’
As a third pillar in multimodal therapy, neurologists recommend engaging in an endurance sport such as jogging or swimming three times a week. And finally, physiotherapy as a fourth pillar can target muscle tension, for example in the neck.