Tension Headaches: When to Seek Medical Attention

Head pressure and headache?

Hello Doctor, in the past few months, I've been experiencing a feeling of pressure and tightness in the back of my head to the top of my head about once or twice a week.
Occasionally, I have sharp pains, mostly starting in the afternoon or evening.
Most of the time, I can tolerate it without taking painkillers, but I do feel more discomfort during my menstrual period, which sometimes requires medication.
Yesterday afternoon, while I was busy at work, the pressure and tightness in my head started again.
Usually, it resolves after I sleep, but this time it persisted into the next day.
Although it's not severe enough to require painkillers, I'm still a bit concerned.
Should I go to the hospital for an MRI? Thank you.

Xiang, 20~29 year old female. Ask Date: 2020/09/08

Dr. Jiang Junyi reply Neurology

Hello, based on your description, the most common cause of neck pain is cervical myofascial pain.
Prolonged periods of looking down can lead to overuse of the trapezius muscle in the back of the neck, resulting in neck and shoulder discomfort.
Initially, resting may alleviate the pain, but eventually, it can worsen and affect daily activities.
Some patients experience severe neck pain upon waking, accompanied by stiffness, tightness, and intolerable pain levels.

I recommend the following strategies:
1.
Change positions: Alter your posture every 15 minutes to allow the neck tissues to rest.
Any sustained position (including a normal one) can lead to tissue fatigue and inflammation, so brief movements can reduce the risk of muscle inflammation.
2.
Rest: Allowing the muscles to utilize their self-repair capabilities is essential, and vigorous exercise should be avoided during this time.
3.
Apply heat to the neck: Use a heating pad for 15 to 20 minutes, ensuring the temperature is safe to avoid burns.
4.
Non-steroidal anti-inflammatory drugs (NSAIDs): If you do not have a history of peptic ulcers, allergies to NSAIDs, or impaired kidney function, consider using NSAIDs to reduce inflammation and alleviate pain when necessary.
5.
Neck muscle stretching exercises: After the acute pain phase, develop a habit of performing slow, gentle neck stretches every 15-20 minutes, ensuring the angles do not cause discomfort.
Regarding menstrual-related headaches, you may want to consider vascular headaches (migraines), which typically last from 4 to 72 hours.
The characteristics of these headaches include unilateral pain, throbbing or pulsating sensations, often accompanied by nausea, vomiting, and sensitivity to light and sound.
Activities such as walking, climbing stairs, or head movements can exacerbate the pain.
Many patients require analgesics or preventive medications for relief.

In addition to medication, lifestyle adjustments are crucial.
Establishing good habits, maintaining a regular schedule, ensuring adequate but not excessive sleep, avoiding overexertion, and managing stress are all important.
Certain triggers, such as specific foods, alcohol, drastic temperature changes, or moving in and out of air-conditioned environments during hot weather, should be avoided to help prevent migraines.
I suggest consulting a neurologist for further evaluation and treatment.
Wishing you good health, peace, and joy.

Dr.
Jiang, Department of Neurology, Tao Medical Center, cares about you.

Reply Date: 2020/09/08

More Info

Tension headaches are one of the most common types of headaches, characterized by a feeling of tightness or pressure around the forehead, temples, or back of the head and neck. They can be triggered by stress, anxiety, poor posture, or prolonged periods of concentration, such as working at a computer. Your description of experiencing a "tight" and "pressure-like" sensation in your head, particularly in the afternoons or evenings, aligns well with the typical presentation of tension-type headaches.

Given that you have been experiencing these symptoms for several months, occurring about once or twice a week, it is important to consider a few factors before deciding whether to seek further medical evaluation, such as an MRI. Here are some key points to consider:
1. Symptom Duration and Frequency: Tension headaches can be episodic or chronic. If your headaches are infrequent and resolve with rest or over-the-counter pain relief, they may not require extensive investigation. However, if the frequency increases, or if the nature of the headaches changes (e.g., becoming more severe or associated with other symptoms), it may warrant further evaluation.

2. Associated Symptoms: You mentioned that your headaches occasionally become more uncomfortable during your menstrual period. Hormonal fluctuations can indeed influence headache patterns, particularly in women. However, if you start to experience additional symptoms such as visual disturbances, nausea, vomiting, or neurological deficits (like weakness or numbness), it is crucial to seek medical attention promptly.

3. Response to Treatment: You indicated that most of the time, you can tolerate the headaches without medication, which is a positive sign. However, if you find that you need to rely on pain relief more frequently or if the headaches begin to interfere with your daily activities, it would be wise to consult a healthcare professional.

4. Lifestyle Factors: Consider evaluating your lifestyle for potential triggers. Stress management techniques, regular physical activity, maintaining good posture, and ensuring adequate hydration can help reduce the frequency and intensity of tension headaches. Additionally, practicing relaxation techniques such as yoga or mindfulness may also be beneficial.

5. When to Seek Help: If your headaches persist beyond a few weeks without improvement, or if they begin to disrupt your daily life significantly, it is advisable to consult a neurologist. They may recommend imaging studies, such as an MRI, to rule out other potential causes of your symptoms, especially if there is a change in the pattern or severity of your headaches.

In summary, while your symptoms are consistent with tension headaches, it is essential to monitor their frequency and any associated symptoms. If you notice any concerning changes or if the headaches become more debilitating, seeking medical advice is the best course of action. A healthcare professional can provide a thorough evaluation and recommend appropriate treatment options tailored to your specific situation.

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