Tension Headaches: When to Seek Medical Advice

Head pressure and headache?

Hello Doctor, in the past few months, I have 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, there is a sharp pain that occurs, mostly starting in the afternoon or evening.
Most of the time, I can tolerate it without taking pain relief medication, but I do feel more discomfort during my menstrual period, which sometimes requires me to take pain relief.
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 with the same feeling of pressure and tightness at the top of my head.
Although it’s not severe enough to require pain relief, I am a bit concerned.
Do I need to go to the hospital for an MRI? Thank you.

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

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 over time it can worsen and affect daily activities.
Some patients may experience severe neck pain upon waking, accompanied by stiffness, tightness, and intolerable pain levels.

I recommend the following:
1.
Change positions: Alter your posture every 15 minutes to allow the neck tissues to rest.
Maintaining any posture (including a normal one) for an extended period can lead to tissue fatigue and inflammation, so moving around briefly can reduce the chance of muscle inflammation.
2.
Rest: Resting allows the muscles to utilize their self-repair capabilities; avoid vigorous exercise during this time.
3.
Neck heat therapy: Apply heat for 15 to 20 minutes, ensuring the temperature is safe to avoid burns.
4.
Non-steroidal anti-inflammatory drugs (NSAIDs): For individuals without a history of peptic ulcers, allergies to NSAIDs, or normal 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 to 20 minutes, ensuring the angles do not cause discomfort.
Regarding menstrual-related headaches, consider vascular headaches (migraines), which typically last from 4 to 72 hours.
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.
Establish good habits, maintain a regular schedule, ensure adequate but not excessive sleep, avoid overexertion, and practice relaxation techniques.
Some individuals may have specific triggers, such as certain foods, alcohol, drastic temperature changes, or moving in and out of air-conditioned spaces during hot weather; avoiding these situations can help prevent migraines.
As for brain imaging, a neurologist may consider arranging it if neurological symptoms or thunderclap headaches occur.

Wishing you good health and happiness.

Dr.
Jiang, Neurology, Taoyuan Hospital.

Reply Date: 2020/09/09

More Info

Tension headaches are a common type of headache characterized by a sensation of tightness or pressure around the forehead or back of the head and neck. They can be triggered by various factors, including stress, poor posture, fatigue, and prolonged periods of concentration, such as working at a computer. Your description of experiencing a tight, pressure-like pain in the back of your head and at the top, especially during busy work periods, aligns well with the typical presentation of tension headaches.

Given that you mentioned these headaches occur about once or twice a week and are often manageable without medication, it suggests that they may be episodic tension-type headaches. However, the fact that you experienced a more persistent headache that lasted into the next day is concerning and warrants further evaluation.

In general, tension headaches can be managed with lifestyle modifications, such as improving posture, taking regular breaks from screen time, practicing relaxation techniques, and ensuring adequate hydration and nutrition. Over-the-counter pain relievers like acetaminophen or ibuprofen can be effective for symptomatic relief when needed. However, if you find yourself relying on medication more frequently or if the headaches are becoming more intense or persistent, it is essential to consult a healthcare professional.

Regarding your question about whether you should undergo an MRI, it is important to consider the following factors:
1. Duration and Frequency: If your headaches have changed in frequency or intensity, or if they are accompanied by other symptoms such as visual disturbances, nausea, or neurological deficits (like weakness or numbness), it is advisable to seek medical attention. These could be signs of a more serious underlying condition.

2. Response to Treatment: If your headaches do not respond to typical over-the-counter medications or if they disrupt your daily activities significantly, this is another reason to consult a healthcare provider.

3. Associated Symptoms: If you experience any unusual symptoms, such as confusion, difficulty speaking, or severe nausea, these could indicate a more serious issue that requires immediate evaluation.

4. Medical History: If you have a history of migraines or other headache disorders, or if there are any significant changes in your health status, it is wise to discuss these with your doctor.

In conclusion, while tension headaches are often benign and manageable, the persistence of your symptoms and their impact on your daily life suggest that a medical evaluation is warranted. A healthcare provider may recommend imaging studies like an MRI to rule out any serious conditions, especially if there are any red flags in your symptoms. It is always better to err on the side of caution when it comes to headaches that are new, persistent, or changing in character.
I encourage you to schedule an appointment with a neurologist or your primary care physician to discuss your symptoms in detail. They can provide a thorough evaluation and determine the most appropriate course of action, which may include lifestyle modifications, physical therapy, or medication adjustments. Taking proactive steps now can help manage your headaches effectively and improve your overall quality of life.

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