-DR. ARVIND DUBEY
Though the word ‘tension’ is a very commonly used word, it is one which
cannot be easily defined. Its literal
meaning is given as ‘stretched tight’.
In common parlance the word is used for mental condition arising out of
nervous strain. Scientifically, it is
defined as a state of increased motor and psychological activity, which is
unpleasant.
It is generally accepted
that headache and emotional stress are interconnected. Headache is the expression of conflicting
emotions and anxiety. It may be the
result of a complicated biochemical alteration.
Usually the origin of anxiety is rooted deeply in an individual’s past
interpersonal conflicts. Feeling of
inadequacy, guilt, shame, helplessness, envy, loneliness or fear of
abandonment, all of which may contribute to resentment or hostility towards a
loved person. Such feelings are usually
repressed or rejected at conscious level, may emerge as bodily symptoms.
Headache is the expression of conflicting emotions and anxiety (Courtesy- Wikipedia)
The severity of these
headaches ranges from minimal discomfort, commonly experienced followed fixed
attention, a prolonged car drive or long periods of intensive studies; to
incapacitating headaches or pains that are totally disabling and thereby
precluding physical activity. Such
headaches are said to be the consequence of eyestrain or concentration, but
perhaps, the necessity to perform an unpleasant task or to continue an
emotionally repugnant involvement may be the more likely cause.
Treatment
Treatment of tension headaches can be very
frustrating. Mild analgesics such as
aspirin and paracetamol are generally preferred in treating headaches. As is the usual practice, during
self-medication, the patient keeps on increasing the dosage while the headache
persists. But contrary to the belief,
the amount of drug taken, over and above its optimal dose, does not relieve the
discomfort but adds to its side effects.
Self-medication should be avoided as many drugs for headaches contain
caffeine, the stimulant action of which may be undesirable when a large amount
of the drug is consumed. Besides, these
drugs cause gastric irritation, nausea and vomiting and even gastric ulcer and
other blood coagulation disorders.
Anxious patients with
tension headaches also use sedatives, viz. Diazepam, but these too are
accompanied by problems of over dosing, psychological dependence and side
effects, when taken beyond the optimal level.
However, to date, no drug is available to treat tension headaches. Despite the uncertainties surrounding the
exact relationship of psychological disturbances to headaches, certain types of
psychotherapies and behavioural alterations appear to be curative in many
patients. The value of simple reassurance
should never be underestimated.
The unconscious choice of
headache as an expression of anxiety is probably governed by many factors, the
most common amongst which is the concept and image of one’s body and its
functions that develop early in life. Along
with the growth of the though process, the importance of the head and its
function get impressed on the mind.
Headache is often one of the earliest words related to bodily ailments
that children recognise when unsuspecting mothers choose headache as a physical
expression of anxiety. Thus a child
begins to associate a state of anxiety with a headache.
Tension headaches are
caused when the skeletal muscles contract about the face (top of head, neck and
shoulders). The arteries supplying blood
to the above muscles contract too when they respond to generalised noxious
stimuli. This decreases the blood supply
to the muscles. Often, headaches are
associated with fatigues tensions.
There is no fixed pattern
for headaches. It is a dull aching pain
and is expressed as tightness, pressure, drawing or soreness of the head. It is usually in both sides of the head and,
more so on the back of the head.
Use of physical therapy
for tension headaches has a long history.
Heat and massage have been used as muscle relaxants since
antiquity. Often there is a prompt
relief but it is usually short lasting.
There are some techniques by which within a few weeks, the patient
learns to relax his head muscles on his own will. Biofeedback therapies are also tried but they
need the help of a trained psychiatrist.
Remember that it is just an outward symptom of an inner tension. The real culprit is deep-seated anxiety about anything between unpleasant involvements to fear of loneliness.
The above modalities do not treat the underlying
tension that may be causing the symptom.
To alleviate the tension, the approach should be to provide the patient
with the necessary understanding and insight into how he translates his anxiety
into muscle tautness, which manifests as tension headache. Change in atmosphere and stimulus, which
brings about these tensions, should be tried.
Though it is very difficult to implement, yet sometimes, by minor
changes, tension can be alleviated. But
this also has individual variability.
Yoga, meditation can also offer hope in this direction.
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