What are tension headaches?

While the term migraine surgery is commonly used to describe the surgical treatment of migraine headache pain, migraine surgery can treat a wide array of different types of headaches. Aside from migraines and occipital neuralgia, tension headaches are another type of headache that can be treated by migraine surgery. Tension headaches are the most common kind of headaches, affecting more than 20% of the human population.

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What Causes Tension Headaches?

There are many different causes for tension headaches. Stress or strain at work and home is the most common cause. Daily activities such as staring at our computer or phone screens for long periods and driving as part of a long commute often cause patients to “hold their stress” in their shoulders and back. Unfortunately, these things are natural parts of day-to-day living, and as a result, tension headaches are on the rise.

Tension headaches are characterized by the tension of the muscles in the head and neck, typically including the muscles in the back of the neck and upper back. Muscle contractions in the head and neck region tighten around the occipital nerves which contributes to the pain, and the discomfort caused by these headaches only creates more tension. This creates a never-ending cycle of pain—where tight muscles create pain in the occipital nerves, and pain creates more tight muscles—which is why tension headaches can often last up to four hours or more.

Can Poor Sleep Lead to Tension Headaches?

It’s thought that not having adequate, quality sleep can be a trigger for a tension headache, but research has not shown a direct relationship between tension headaches and lack of sleep. However, fatigue from poor sleep could make it more likely a person could develop episodic tension headaches.

Sleeping in a cold room or sleeping with your neck in a bad position may be triggers for tension headaches. Even if it is not the direct cause behind a tension headache, poor sleep is often one of the side effects of a tension headache, as the pain can directly affect one’s ability to fall asleep and stay asleep.

What Nerves Cause Tension Headaches?

Greater Occipital Nerve (GON)

While it is true that tension of the muscles and tissue in the back of the head and neck is often the major contributing factor to tension headaches, it is actually the nerves in these regions that are the main culprits. The Greater Occipital Nerve (GON), which rises from the cervical spine of the neck, is the largest nerve in this area. This nerve courses through several muscle layers on its way to the scalp, where it supplies feeling to the skin at the back of the head. The GON courses through the semispinalis capitis muscle and the trapezius muscle, both of which tend to be tight with tension in patients who experience tension headaches.

Third Occipital Nerve (TON)

The Third Occipital Nerve (TON), which is a much smaller nerve branch, is also found in this area and takes a similar path through these muscles.

Lesser Occipital Nerve (LON)

The Lesser Occipital Nerve (LON) is found on either side of the neck. This nerve travels around the sternocleidomastoid muscle, which runs from the collar bone to the back of the head and behind the ear. This muscle aids in the stability and turning of the head and usually feels like a tight band in patients who complain of tension headaches. The muscles that tend to be tight in patients with tension headaches are closely related to these nerves: the GON, TON and LON. These nerves become chronically irritated, compressed and inflamed by the constricting structures surrounding them.

Nerve inflammation is called neuralgia. The tension headache patient typically has neuralgia of one, two or three of these nerves on either or both sides of the head and neck. It is actually this nerve inflammation that sends distress signals back to the brain, complaining of the compression from the tight surrounding structures. The tension headache patient then experiences an array of symptoms resulting from these distress signals, ranging from head and neck pain, dizziness, photophobia, nausea, vomiting and other similar issues.

How Common Are Tension Headaches?

Tension headaches are the most common type of headache. It is estimated that up to 80% of adults in the U.S. get tension headaches from time to time. About 3% have chronic tension headaches.

There are two main categories of people who get tension headaches:

  • Episodic tension headaches: For these patients, a tension headache occurs on less than 15 days out of a month for three months. These headaches can last anywhere from 30 minutes to a week.
  • Chronic tension headaches: For these patients, a tension headache occurs on 15 or more days out of the month for three consecutive months.

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What Are the Signs and Symptoms of a Tension Headache?

The main symptom of a tension headache is a feeling of tightness around the head. Some patients describe it as a “vise” sensation or that of an overly tight headband. During these headaches, the neck and shoulder muscles are often tense and sore to the touch. Sleep can be difficult, as can concentration.

Like migraine headaches, tension headaches can be exacerbated by bright lights or loud noises. When comparing the two, migraine headaches tend to be a throbbing pain, while the pain is more constant with a tension headache. Areas of pain with tension headaches are usually the neck, back of the head, and often the temple and forehead.

Unlike migraines, tension headaches aren’t associated with visual disturbances, nausea or vomiting. Physical activity aggravates a migraine headache, but not usually a tension headache.

On Average, How Long Does a Tension Headache Last?

The average duration of a tension headache is 30 minutes to several hours. This is only the average, and unfortunately for some, tension headaches can last up to seven days.

How Can We Provide Relief From Tension Headaches?

Nerve decompression surgery, also called migraine surgery, is the procedure in which the GON, TON and/or LON are released from the tension of the surrounding muscle tissue. In patients who have tension headaches in the temple or forehead, there are small nerves in these areas that can be problematic as well and can be relieved with nerve decompression surgery. This outpatient procedure has a greater than 90% success rate in providing long-term improvement from chronic pain and other symptoms of a tension headache.

The details of the surgical procedure can be found here. In this kind of headache surgery, small, well-concealed incisions are used to access the regions of concern, and the nerves are released from the surrounding pressure. The nerves are often padded with a piece of adjacent fat to avoid further compression and maintain their new relaxed position. Nerve decompression surgery is NOT brain surgery, but rather outpatient surgery that involves the superficial nerves of the head and neck.

Because the compression is released, the neuralgia subsides, and the nerve returns to its normal state. It no longer sends distress signals to the brain, so pain is not triggered, and the feedback cycle of tight muscles that the pain caused is no longer present. The entire loop of pain is broken, and the tension headache is relieved.

When Should I Consider Surgery for Tension Headaches?

Tension headaches can be hard to manage as some patients have chronically tight muscles surrounding the nerves above the eyes and in the back of the head and neck. Headache surgery can decompress these nerves and prevent the pain of tension headaches. For patients who cannot control their headache pain with medications or other means, headache surgery can be an excellent choice for long-term relief.

Why Choose Dr. Lowenstein for Your Tension Headache Treatment in Santa Barbara

When less invasive treatments fail to provide relief, it is crucial for tension headache sufferers to be their own advocates and explore other options. Dr. Lowenstein is a board-certified plastic surgeon who sees many people with chronic tension headaches and is passionate about providing his patients with the information they need to make informed choices for themselves.

Dr. Lowenstein operates at the Migraine Surgery Specialty Center in Santa Barbara, CA, and also consults out of the Migraine Surgery Speciality Center in Denver, CO. Dr. Lowentsein additionally has a Migraine Surgery Specialty center for consultations in Los Angeles, CA. Dr. Lowenstein is dedicated to helping his patients improve their quality of life by reducing the physical and emotional toll of prolonged periods of headaches.

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