Stress headaches

Stress headaches are one of the many effects stress has on the body. These headaches are known as tension-type headaches, or tension headaches for short. How are stress headaches different from other headaches, and how can they be treated?

Tension headaches

Tension headaches are a dull pain combined with a feeling of pressure around the forehead or back of the head and neck. Some people describe it as a clamp squeezing the skull. Stress headaches can last from 30 minutes to a few days.

Stress headaches can occur because of the building up of stress over a couple of days. Also, stress headaches can arise when the stress has passed. This is what is referred to as “weekend headaches” that occur once the pressure from work is no longer present.

There are two types of stress headaches: the episodic and chronic stress headaches, which are identified by the number of days per month the headaches occur. Episodic stress headaches occur up to a maximum of 15 days per month, and chronic stress headaches occur more than 15 days per month. Episodic headaches usually start gradually, more often than not in the middle of the day. Chronic headaches last longer. The intensity of the pain varies in chronic headaches, meaning it can become less or more severe during a day. However, some pain will always be there.

It has been estimated that 80% of adults in the United States suffer from stress headaches from time to time. 3% of Americans have chronic stress headaches, with women twice as likely to get them as men. Most people with episodic stress headaches have them only once or twice per month, thus far less than the 15 times per month which separates episodic from chronic stress headaches. People with the chronic type are much worse off, with many of them reporting having them for long periods of time, often between 60 and 90 days.

Episodic stress headaches can evolve into chronic stress headaches. This transformation is caused by stress that is evoked by minor daily problems. In other words, patients with transformed headaches are characterized by different ways of reacting to the stress of daily hassles rather than by greater exposure to major stressful events.

Symptoms of stress headaches

Stress headaches have a couple of common symptoms that separate them from other types of headaches such as migraine (which can also be induced by stress). Some of the symptoms are:

• Headache that usually starts in the afternoon

• Pain and / or pressure in the top, front, or sides of the head

• Concentration problems

• Irritability

• Sleeping problems, yet feeling tired

• Muscle aches, especially in the neck and sometimes jaws and shoulders

• Some sensitivity to noise or light, but far less so than in migraine

Except for the absence of extreme sensitivity to light or noise, other symptoms of migraine are absent, such as muscle weakness, blurred vision, or nausea.

Stress as a cause of tension headaches

Stress has been described as a trigger of tension headaches, hence the alternative name of stress headaches. The evidence for stress as an immediate antecedent or trigger of headaches comes from three main types of studies: (i) retrospective studies (asking headache sufferers whether stress triggers their headaches), (ii) prospective studies (headache sufferers concurrently self-monitoring stress and headaches), and (iii) laboratory studies (investigating effect of induced stress).

The percentage endorsing stress as a trigger is high in most retrospective studies, ranging from 71 to 97%. One study reported strong associations between headaches and job stress. Stress was caused by limited control over their activities, high job demands, and low social support. These are typical stressors at the workplace.

Prospective studies also found a relationship between stress, and the headaches that followed. In these studies, the intensity of stress was predictive of the development of headaches. Surprisingly, however, a prospective study that included measurements of stress hormones in the blood (cortisol) and heart rate changes (mediated by the stress hormone epinephrine or adrenaline) reported no differences in these physiological parameters of stress. Thus, although there was a link between perceived stress and headaches, this was not recapitulated by stress biology measurements. Therefore, the physiological mechanisms underlying the effects of stress on headaches are not precisely known.

In laboratory studies, people suffering from headaches are exposed to mental stress. Such stress can come from doing a difficult task, such as difficult-to-solve anagrams or an arithmetic task, coupled to negative remarks by one or two evaluators. It has been found that between 63 and 83% of the participants developed headaches following the stress. These studies have provided some of the strongest evidence that stress can cause headaches as they involve a manipulation of stress.

Stress “setting the scene” for headaches

According to the philosopher Popper (1902-1994), living means the solving of problems. Indeed, every-day hassles may be experienced as stress. Research has revealed that people who are suffering from headaches are more bothered by daily hassles than people who do not experience headaches on a regular basis. Their stress levels are higher, and this correlates with the occurrence of headaches. Also, people with headaches tend to interpret ambiguous situations more readily as potential problems.

People with tension headaches often try to avoid situations that cause stress. Unfortunately, avoiding stress is often not possible, so that avoidance is frequently not the best strategy to cope with stress. Instead of adopting an active strategy to deal with the stressor, headache sufferers engage themselves in wishful thinking, self-criticism, and social withdrawal. The consequence of social withdrawal is that people with stress headaches make less use of their social network to deal with stress.

Thus, it appears that the appraisal of minor stressful events is important for the development of stress headaches. Thus, the way people deal with stress is an important determining factor for the onset of stress headaches, perhaps even more important than the stressful events themselves.

Treatment of stress headaches

It is clearly unrealistic to advise avoiding stress if the term stress refers to events (major or minor) that can lead to a psychobiological stress response, as such events are inescapable facts of life for everyone. The phrase “Learning to Cope with Triggers” seems particularly apt with respect to stress as individuals need to learn to cope with events that can evoke stress. Stress management training typically involves exposure rather than avoidance as participants are taught stress management strategies and then encouraged to practice using these strategies under conditions of mildly elevated stress, often achieved via participants imagining themselves in a stressful situation.

Thus, learning to effectively deal with stress is the best thing to do to prevent stress headaches. This can be achieved by a number of stress management techniques that have shown to be helpful for a significant number of patients:

• Relaxation training, which is designed to reduce tension
• Biofeedback training, which aims to change physiological variables in the body, such as a decrease of muscles tension and to reduce the activity of the sympathetic nervous system (to lower arousal)
• Cognitive behavioral therapy, which targets the dysfunctional thoughts and beliefs associated with stress and negative emotions. These can be triggers of, or responses to, headaches.

Other means by which stress and headaches can be reduced include lifestyle changes, meaning trying to lead a healthy life with

• sufficient sleep
• good quality food and eating at regular times
• regular exercise
• taking control of your life and your job

When headaches occur, the pain can often be alleviated by over-the-counter painkillers. In more severe cases, doctors can prescribe other medication such as a muscle relaxant, or even stronger drugs like antidepressants, blood pressure medication, or anti-seizure drugs.

However, medications do not cure headaches, so that stress prevention and improving stress management are important approaches to prevent stress headaches from happening. Both approaches are central to stressinsight.com. By browsing through the Stressinsight website, you will better understand what stress is and how to deal with it. And if you really like the website, you could also consider becoming a Stressinsight member, so that you have access to the forum and the course "Surmounting Stress".