Tension headache and Prevention

A tension headache is generally a diffuse, mild to moderate pain in your head that’s often described as feeling like a tight band around your head. A tension headache (tension-type headache) is the most common type of headache, and yet its causes aren’t well-understood.

Treatments for tension headaches are available. Managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately.

Symptoms

Signs and symptoms of a tension headache include:

  • Dull, aching head pain
  • Sensation of tightness or pressure across your forehead or on the sides and back of your head
  • Tenderness on your scalp, neck and shoulder muscles

Tension headaches are divided into two main categories — episodic and chronic.

Episodic tension headaches

Episodic tension headaches can last from 30 minutes to a week. Frequent episodic tension headaches occur less than 15 days a month for at least three months. Frequent episodic tension headaches may become chronic.

Chronic tension headaches

This type of tension headache lasts hours and may be continuous. If your headaches occur 15 or more days a month for at least three months, they’re considered chronic.

Tension headaches vs. migraines

Tension headaches can be difficult to distinguish from migraines. Plus, if you have frequent episodic tension headaches, you can also have migraines.

Unlike some forms of migraine, tension headaches usually aren’t associated with visual disturbances, nausea or vomiting. Although physical activity typically aggravates migraine pain, it doesn’t make tension headache pain worse. An increased sensitivity to either light or sound can occur with a tension headache, but these aren’t common symptoms.

When to see a doctor

Make an appointment with your doctor

If tension headaches disrupt your life or you need to take medication for your headaches more than twice a week, see your doctor.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different. Occasionally, headaches may indicate a serious medical condition, such as a brain tumor or rupture of a weakened blood vessel (aneurysm).

When to seek emergency help

If you have any of these signs or symptoms, seek emergency care:

  • Abrupt, severe headache
  • Headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties
  • Headache after a head injury, especially if the headache gets worse
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Causes

The cause of tension headaches is not known. Experts used to think tension headaches stemmed from muscle contractions in the face, neck and scalp, perhaps as a result of heightened emotions, tension or stress. But research suggests muscle contraction isn’t the cause.

The most common theory supports a heightened sensitivity to pain in people who have tension headaches. Increased muscle tenderness, a common symptom of tension headaches, may result from a sensitized pain system.

Triggers

Stress is the most commonly reported trigger for tension headaches.

Complications

Because tension headaches are so common, their effect on job productivity and overall quality of life is considerable, particularly if they’re chronic. The frequent pain may render you unable to attend activities. You might need to stay home from work, or if you do go to your job, your ability to function is impaired.

Prevention

In addition to regular exercise, techniques such as biofeedback training and relaxation therapy can help reduce stress.

  • Biofeedback training. This technique teaches you to control certain body responses that help reduce pain. During a biofeedback session, you’re connected to devices that monitor and give you feedback on body functions such as muscle tension, heart rate and blood pressure. You then learn how to reduce muscle tension and slow your heart rate and breathing yourself.
  • Cognitive behavioral therapy. This type of talk therapy may help you learn to manage stress and may help reduce the frequency and severity of your headaches.
  • Other relaxation techniques. Anything that helps you relax, including deep breathing, yoga, meditation and progressive muscle relaxation, may help your headaches. You can learn relaxation techniques in classes or at home using books or tapes.

Using medications in conjunction with stress management techniques may be more effective than is either treatment alone in reducing your tension headaches.

Additionally, living a healthy lifestyle may help prevent headaches:

  • Get enough, but not too much, sleep.
  • Don’t smoke.
  • Exercise regularly.
  • Eat regular, balanced meals.
  • Drink plenty of water.
  • Limit alcohol, caffeine and sugar.

Fioricet Warnings and The Fioricet ‘High’ and Abuse

Fioricet is a prescription medication used to relieve tension headaches. It works by relaxing muscle contractions that can result in mild to moderate head pain.

Fioricet is a combination of three ingredients: the pain reliever acetaminophen; butalbital, a barbiturate; and caffeine, a stimulant.

The Food and Drug Administration (FDA) approved Fioricet in 1984. Novartis Pharmaceuticals was the original manufacturer. In 2003, Watson Pharmaceuticals bought the rights to Fioricet (Watson is now known as Actavis).

Fioricet is currently available from many manufacturers as a generic.

The original formulation of Fioricet included 50 milligrams (mg) of butalbital, 40 mg of caffeine, and 325 mg of acetaminophen.

However, in 2011 the FDA asked makers of prescription combination drugs with acetaminophen to limit the amount of that drug to no more than 325 mg in each tablet by 2014. This action was taken to protect consumers from severe liver damage, a risk linked with taking too much acetaminophen.

Today Fioricet includes 320 mg of acetaminophen, though some versions of the product sold online still have 325 mg.

The Fioricet ‘High’ and Abuse

The butalbital in Fioricet belongs to a class of drugs called barbiturates, a central nervous system depressant. Like other barbiturates, it has the potential to cause physical and psychological dependence, which can lead to abuse.

Those who use too much Fioricet may report feeling so relaxed and stress-free that they seek out the drug as a way to get high. Some describe it as feeling intoxicated. However, users can feel depressed and “crash” once the effects wear off.

Fioricet with Codeine

Another formula, Fioricet with codeine, is also made by Actavis to treat tension headaches. It contains 30 mg of codeine in addition to the other three drugs, and has an increased acetaminophen dose of 325 mg.

Fioricet with codeine carries a black-box warning about liver toxicity, and about the risk of respiratory problems and death in children caused by codeine.

Fioricet Warnings

Fioricet carries a black-box warning cautioning users about the link of acetaminophen to acute liver failure. In some cases, users of Fioricet have needed a liver transplant; in other cases, use of Fioricet has proven fatal.

Most problems have occurred with an acetaminophen dose of more than 4,000 mg a day. Those affected are often taking more than one product containing acetaminophen at the same time or have underlying liver disease.

Another caution concerns butalbital, which may be habit-forming and therefore has the potential to be abused.

Those with a condition known as porphyria, a rare hereditary blood disorder, should not use Fioricet.

What’s in Fioricet?

Fioricet is a tablet which contains three active ingredients, including 325 mg acetaminophen, 50 mg butalbital, and 40 mg caffeine. The drug was approved by the Food and Drug Administration in 1984. But the FDA in 2011 advised drug manufacturers to limit acetaminophen to not more than 325 mg to prevent consumers from developing severe liver damage that was associated with too much acetaminophen.

Acetaminophen acts as a pain reliever and helps in reducing the patient’s fever. Butalbital, on the other hand, relaxes muscle contractions that develop in a tension headache. Similar to butalbital, caffeine, a widely used psychoactive drug, also helps patients to relax muscle contractions and improve blood flow.

The patients who used Fioricet reported varying effects. Some patients reportedly find it effective in managing migraine. A 50-year-old patient said she didn’t find any side effects whenever she used the drug at the onset of her migraine. She said the medicine works after about 20 minutes of taking Fioricet. However, a 34-year-old patient found it “considerably effective” and noted some moderate side effects after taking the drug.

The patient took one to two tablets of Fioricet every four hours for the six months. She said each time she takes more than one pill since she finds the first dose ineffective in improving migraine, she will feel very dizzy and will be incapacitated until the effect has worn off. Some patients also reported having the feeling of agitation, insomnia, withdrawal syndrome and hallucination after taking Fioricet.