If you are working a changing shift pattern, getting a good sleep routine can be difficult to say the least. We know that working night shifts disrupts our natural body clock, known as your circadian rhythm, which regulates many of our physiological processes. This is affected by environmental cues such as sunlight and temperature, which if you are working a changing and/or night shift pattern, are altered from the the natural rhythm and may affect your health.
Research* has shown that if you experience significant sleep loss, due working nights shifts for example, it may increase your risk of accidents at work, weight gain, type 2 diabetes and heart issues to name a few.
Setting an appropriate routine for getting good quality sleep is therefore vital to keeping healthy. Below is advice to help you get the best sleep pattern possible:
Based on the latest research* below you will find advice to optimise your sleep when working night shifts.
Day of first night shift – Minimise your sleep debt
Wake naturally, avoid a morning coffee and take a nap in the afternoon.
During your nigh shift – Improving your performance
Stay active during your shift, eat lightly and build in checks during your shift to make sure your critical tasks are not affected if you are feeling less alert.
Last few hours and on your way home
Try to avoid caffeinated drinks or smoking late into your shift or on your way home. Try to avoid sunlight by wearing sunglasses, even if its cloudy. Think twice about driving if tired. Opt for public transport if available.
On the days between your night shift – minimise your sleep debt
Try to get to sleep as early as possible and avoid sleep disruptions such as bright screens, alcohol – see also tips on improving sleep. Any sleep is better than none so don’t worry if it is broken sleep or short naps.
Resetting after night shifts – re-establishing a normal sleep rhythm
Try and get a nap immediately following your night shift then go outside when you have woken up. To get back into normal rhythm go to bed as close to a normal time and avoid napping during the day.
(* Research and supporting advice originally published by the British Medical Journal. March 2018)
Here are some useful tips and advice from theOsteopath to help you to get a good night’s sleep:
Create a routine
Try to get up in the morning and go to bed at the same time each day, even at weekends. You may need to set an alarm. Creating a sleep routine will help your body make the chemicals that control sleep. Having a sleep routine such as listening to soothing music or doing stretching or relaxation exercises before bed can also remind the body that it is time to slow down and sleep. Taking a warm bath before bed may help you to feel relaxed and sleepy, and try to avoid using your bedroom to watch television or work so that when you do go to bed, your body knows that it is time to sleep.
Avoid blue light before bed
Electronic devices such as televisions, tablets and computers produce a certain type of light called “blue light”. Blue light interferes with a chemical called melatonin which helps us sleep, and it can also reduce a type of sleep called slow-wave sleep which is essential for us to feel rested.
Blue light during the day, especially in the mornings and after lunch can be useful because it can make us feel more alert, but if we have too much blue light before bedtime then sleep can be disturbed, so avoid using a computer for long periods or watching too much television just before bed. Getting more natural rather than artificial light by going outdoors as much as possible during the day can also help increase daytime alertness and improve sleep quality.
Do some regular exercise but not too close to bedtime
Regular exercise, especially aerobic exercise which gets your heart beating faster, has been proven to improve the quality of sleep and just being more active during the day can also help improve sleep and fight fatigue. If you exercise too close to bedtime though, the exercise may make you feel more alert and this may disturb your sleep. Try to do some exercise in the early evening so that by bedtime you are ready to sleep.
Try to keep your mind blank
Many people who lie awake at night find that their minds are too active, for example thinking about worries, things that they need to remember or things that they have to do the following day. Some people also find that worrying about not sleeping then makes the problem worse.
Clearing your mind is not easy but trying to be more relaxed about not sleeping can help. Try to concentrate on feeling calm and comfortable rather than thinking about getting to sleep. If a good idea is keeping you awake, keep a pad and pencil next to your bed and just write down the idea so that you can forget about it until the morning. Try some slow breathing and just concentrate on the action of breathing, perhaps counting your breaths as the air moves in and out or try some progressive muscle relaxation – tense and relax each part of your body in turn starting with the toes and working upwards. Try visualising a relaxing place such as a wood or beach. Learning meditation or mindfulness and cognitive behavioural therapy (CBT) may also help to calm your thoughts.
If you are still awake after 15 minutes or so, try getting up and doing a light relaxing task such as having a warm drink, reading or listening to an audio book or quiet music then go back to bed when you feel sleepy again.
Avoid stimulants and alcohol
Coffee, tea, cola, cocoa, chocolate and some medicines contain caffeine and other stimulants which can disturb sleep. The effects of caffeine can last for many hours in the body so consider switching to decaffeinated drinks or avoid caffeine apart from in the morning. Alcohol may help you feel sleepy at night, but overall it will interfere with the quality of your sleep and prevent you from feeling rested when you wake up.
Avoid eating large meals late at night
A heavy meal before bed or too much spicy food at night can make it difficult to sleep, so consider how much you eat before bed. Herbal tea or a milky drink may help you relax but don’t drink too much before bed as this may mean you have to wake to go to the toilet at night.
Make your bedroom cool, dark and quiet
Sleep quality can be improved by sleeping in a slightly cooler room—around 17C is comfortable for most people, so make sure that you have enough, but not too much bedding. Opening a window at night may help. If you are disturbed by noise at night, consider wearing ear plugs and if you are woken by daylight, try a blackout blind.
Try not to have a nap during the day
If your sleep is disturbed at night, you may feel sleepy during the day, especially in the afternoon. If you fall asleep during the day, even a short nap can then disturb your sleep at night. If you have to have a short sleep, make sure that you go to bed and set an alarm clock so that you don’t sleep for too long – 15 to 20 minutes maximum, and not later than the early afternoon. If you find yourself dozing in the afternoons or evenings, try to get up and do something, perhaps go for a short walk or do something active to make you feel less sleepy. Daylight and or blue light from a tablet or computer can also increase alertness if you feel sleepy in the afternoon.
Medication
In general, taking medicines for long periods to improve sleep is not a good idea and lifestyle changes are much more helpful. Although medicines that help us sleep, they are not useful for long periods because they can be addictive, can stop working after a few days, or affect sleep quality.
Some prescription medicines can also affect sleep, such as some antidepressants, painkillers and betablockers, so it is worth discussing changing your medication with your GP if your tablets seem to be causing a problem.
Have you ever had a migraine attack that continues for days or even weeks and just won’t respond to treatment? Status migraine can leave us debilitated and bedridden, not knowing what to do to end the pain. Christina Treppendahl is the founder and director of The Headache Center, Mississippi. She is also an award-winning family nurse practitioner who specializes in headache, and frequently helps patients develop effective strategies to treat such stubborn attacks.
What is a status migraine?
Ms. Treppendahl: If a disabling migraine goes on for longer than 72 hours, perhaps for days and sometimes even weeks, it’s called status migraine, also known as status migrainosus, refractory migraine, or intractable migraine. It can occur with or without aura and is a prolonged exacerbation of a migraine attack, rather than a rebound headache, as when abortive medicines wear off and a migraine goes but then returns. In status attacks, a peripheral sensitization occurs, whereby neurons in the meninges send signals to the deep brain, causing it to autoplay ever more pain that the brain does not know how to shut off. Along with the pain, other symptoms like nausea, sensitivity to light, noise, and smell, and a disability to function or eat are also triggered. Unfortunately, because there are no diagnostic tests or biomarkers for migraine and all test results are likely to be normal, doctors not specializing in headache often either suspect the patient of fraud or diagnose a psychiatric condition. And so there’s a problem of stigma attached to migraine generally and to status migraine in particular.
How common is status migraine?
Ms. Treppendahl: In the U.S. about 12% of the general population are subject to migraine but only about 2% have chronic migraine. Although most status migraine patients have had chronic migraine, those with only episodic migraine can also have status migraine. However, we’ve never had a report of an epidemiological study looking at which patients with episodic or chronic migraine have been in status, or how many of them there are.
What treatment options are there?
Ms. Treppendahl: Almost everybody who has chronic or status migraine should be offered a preventive. Abortive medicines include both NSAIDs, such as ibuprofen or Aleve, that can be bought over the counter; and diclofenac, a prescription medicine with level A evidence that it works in migraine. Migraine-specific abortives include triptans and ergotamines. Dihydroergotamine (DHE) typically has to be given either intramuscularly, intravenously, or intranasally, and because it tends to make people a little nauseated, it’s less in fashion than the triptans. Neuromodulation devices are another option, and we will soon have gepants and ditans to provide more categories of attack medications. If any one treatment fails, I offer a combination of a triptan, plus an NSAID, plus a dopamine receptor antagonist. For a status migraine, the most effective treatment is either a dopamine receptor antagonist, like metoclopramide (brand name Reglan), given intravenously, or prochlorperazine. Actually, prochlorperazine is the winner, hands down, against all other medications studied for status migraine.
Watch the full interview to find out:
What is status migraine?
How common is status migraine?
How can someone with chronic migraine know if they’re having individual daily attacks or one prolonged status migraine?
How do low- and high-pressure headaches compare to status migraine?
Is medication overuse headache, or rebound headache, sometimes confused with status migraine?
Are some people more at risk for status migraine than others? What are some of the risk factors?
What is the importance of prevention of migraine, particularly for those prone to status migraine?
What can patients do when acute treatment fails?
Do patients with status migraine always need to go to the emergency room or urgent care, or is there a backup plan they can follow to self-treat at home?
What type of medical professionals are best suited for treating status migraine?
Sprains and strains to muscles and joints happen to all of us and for most they are a painful, but temporary reminder to be a little more careful. Prompt action can help your body to heal faster and may prevent further injury or prolonged pain.
Strained or ‘pulled’ muscles often happen when we over exert untrained muscles, train without properly warming up or try to go beyond a joint’s natural flexibility. Sometimes we feel the pain straight away, however some injuries might not cause pain until later on. What can you do?
Remember RICE (Relative rest, Ice, Compression and Elevation), using these can help to relieve the pain and start the healing process.
Relative rest: The first thing to do if you feel pain is to reduce the offending activity – pain is usually your body’s way of telling you that there is something wrong that needs your attention. It can be normal to feel a little sore after exercises for a day or two, but if it is more than this, pushing through the pain is rarely beneficial.
However, movement stimulates the healing process so stay as mobile as you comfortably can. Try to keep the joint moving through a comfortable range of motion, without forcing it to the point of pain. This will help to encourage blood flow and keep your joint flexible whilst it heals. This is particularly relevant for back pain as gentle exercise, such as walking, can help. You should slowly build your activity levels up as soon as your symptoms begin to resolve and as soon as you are able.
Ice: Cooling the area using an ice pack can help to reduce swelling and pain. Wrap a thin tea towel around the area so as to avoid direct skin contact and then apply the pack to the injured area for 10 – 15 minutes. You should repeat this several times per day for the first 72 hours. This will help to control inflammation, making it easier for your body to get blood and nutrients to the area and resolve the injured tissues.
Compression: Gently applying a compression dressing may help to temporarily support the injured joint and reduce swelling, though remove this immediately if there are signs that this is reducing the circulation to the area (numbness, pins and needles, the skin turning white or blue etc).
Elevation: If the injury is in the lower limb (knee or ankle), elevating the area a little can make it easier for your body drain fluids that might accumulate around the area, causing swelling. For example, if you’ve hurt your knee, sitting down with the knee raised on a low foot stool may ease your pain.
Seek medical attention. If you have pain that can’t be controlled with over the counter painkillers, can’t put weight on the injured limb, experience paralysis or loss of sensation or the swelling is very bad seek help from your local A&E department, urgent care centre or telephone 111 for advice.
If the pain or swelling fails to improve within a week, a visit to an osteopath may be beneficial. They will be able to assess the injury, advise you on the correct treatment and can provide some manual therapy which may help it get better faster.
Everyone knows the feeling after a bad night’s sleep, from irritability to unproductivity, but longer lasting sleep disruption can have a much more significant effect on both our mental wellbeing and our physical health. Regular poor sleep increases our risk of obesity, heart disease and diabetes, and can lead to shortened life expectancy.
Insomnia is so common that it now affects 1 in 3 people in the UK and every year 200,000 working days are lost to insufficient sleep. This amounts to an annual cost of 30 million pounds. Adults who sleep for fewer than 6 hours a night also have a 13% higher mortality risk than those who sleep for at least 7 hours and adults who sleep for less than 7 hours a day are also 30% more likely to be obese than those who sleep for 9 hours or more.
A number of factors can affect sleep, and not surprisingly if your are experiencing muscle and joint difficulties, it may affect the quality of your sleep. This sleep disruption can, in turn, make make managing your pain more difficult.
If you have difficulty sleeping, an. Osteopath can provides some useful information and advice to help you to get a better night’s sleep:
Looking after your mental health and wellbeing during lockdown
A lockdown in response to a pandemic will impact the daily lives of everyone. Protecting your physical and mental wellbeing is essential in helping to keep us safe, and adapting to rapidly changing times.
Each person will have a different response to the situation, and remember it’s okay to have feelings of stress, anxiety and sadness.
If you are experiencing stress, feelings of anxiety or low mood, use the NHS mental health and wellbeing advice website for self-assessment, audio guides and practical tools.
Every Mind Matters also provides simple tips and advice to start taking care of your mental health. If you are struggling after several weeks and it continues to affect your daily life, please contact NHS 111 – either online or by phone.
Connect. Consider how to stay in touch with friends and relatives via telephone calls, video or social media instead of meeting with them in person.
Help and support others. Think about how you can help support those around you.
Voice your worries. Feeling worried, scared or helpless is normal during lockdown circumstances. A lockdown is a difficult time for everyone, so sharing your worries can also help others.
Take care of your physical health. Mental wellbeing has a big impact on how we feel emotionally and physically. Taking decisions to have healthy behavioural patterns will help to manage stress and maintain wellbeing. Try to eat healthy, well-balanced meals, drink enough water, exercise inside where possible and outside once a day, and try to avoid smoking, alcohol and drugs.
Get good sleep. Maintaining regular sleeping patterns and keeping good sleep hygiene practices – such as avoiding screens before bed, cutting back on caffeine and creating a restful environment. The NHS Every Mind Matters sleep page provides practical advice on how to improve your sleep.
Manage difficult feelings. Acknowledging that under lockdown circumstances there may be some things that are out of our control will help to manage anxiety. Focus on things you can control, including where you get information from, and actions to make yourself feel better prepared.
Manage media and information intake. 24-hour news and constant social media updates can make you more worried. If it affects you, try to limit the time you spend watching, reading, or listening to media coverage.
Focus on the present. Focusing on the present moment, rather than worrying about the future or thinking about the past, can help to manage difficult emotions. Relaxation techniques and breathing exercises can help to reduce anxiety.
Latest news, events and updates from The Migraine Trust
Understanding and adjusting
We hope you are all safe and well. The change to our lives is affecting us in many ways. It is important to understand these changes as we can then start to manage them.
Here is some information that we hope will help you at this time.
We also want to say thank you for supporting the migraine community and our charity at this time. We can’t think of a time when the community has needed each other as much and it is wonderful to see so much support and solidarity at this very difficult time.
Migraine and stress
Our survey into the impact of Covid-19 on migraine found that a significant number of people’s migraine has worsened. The main reason that people attributed it to was stress.
A huge thank you to all the friends and family of people with migraine who have given something up for a month for the #GiveUpForMigraine campaign to support and show them solidarity.
There has been a fantastic response from friends and family, and there’s a great range of things that people are giving up. Simon is giving up processed sugar and sweet treats altogether for a month as his mother gets migraine. While Frances is very specific in what she is giving up – Rioja – as a close friend gets migraine. Thank you all!
Please encourage your friends and family to take part! You can find out more about the campaign and how to take part here.
Distinguishing what is and isn’t a trigger
Do you know what your migraine triggers are? It can be hard to identity them. Gemma Jolly, our Information and Support Services Manager, has written a blog about distinguishing what is and isn’t a migraine trigger.
Thanks for your support!
The pandemic has had a catastrophic effect on the UK’s charities with the cancellation of thousands of events and the loss of billions in income through fundraising events.
We have been affected by this with the cancellation and postponement of events. It has also coincided with an increase if demand for our support from people whose migraine has worsened and many who are struggling to access care and treatment.
That’s why we are so grateful to everyone who supported our recent appeal. There has been an incredible response which will help us continue our work.
If you’d like to support our appeal, you can make a donation here. Anything you can give would make a huge difference.
Save the date!
We are delighted that our Migraine Trust International Symposium (MTIS) will be taking place virtually this year. It will be taking place from 3-9 October.
This means that our MTIS Public Day will now take place on Sunday 11 October.
We are just finalising the programme and will share it and details about registering for a place in the next ebulletin, but save the date if you are interested in taking part!
New trustees
We are delighted to announce that we have four new trustees who bring a wealth of expertise about migraine into our charity.
They are leading migraine specialist Professor Peter Goadsby, Wendy Thomas, our former chief executive, Dr Kay Kennis and Dr Louise Rusk, who are both GPs with special interest in headache. You can read about their appointments and the first of a series of blogs about why they are joining the board and the key parts of our new strategy that they will champion here.
The holiday season can be a wonderful time of year when the spirit of giving connects us with our closest family and friends.
It can also be a minefield for migraine. For some, it’s a storm of triggers, stress, travel, and rich foods that completely overwhelm whatever threads of resilience remain against another migraine attack.
How can you navigate the holiday period with minimal migraine disruption? Below are a few suggestions and reminders:
The first thing you can start trying now is to get enough good quality sleep. The brain loves sleep, and having a couple good nights of rest (or as close to that as you can get) will only build up your resilience when heading into the holiday festivities. Improve your sleep hygiene and prepare for bed earlier.
2) Stock your treatments
Ensure you have enough of your treatment(s) as you need for the holiday period. Doctors and pharmacies close and may become harder to reach during the busy period. Make sure you stock up on what you need, and carry your treatments with you at all times. You might have three types of acute treatments on hand: one for the very first signs of a migraine attack, another for the onset of the attack, and a third if the attack does not respond to the first two interventions.
3) Know your limits
The holidays and travel can be a migraine pressure cooker. Travel, stress, food, smells, weather, loud noises, and crowds can put us all to the test. Be prepared to opt out of certain activities, foods, or responsibilities. Allow yourself time for breaks if needed. Manage people’s expectations in advance rather than making too many commitments ahead of time and placing more pressure on yourself.
4) Have a plan B
Be prepared if an attack does hit at the wrong time. Were you responsible for making the dessert? Have a backup option if you get wiped out with an attack and cannot deliver. Having a backup plan in place alone can reduce the stress of the holidays just by knowing someone has your back if you need them.
5) Know how to respond
By now you probably know what conversations, questions or comments may be made about you or your migraine attacks from certain family members. Anticipate these questions in advance and have your answers ready. Here are a few common ones, i.e.:
Question: “Isn’t migraine just a bad headache?”
Suggested response: “There are several phases to a migraine attack, many of which don’t involve head pain, such as nausea, vomiting, visual auras, temporary blindness, paralysis, motor weakness, and vertigo. Moderate to severe head pain is common but it is much more than that.”
Question: “I just take two painkillers for my headaches and I’m fine…Doesn’t that work for you?”
Suggested response: “Like epilepsy, autism, and other chronic disorders, migraine is experienced differently by different people. Some people respond to simple painkillers while others have spent thousands of dollars trying dozens of treatments and combinations seeking relief.”
Question: “Do you think maybe you’re just stressed?”
Suggested response: “Stress can set off many things but there are people who are highly stressed who don’t have migraine. Stress may be a contributing factor but it is not considered the primary cause of migraine. Migraine has a biological basis in our genes and environment.”
Many patients will come in saying “ I think I have a pinched or trapped nerve”. What exactly does this mean? What is a “pinched nerve”? Does a pinched nerve cause back pain? Is there really such a diagnosis? Well, yes and no.
In order to delve into this concept, we need to initially start with very simple terms, and a brief anatomy lesson. The human nervous system is broken down broadly into two parts. These are the central nervous system or CNS and the peripheral nervous system or PNS. The CNS is composed of the brain and spinal cord, which branches off into the spinal nerves, feeding the rest of the body. When these spinal nerves exit the spine, the PNS starts. Thousands of nerves exist in the human body, in essentially every body part; these nerves are all part of the PNS.
The biggest nerve in the human body is the sciatic nerve, which is formed in the pelvis from multiple spinal nerves, after they have exited the spine. Anatomically, the sciatic nerve travels down the leg, and can cause leg pain. Before the advent of modern technology, when people had nerve related leg pain or buttock pain, it was presumed that this was caused by compression or damage occurring to the sciatic nerve. The term “sciatica” was born based upon the above concept. With the advent of modern technology, and MRI in particular, we now know that this is incorrect. Although the sciatic nerve can, in fact, cause leg pain, and get compressed or “pinched” by the piriformis muscle in a region called the “sciatic notch” (a condition called piriformis syndrome), this is very rare. Sciatica, in over 95% of cases actually has nothing to do at all with a sciatic nerve problem or compression…aka “pinching”.
A far more common cause of nerve related arm or leg pain is compression of a spinal nerve. This condition is called “radiculopathy” . In most cases, “pinching” of a lumbar spinal nerve causes buttock and leg pain, and pinching of a cervical spinal nerve causes shoulder and arm pain.
How are pinched nerves identified by an Osteopath? In addition to obtaining an astute history of the patient’s symptoms, and performing a detailed physical examination, such as a complete neural examination other measures can be taken. Imaging studies such as X-ray or CT scan provide good detail of actual bony anatomy of the human body, but very poor visualization of soft tissues and nerves. The best test to visualize the spinal nerves is an MRI, and this is considered the “gold standard” imaging study that Osteopaths and Doctors prefer. MRI is performed with magnets, and this can interfere with the function of some medical devices such as pacemakers. If an MRI cannot be performed, a CT scan is often needed, usually in conjunction with an injection of dye into the spinal canal to visualize the spinal nerves. This dye injection procedure is called a “myelogram”.
In some cases a procedure called an electrodiagnostic study, or EMG/NCS, can assist Neurologists and Spinal surgeons in identifying the affected nerve. This is a neurologic test involving electrical discharges and small needles that are inserted into various muscles that can provide information on the actual function of the various nerves in the arm or leg where symptoms are located
. This test can also identify if nerves other than spinal nerves are responsible for the symptoms that are experienced anywhere in the arm or leg.
A commonly debatable topic is whether or not lumbar spinal nerves can cause back pain. Generally, it is accepted that they can, but usually just lateral of the midline, off to the right or left side of the spine. An area called the sacral sulcus, is often painful when spinal nerves are compressed. With severe compression and inflammation of the spinal nerves however, it is generally expected that symptoms will travel distally, down the arm or leg supplied by the respective nerve affected. This is called a “dermatomal pattern”.
Pinched spinal nerves can develop suddenly or gradually. Sudden compression usually occurs in the setting of an acute joint problem called a “herniated disc”, also discussed in more detail elsewhere. More gradual compression usually occurs over time due to bony changes that develop with the aging process and development of bony overgrowth and bone spurs. If there is narrowing in the spine in the areas where the nerves are located, this is called “stenosis”. If the center part of the spinal canal is stenotic, or narrowed, this is called central stenosis, and if the lateral part of the spine is narrowed, where the spinal nerves are trying to exit from the sides, this is called foraminal stenosis or lateral stenosis.
Gradually developing chronic pain and functional decline coming from the pinching of spinal nerves due to bony stenosis is generally considered to be surgical diagnosis. The pinching of spinal nerves from a sudden (or acute), soft disc herniation can often be treated non-surgically with avoidance of activities that cause pain, appropriate physical therapy, oral medications, and frequently x-ray guided (also known as fluoroscopically guided) selective nerve root blocks or epidural steroid injections at the area of irritation and inflammation.
Since the human body is generally so adaptable to changes that occur during the ageing process, often compressed, or pinched, spinal nerves are identified incidentally and do not cause any symptoms at all. It is natural for this compression to gradually develop during the ageing process. It is important to realise that unless a compressed nerve is causing symptoms such as severe pain, weakness, or numbness leading to longstanding functional changes, that no treatment is necessary. Although Osteopaths and Surgeons can address seemingly significant findings on a picture, we treat patients and not imaging studies. It is exceedingly rare that a patient with no symptoms will require any kind of aggressive interventions, such as spinal surgery.
Tension-type headache (TTH) is usually described as a pain that feels like a tight band round your head or a weight on top of it. Your neck or shoulder muscles may also hurt along with the headache. The pain can last from 30 minutes to several days, or may be continuous.
Tension-type headache can develop into chronic tension-type headache when it becomes more disabling.
Differences between tension-type headache and migraine
If you have TTH, it will produce a mild to moderate pain whereas the pain of migraine can reach disabling severity. Normal movement during everyday activities shouldn’t make TTH worse, unlike a migraine, which can be aggravated by movement. Table 1 (see end) shows the symptoms commonly associated with TTH and migraine.
There is an overlap in the triggers of migraine and TTH, as both may be brought on by stress or tiredness. Head and neck movements are important triggers in patients with TTH whereas hunger and odour were significantly common triggers in migraine.
Mixed headaches
You may hear the term ‘mixed headaches’ if you have migraines and tension-type headache. Medical experts believe this term has no useful place in modern practice. Patients with migraine may experience headaches that are mild and thus are labelled tension-type headache. This does not change the underlying problem and most such patients have migraine attacks that just differ in severity.
Tension-type headache triggers
The most common causes of TTH reported are anxiety, emotional stress, depression, poor posture, and lack of sleep, although the evidence for each of these (except stress) is poor.
Physical exhaustion is also a common cause of TTH, so make sure you are getting enough sleep.
Treating tension-type headache
Obviously removing the cause of headaches would be the best treatment. Over-the-counter painkillers such as ibuprofen, aspirin, paracetamol and naproxen are commonly used to treat TTH and remain the mainstay of treatment for TTH. It shouldn’t be necessary to take stronger medications. Using painkillers more than twice a week, however, can increase the risk of TTH developing into chronic daily headache. This occurs when ‘rebound headaches’ form as each dose of medication wears off, and is especially common if the painkillers contain caffeine or codeine.
Psychological factors affecting your headaches are hard to tackle. You may find it helpful to learn relaxation techniques, and avoid stressful situations as much as possible. If you find you can’t reduce, or even identify the causes of stress in your life, that may be triggering your headaches, you may find it beneficial to seek help from a psychotherapist or counsellor.
Different treatments for TTH work for different people, so if one thing doesn’t help try another. Discovering what works for you is the key.
If you are pregnant you should discuss use of any drugs (both prescribed and over the counter) with your doctor. Not all drugs are safe to use in pregnancy.
Chronic tension-type headache
Overusing painkillers to treat TTH can cause chronic daily headaches to develop. These headaches usually occur early in the morning, and their symptoms include: poor appetite, nausea, restlessness, irritability, memory or concentration problems, and depression. Chronic daily headache is usually resistant to painkillers, and most people with it experience migraines as well as an almost permanent TTH. The headache can vary in intensity, duration, and location, and the symptoms can be more severe than in people who have occasional TTH.
If you get chronic tension-type headache you are advised to see a neurologist or headache specialist.
Also, although it is hard to do, if painkiller overuse has caused you to develop chronic daily headache, you should try to withdraw from the painkillers slowly. The headaches will initially get worse, and can cause problems such as nausea, but the headache intensity and frequency will begin to reduce within two weeks after you finish the withdrawal.
Many people find when they realise that overuse is doing them more harm than good, that stopping painkillers is the best option. However, if you are at all concerned about your headaches, especially if they persist, you should seek medical advice.
Table 1 – Symptoms associated with tension-type headache and migraine
Tension-type headacheMigraineOccurs without warningOccurs after warning signs or auraPain more likely to be all overPain more likely to be one-sidedNo throbbingThrobbingNo nauseaNausea and/or vomitingNo light or noise sensitivityLight and/or noise sensitivityNo visual disturbancesVisual disturbancesRare to start during sleepNot uncommon to start during sleep
*These are typical symptoms, and may not apply to all people with TTH and migraine.
