Headache - mixed tension migraine

Migraine headaches affect millions of people. Tension headaches are even more common, affecting about 40% of the population. People with mixed tension migraine have features of both types of headaches and it is difficult to differentiate which symptoms are migrainous and which are tension related. Women are more commonly afflicted than men.

Common triggers for these headaches are hormonal changes, dietary factors, environmental factors, sensory stimuli, and stress. Examples include too much or too little sleep; missed or delayed meals; menstruation; alcohol; food and food additives; chemical and drug ingestion and withdrawal; light glare; and odors.

• Headache on one or both sides
  • Throbbing pain
  • May feel dull, tight, or like a band around the head
  • Pain varies from mild to severe
  • May get worse with activity
  • May last from 4-72 hours (in some people, the headaches may occur every day)
• Nausea or vomiting
• Sensitivity to light or sound
• Irritability
• Depression
• Sluggishness
• Numbness, tingling, weakness
• Neck pain

Your doctor will perform a physical exam and ask you about your symptoms. Tests that may be done include:

• CT or MRI of the head and neck
• Blood work
• Lumbar puncture (spinal tap)

Certain things may cause your headaches. For example, some people get headaches after drinking alcohol or eating certain foods. These are called triggers. You should identify your specific triggers and avoid them as much as possible.

It is important to follow a healthy lifestyle, get plenty of sleep, and to avoid stress as much as possible.

Over-the-counter medicines such as ibuprofen and acetaminophen may help. If your headaches are severe, your doctor may prescribe other medicines.

If your headaches become frequent and interfere in daily functioning, your doctor may prescribe medicine to take everyday to prevent them. Such medicines include beta blockers, calcium channel blockers, anticonvulsants, and antidepressants.

Avoiding triggers and taking the appropriate medicine can help manage headache symptoms in many people.

Rebound headaches may occur from overuse of medications. It is important to only use medication as directed.

It is important to have a full medical and neurological exam if you suddenly have regular headaches, if your headaches are more severe than in the past, or if new symptoms develop along with the headaches.

Also call your health care provider if your current treatment does not help your headaches.

Tips for preventing headaches:

• Avoid triggers
• Get enough sleep
• Eat a proper diet
• Exercise regularly

Medicine may be needed to prevent headaches.

Krusz JC. Tension-type headaches: what they are and how to treat them. Prim Care. June 1, 2004; 31(2): 293-311, vi.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 1187-1194.