Mixed tension migraine

Definition

Mixed tension migraine is a headache with features of both tension and migraine headaches.

See also:

• Cluster headache
• Headache
• Migraine
• Tension headache

Alternative Names

Headache - mixed tension migraine

Causes, incidence, and risk factors

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. It is difficult to differentiate which symptoms are due to which type of headache. Women have mixed tension migraines more often than men.

Common triggers for these headaches are hormonal changes, dietary factors, environmental factors, stimulation, and stress. Examples include:

• Alcohol
• Bright light
• Food and food additives
• Missed or delayed meals
• Menstruation
• Odors
• Too much or too little sleep
• Use and withdrawal of certain drugs or medications

Symptoms

• 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 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

Signs and tests

Your doctor will perform a physical exam, including a detailed examination of your nervous system, and ask you about your symptoms and family history.

Tests that may be done include:

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

Treatment

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.

A headache diary can help you identify your headache triggers. When you get a headache, write down the day and time the pain began. The diary should include notes about what you ate and drank in the last 24 hours, how much you slept and when, and what was going on in your life immediately before the pain started. For example, were you under any unusual stress? Also include information about how long the headache lasted, and what made it stop.

Hot or cold showers or baths may relieve a headache for some people. 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 to relieve your pain and prevent further attacks.

For specific treatment information, see:

• Migraine
• Tension headache

Support Groups

Expectations (prognosis)

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

Complications

Pain medications only relieve headache symptoms for a short period of time. After a while, they do not work as well or the help they provide does not last as long. Regular, overuse of pain medications can lead to rebound headaches. Typically this occurs in people who take pain medications 3 or more times a week on a regular basis.

It's important to see a doctor if you have chronic headaches. In some cases, the headache may be a symptom of a more serious disorder.

Calling your health care provider

It is important to have a full medical and neurological exam if you suddenly have regular or severe headaches.

Call 911 or your local emergency number if:

• You are experiencing "the worst headache of your life"
• You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before
• Your headaches are more severe when lying down
• The headache starts very suddenly

Also, call your doctor if:

• Your headache patterns or pain change
• Treatments that once worked are no longer helpful
• You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
• You are pregnant or could become pregnant -- some medications should not be taken when pregnant

See the general headache article for more information on emergency symptoms.

Prevention

Tips for preventing headaches:

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

Medicine may be needed to prevent headaches.

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References

Silberstein SD, Young WB. Headache and facial pain. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, PA: WB Saunders; 2007:chap 53.

Wilson JF. In the clinic: migraine. Ann Intern Med. 2007;147(9):ITC11-1-ITC11-16.

Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008:7(1):70-83.