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THE MUSCLE CONTRACTION (TENSION) HEADACHE
“We’ll be late!”
“The car won’t start.”
“What! He’s done it again!”
“No, Mother, I’d rather do it myself.”
“I have twelve chapters to read!”
“I hate going to work every day.”
“I’m so angry at my boss that I could explode!”
Do your headaches have a tendency to occur when you are under emotional stress? If they do, it is likely that you have concluded that you have “tension headaches.” But like other headaches, the condition called tension, or muscle contraction, headaches is terribly misunderstood, and the simple association between your headaches and stress does not alone qualify them for such a diagnosis. Many illnesses are provoked or worsened by emotional circumstances, and headaches of many types are triggered by stress, depression, and frustration.
Tension headache probably affects more people than any other type of headache. It is quite likely that the majority of day-to-day mild headaches, the kind that usually respond to a few aspirin, are due to muscle contraction. Most examples of this type of headache are so mild and easily treated with simple nonprescription analgesics that medical care is seldom sought. Our discussion will emphasize those muscle contraction headaches that are particularly persistent and unresponsive to simple analgesic therapy.
One factor that probably accounts for much of the misunderstanding that surrounds this disorder is the word “tension.” The word “tension” in “tension headache” does not refer to emotional tension at all, but to tension, or spasm, of muscle. To avoid the obvious confusion, we will refer to this type of headache as a muscle contraction headache, since the origin of pain in this condition comes from spasms, or contractions, of neck, face, and scalp muscles. While emotional factors, like tension, anxiety, and worry, can provoke these spasms, they are not the only events that can trigger this painful condition. In some examples of this disorder, emotional stress is absent.
In order to understand this muscle contraction headache better, it should be recalled that the skull rests on a column of bones called vertebrae. Like other bones, the vertebrae of the spine and neck are held in position by tendons, ligaments, and many layers of muscle. The muscles surrounding the vertebrae are called paraspinal muscles because they are located on the side (para-) of the vertebral spines. The spines of the vertebrae are the bony bumps you feel when running a finger up and down the center of your neck and back.
Paraspinal muscles in the region of the neck extend upward to join the base of the skull, overlapping other muscles running down the back of the neck and into the shoulders. These muscles support the vertebrae and skull and help control the movement of the head, neck, and shoulders.
The skull, forehead, and facial bones are also surrounded by thin layers of muscle, and these assist in moving the face, forehead, eyelids, nose, jaw, mouth, and, in a few people, the ears. Smiling, squinting, frowning, and the furrowing of your brow require the use of these muscles.
These muscles and most other muscles of the body are part of an elaborate fully automatic system of reflexes that help protect you against injury. Muscles play a critical role in this system; emotional as well as physical factors can trigger the automatic response.
When you suddenly sense danger, for example, muscles cause your pupils to dilate, your heart muscle increases its rate of contraction, and the muscles in the walls of some blood vessels loosen to allow more blood to flow into your muscles and brain; your entire body automatically prepares to defend itself against the danger with the use of muscles. These functions represent a physical response to, in the case of sensing danger, an emotional stimulus. Blushing when you are embarrassed or turning pale when fearful are additional examples of physical responses to emotional circumstances.
An automatic physical response can also occur as a result of a physical stimulus. For example, when a bone is fractured, the muscles around the injured bone will contract and “splint” the fracture and prevent movement and further injury. A similar response occurs when your appendix becomes swollen and inflamed, the condition called appendicitis. Abdominal muscles will contract tightly, making the abdomen rigid and protecting the organs inside the body.
These automatic muscle responses are protective. But, unfortunately, the contraction of some muscles, like those around the head, neck, and back, also produces pain. While the pain serves to protect by way of warning of possible injury and preventing the movement of injured joints, which might be harmful, very often the pain of the muscle contraction is more intense than the injury or the situation that caused the muscles to react.
Keep in mind that the muscles around the head and neck cannot discern between emotional pain and physical distress, and a “splinting” protective response may occur when either emotional or physical assault is perceived in the head and neck region.
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