Alternate Names: Headache - mixed tension migraine

Causes and Risks:

Migraine headaches are a common cause of headache affecting up to 16% of the general population. Likewise, tension headaches are even more common affecting about 40 % of the population. Women are more commonly afflicted than men. Sometimes 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. This may be a continuum with a varied clinical spectrum.

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.

Prevention: Prevention of headaches includes avoidance of triggers and maintaining adequate sleep, nutrition, diet and exercise. In some cases, preventetive medication may be required.

Symptoms:

Symptoms associated with mixed tension-migraine headache may include:

• Unilateral or bilateral headache
• throbbing
• dull, tight or band-like sensation
• pain varies in intensity from annoying to incapacitating
• may be aggravated by routine physical activity
• nausea or vomiting
• sensitivity to light or sound
• visual scintillations
• may last from 4-72 hours, however, may evolve into chronic daily headache
• irritability, depression
• sluggishness
• numbness, tingling, weakness
• neck pain

Signs and Tests:

If headaches have just started to occur regularly or if the intensity or symptoms of the headache are different from your previous experience of common headaches, it is important to have a full medical and neurological evaluation. Based on the history of symptoms and findings on physical examination, a physician will decide whether the history is classic for migraine-tension headache and requires symptomatic treatment, or whether further evaluation to rule out other causes of headache is necessary. These tests may include:

• a head and or neck CT or MRI
• blood tests
• lumbar puncture (spinal tap)

Treatment: Treatments include avoiding triggers if possible and reducing stress. It is important to eat a proper diet, exercise regularly and get adequate sleep. Pharmacologic therapy includes anti-inflammatory medications and over the counter analgesics such as ibuprofen and acetominophen. Some people benefit from ergot derivative drugs and triptans. If headaches become frequent and interfere in daily functioning, prophylactic medication may be given on a daily basis to prevent the onset of the headaches. Many medications can be used including beta blockers, calcium channel blockers, anti-convulsants and anti-depressants, depending on the type of headache and what proves effective for the particular person.

Prognosis: Prognosis is good if the headache symptoms can be brought under control by avoidance of triggers and pharmacological therapy.

Complications: Complications may occur from side-effects of medications. Rebound headaches may occur from overuse of medications. It is important to only use medication as directed.

Call your health care provider if you experience a new headache, a change in quality of a previous headache or difficult to manage symptoms of headaches.