Muscle relaxants help ease tension headaches
Dear Doctor K: I get tension headaches. Overthe-counter pain relievers help, but not completely. What else can I try?
Answer: Tension headaches are the most common type of headache. They cause a dull tightness or pressure in a bandlike pattern across the forehead or in the back of the head. Sometimes the entire head hurts. (I’ve put an illustration of the typical tension headache pattern on my website, AskDoctorK.com.)
Tension headaches tend to cause mild or moderate pain. They’re generally not intense enough to keep you from functioning or to awaken you at night.
How do you distinguish tension headaches from another common cause of headache, migraines? Migraines have several features not seen with tension headaches; they tend to begin on just one side of the head, often around the eye, even though they may later spread to the whole head.
Migraines often are accompanied by nausea and sometimes vomiting. They typically cause a throbbing or pounding pain. Migraines often are pre- ceded or accompanied by changes in vision. You may see black spots or flashing lights, or just have blurry vision for a while.
Finally, people with migraines are often very sensitive to lights or noises, and want to rest in a quiet and dark place. Migraines don’t necessarily have all of these features, but they typically have at least one.
Tension headaches are caused by tightness in the muscles of the scalp and the back of the neck. For many people, an overthe-counter (OTC) painkiller such as ibuprofen is enough to banish the headache. But for others, OTC painkillers and even stronger prescription pain relievers don’t provide complete relief.
Painkillers can actually turn an occasional problem into a chronic one. That’s because both OTC and prescription pain relievers target only the symptom of tension headaches (pain); they don’t address the underlying cause (muscle tightness). Rely too much on pain relievers, and you may find that your tension headaches gradually increase in frequency. To make matters worse, frequent use of pain relievers may make other medications less effective at relieving your headaches.
That’s why targeting the root cause of tension headaches — muscle tightness — is a better strategy. A fast-acting but short-lived muscle relaxant such as carisoprodol (Soma, Vanadom) or metaxalone (Skelaxin) can loosen head and neck muscles. These drugs slow the functioning of your central nervous system, creating an overall calming effect.
Muscle relaxants don’t relieve pain any more effectively than OTC pain relievers, but they address the mechanism of the tension headache. So combining a muscle relaxant with a pain reliever can give good relief.
Muscle relaxants work quickly, within 15 to 30 minutes. Their effects last only three to four hours, but that’s enough, since tension headaches rarely continue for more than a few hours. If you decide to try a muscle relaxant, be aware that it may cause drowsiness and fatigue. But if your headaches are migraines, they are much less likely to respond to muscle relaxant treatments. Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK. com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.