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Definition:

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

See also:



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 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)


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:



Support Groups:



Expectations (prognosis):

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



Complications:

Rebound headaches -- headaches that keep coming back -- may occur from overuse of painkillers.

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.

See your health care provider if headaches are severe, persistent, recurrent, or are accompanied by other symptoms, including:

  • Drowsiness
  • Vision changes
  • Changes in movement or sensation
  • Seizures
  • Changes in alertness
  • Nausea
  • Vomiting

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



Prevention:

Tips for preventing headaches:

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

Medicine may be needed to prevent headaches.



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.




Review Date: 6/19/2008
Reviewed By: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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