My Doctor Online The Permanente Medical Group

Symptoms

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Tension headaches cause pain on both sides of the head in the area where your scalp muscles attach to the bones of the head. Tension headaches feature a dull ache or feeling of pressure which can feel like pounding. Tension headaches have the following features:

• Aching pain and tightness around the forehead, temples, or back of the head and neck.
• Sensation of a pressing, tightening band around the head.
• Sensitivity to lights or sound, but not both.
• Headache lasts from 30 minutes to 7 days.
• Can develop into chronic headaches.

Causes and Risk Factors

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We don't really know what causes tension headaches. We believe that the same things that cause migraines are likely to cause tension headaches but to a lesser extent. In fact, experts are beginning to believe that tension headaches are a mild form of migraine. Causes and risk factors for tension headaches include:

• Sleep apnea can cause tension headaches. If you wake up with a headache and experience frequent daytime sleepiness, talk to us. We can test you for sleep apnea which can be treated with a c-pap machine.
• Underlying anxiety and depression are significant triggers of tension headaches.
• Jaw and neck problems. Tension headaches may be caused by jaw clenching. Neck problems caused by arthritis or whiplash from an injury can also trigger these headaches.

Diagnosis

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Accurately diagnosing the cause of your headaches is important so that we can choose the most effective treatment. 

We diagnose your condition by asking you questions about your symptoms and past medical history, and performing a physical examination. This enables us to verify that your symptoms are not caused by a more serious underlying illness or condition.  

When we suspect another condition we may order a brain scan, such as a CT scan or MRI. We may recommend additional tests if:

• Headaches are a new problem.
• You have a change in your symptoms.
• Your exam indicates you may have another condition.

Some kinds of headaches, particularly chronic daily headaches, can be caused by depression. We will also evaluate you for depression during your examination.

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Treatments

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Home treatment

Tension headaches can be treated with:

• Ice or heat on the affected area
• Over-the-counter medications, such as aspirin, acetaminophen, or ibuprofen
• Rest

You may need to experiment to find out what works best for you when you have a tension headache.

Be careful to avoid daily use of any medication that contains caffeine, as this can lead to daily rebound headaches. If you find that you are taking medications on a frequent basis, schedule an appointment with us to make sure nothing more serious is causing your symptoms. 

Prescription medications

We may prescribe a daily medication if you have very frequent tension headaches. These drugs, which include blood pressure medications, antidepressants, and antiseizure medicines, will help to prevent your headaches.

Some headache medications are not recommended during pregnancy. If you are considering getting pregnant, or are currently pregnant and taking medications to control your headaches, please notify me so we can review these medications together.

When to seek treatment

Contact us about your headaches if:

• Your headaches are affecting your ability to lead a normal life.
• The pattern of your headaches is changing and becoming more frequent or more severe.
• You have new headache symptoms.

Prevention

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• The best way to prevent tension headaches is to understand the events or situations that seem to trigger them.
• If you can, minimize stress. Stress can make your back and neck muscles tense up which can cause tension headaches for some people. Use stress reduction techniques.
• Be aware of good body mechanics and avoid working or sitting in positions that may injure your neck. Make sure that your work station is ergonomically correct.
• Regular exercise can help minimize all kinds of headaches.
• We may prescribe a daily medication if you have very frequent tension headaches. These drugs, which include blood pressure medications, anti-depressants and anti-seizure medicines, help to prevent your headaches.
• Take a moment to listen to our Tension Headaches podcast.

Lifestlyle Changes and Management

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Commit to a healthy lifestyle

Many headaches can be prevented by committing to a healthy lifestyle that includes:

• A healthy diet
• Plenty of exercise
• Getting 8 hours of regular sleep
• Minimizing stress

Use an online program

Our online health coach has programs that can help you lose weight, eat more healthy foods, quit smoking, and manage stress. Please refer to our Managing Your Headaches program for detailed information about everyday changes you can make to help reduce and control your headaches.

Manage anxiety and depression

Anxiety and depression can be underlying causes of headaches. Our online video, Understanding Depression, can help you evaluate your own symptoms to see if depression may be a factor. Contact us if you think you need to be evaluated or treated for depression.

Find a support group

Find, or create, your own headache support group. We have headache management classes at many of our medical centers in Northern California. A number of community headache organizations also have online or in-person support groups for headache sufferers. 

Your Care with Me

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Most headaches can be treated at home with over-the-counter pain relievers. If you have regular headaches that do not respond to these medications, or if you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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