Approximately ten percent of people with chronic tension headaches experience an occasional migraine headache superimposed on the tension headache. At this time, their headache worsens and they feel the throbbing pain of a vascular headache in addition to the steady, dull ache of the tension headache.
This is believed to be due to a vascular component in some tension headaches. Most combination headaches are free of aura displays but the symptoms of common migraine are superimposed on those of the tension headache. Such headaches are best treated as migraines until the migraine ends, at which time therapy should be resumed for the tension headache.
Sexual Headaches. Another combination variant is the Benign Sexual Headache. The headache appears in two ways; either as a steady ache starting a few minutes before orgasm; or as a pulsating headache that suddenly begins at or near climax. Either type of headache may persist for several hours.
Headache specialists have suggested that sexual headaches are due to a combination of muscle contraction and blood vessel dilation set off by a sudden increase in blood pressure resulting from the excitement and exertion. These headaches usually appear in middle-aged men who are overweight, sedentary and mildly hypertensive. After several months, they often disappear. Though physically harmless, a benign sexual headache can have a traumatic effect on a person’s love life.
Since a sexual headache could be confused with a stroke, you should consult a physician to confirm that the headache is actually benign. Your doctor may suggest a combination of exercise coupled with gradual weight loss to effectively lower blood pressure and overcome the headache.
TMJ Headaches. A fairly common variant of tension headache is due to the TMJ or Temporomandibular Joint Syndrome. People with deep anxiety often grind their teeth while asleep. This creates a painful spasm in face, neck and jaw muscles, particularly in the temporomandibular joint at the hinge of the jaw. Nerves refer the pain up to the forehead where it manifests as a headache in the temples and behind or below the eyes. A sign that a headache may be due to the TMJ syndrome is tenseness in the jaw on awakening and a reeling that the teeth have been tightly clenched.
The TMJ syndrome can often be relieved through relaxation or biofeedback naming (Chapter 8). Otherwise, one should consult a dentist, preferably a member of the American Association of Oral and Maxillofacial Surgeons. Dentists are generally more aware of the TMJ process than doctors, and most are equipped to solve the problem.
They do so by making a light acrylic splint to be worn between the teeth while asleep. By making the teeth mesh correctly, the splint relaxes the jaw muscles so that they remain unstressed throughout the night. This usually stops the headaches.