Consejos para familiares y:o cuidadores de pacientes con demencia

Tips for caregivers of patients with dementia

Caring for individuals affected by dementia is a complex responsibility that covers the initial phases up to the advanced stages of the disease. In this context, training for caregivers becomes a fundamental cornerstone for delivering comprehensive and high-quality care.

A deep understanding of the various stages of dementia is crucial for planning, ensuring home safety, and managing daily routines effectively. To address the unique challenges of each stage, caregivers need specialized skills. The caregiver’s self-care, occasionally overlooked, proves to be a vital element, not only for preventing caregiver burnout but also for enhancing the well-being of the person in their care. Prioritizing ongoing training and personal well-being reinforces the caregiver’s abilities, promoting a healthier environment, and is vital for providing enduring care over time.

Here are some guidance tips to aid caregivers in managing critical aspects of care, thereby improving the quality of life for both the affected individual and themselves.

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Guidelines on how to care for someone with dementia

Future Planning:

Following a dementia diagnosis, proactive future planning becomes crucial. As driving abilities are expected to decline, consulting with professionals is advisable to determine the appropriate time to cease driving. Engaging in open conversations about preferences, particularly concerning end-of-life matters, facilitates informed decisions in the future. Anticipating housing transitions, especially for those living alone, involves evaluating suitable assisted living arrangements. Designating a power of attorney in the early stages allows for effective decision-making on behalf of the patient when needed. Moreover, given the increasing complexity of financial management as the disease progresses, careful financial planning is also essential.

Safety:

Ensuring home safety is vital to prevent accidents. Improving indoor safety involves measures such as maintaining clear hallways and ensuring adequate lighting. To enhance outdoor safety, consider installing alarms on doors and windows, providing patients with GPS devices, and issuing identification cards. These measures collectively contribute to comprehensive safety both inside and outside the home.

Daily Activities:

Scheduling activities during the person’s most alert periods and maintaining a routine are crucial practices to enhance the quality of life. Within these daily activities, vital self-care actions such as personal hygiene and grooming are integrated, playing a fundamental role in ensuring the physical and emotional well-being of the individual. Moreover, activities beyond self-care, including leisure, socialization, and cognitive stimulation, are incorporated. These activities contribute to sustaining vitality, fostering social connections, and promoting mental health, thus adding an enriching component to daily routines. It is important to emphasize that, despite seeking stimulation through these activities, achieving a proper balance is essential, as excessive stimulation can be stressful and fatiguing for the patient.

Toilet Routine:

In the early stages, encouraging consistent bathroom visits and limiting liquid intake before bedtime can help reduce accidents. As the condition advances, the use of absorbent pads or diapers becomes a common and practical approach.

Quality Sleep:

Quality sleep is essential for overall well-being. To achieve this, it is advisable to refrain from daytime napping, establish consistent sleep schedules, and manage environmental factors such as noise, lighting, and temperature.

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Personalized Nutritional Care:

Ensuring adequate nutrition is essential in all stages of the disease. In the early stages, establishing a meal routine with smaller portions to maintain a consistent intake of nutrients and adjusting food textures based on chewing capacity is recommended. As the disease progresses, modifying the consistency of food, opting for softer or pureed options, not only ensures proper nutrition but also reduces the risks of choking or aspiration. Research supports the benefits of the Mediterranean diet in dementia, emphasizing the consumption of vegetables, berries, whole grains, fish, poultry, legumes, and nuts, along with the use of olive oil. This diet restricts the intake of red meat, sweets, processed foods, and alcohol. Regular monitoring of weight is crucial to ensure proper nutrient intake. In case of significant weight loss, seeking guidance from healthcare professionals is essential.

Physical Health in Advanced Stages of Dementia

In the advanced stages of dementia, the condition instigates a series of physical changes that impact both mobility and the overall health of the individual. The following addresses various aspects of this process:

  • Reduced Mobility: In the advanced stages, there is a significant decline in the ability to move, and this limitation is often multifactorial. The progressive loss of functions related to walking, standing, and transitioning from a chair or bed is a common and multifaceted challenge. Contributing factors encompass specific medications for dementia, underlying medical conditions, visual impairment, balance issues, and environments that are not adapted for the individual's needs.
  • Pressure Ulcers: The decreased mobility significantly heightens the risk of developing pressure ulcers, commonly known as bedsores. To prevent their occurrence, it is imperative to consistently change positions, maintain clean and dry skin, and regularly inspect for skin rashes or sores. Seeking guidance from healthcare professionals, such as doctors or community nurses, may result in recommendations, such as the use of specialized mattresses and cushions to alleviate pressure. Additionally, professionals may suggest specific treatments for pressure ulcers, tailored to the individual's condition.
  • Blood Clots: Limited mobility poses an increased risk of infections and blood clots. Encouraging and supporting movement, be it through walks or chair exercises, is crucial. Occupational therapists and physiotherapists can provide advice on equipment and adaptations to facilitate improved mobility.
  • Health Issues Linked to Infections: Physical well-being in these stages is also shaped by concerns such as infections, particularly urinary tract infections (UTIs), known to cause confusion and alterations in consciousness. Given the communication hurdles at this point, closely monitoring changes in behavior becomes imperative for promptly detecting potential health issues.
  • Pain Management: Despite the progression of dementia into advanced stages, individuals may still experience pain associated with factors such as aging, immobility, and other age-related conditions like osteoarthritis. The challenge lies in the inability to verbally express this pain, leading to the manifestation of unusual behaviors. Insufficient pain medication is a prevalent issue, and conditions like urinary tract infections and arthritis can often contribute to discomfort. Addressing this pain through a holistic approach to pain management, including medications and non-pharmacological methods such as massages, becomes essential for comprehensive care.
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Communication in Dementia

As dementia affects the ability to remember and express, the caregiver plays an active role in initiating conversations. Active participation of the affected person in conversations is essential. The active participation of the affected person in conversations is essential. Avoiding mockery and recognizing comments, even if they appear out of context, is essential for fostering a respectful and communicative environment.

Navigating the advanced stages of dementia, where verbal communication wanes, non-verbal signals assume greater significance. Behavioral changes become a key avenue for expressing needs and emotions. Aggression may result from pain or perceived threats, while distress or agitation may indicate confusion. Recognizing these behaviors as responses to unmet needs is crucial for effective intervention. Sudden changes hinting at confusion and agitation may signal underlying medical issues. Such situations warrant consultation with healthcare professionals.

Maintaining patience, a positive tone, and friendly gestures adapted to the individual’s level create a comfortable and non-intimidating environment. This approach promotes more effective communication and understanding of individual needs, thus fostering comprehensive care in the context of dementia.

Addressing Difficult Behaviors

Providing care for individuals exhibiting challenging behaviors in dementia places a strain on caregivers both physically and mentally. Recognizing these behaviors as unintentional, adapting to situations, and taking a step back during moments of frustration contribute to emotional recovery. Stressing the significance of avoiding resentment in aggressive situations underscores the need to seek support for emotional processing. Engaging in conversations with fellow caregivers, professionals, or friends not only provides valuable perspectives but also offers emotional relief.

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Caring for someone with dementia is a complex task that spans from early to advanced stages. It involves meticulous planning, ensuring home safety, and skillfully managing daily routines, including handling challenging behaviors. Ongoing training and seeking support are crucial for caregivers, fostering continuous improvement. Effective communication and a nuanced understanding of behavioral changes significantly elevate the quality of care.

Maintaining a delicate balance to avert burnout is paramount. Often undervalued but indispensable, self-care involves allocating time for rest and incorporating regular breaks, serving as a preventive measure against caregiver burnout. Prioritizing well-being not only fortifies the caregiver’s resilience but also contributes to cultivating a healthier environment, essential for sustaining a high standard of care over time.

About the author:

María Isabel Zamora is a physician with a double specialty in Psychiatry and Neurology. She has experience in the care of patients in general psychiatry consultations, and in a more specialized way, in the care of patients who combine psychiatric and neurological symptoms. She has worked with psychogeriatric patients and patients with functional diversity. She has experience in cognitive impairment, psychological and behavioral symptoms of dementia, psychiatric symptoms related to neurological disorders or chronic pain, autism, ADHD, adaptive disorders, depression, anxiety, addictions, bipolar disorder, obsessive-compulsive disorder, sleep disorders, eating disorders, etc.

Dra. María Isabel Zamora
Division of Medicine
Dra. María Isabel Zamora
Psychiatrist
Adults and adolescents
Languages: English, French and Spanish
See Resumé

Autonomy in dementia

Dementia And Autonomy

Driving

Operating a vehicle involves cognitive and motor skills, and although it becomes automatic for many drivers, giving up driving can be challenging for someone with dementia. When the loss of abilities jeopardizes safety, ceasing to drive becomes crucial. Some individuals recognize the need to do so themselves, but others may resist. Communicating the necessity of giving up driving becomes a challenge for family members, as some affected individuals may show resistance or denial.

At what point should a person with Alzheimer’s stop driving? Although the diagnosis of cognitive impairment doesn’t require an immediate cessation of driving, the gradual decline in skills will make relinquishing it inevitable at some point. It is advised to watch for warning signs such as disorientation, confusion while driving, or slow decision-making. Giving up driving can be difficult, but addressing the issue with empathy and proposing alternative transportation can make it more manageable. Safety should prevail, and in extreme cases, measures like hiding the car keys or selling the vehicle may be necessary.

Living at Home with Dementia

In the early stages of dementia, many people can continue living at home and enjoy life much like before their diagnosis. After receiving a diagnosis of cognitive impairmente, professionals provide advice on how to continue doing what is important for the person for as long as possible. They also offer information about resources and services that could be helpful.

As the disease progresses, it may become more challenging for individuals to take care of themselves and their homes. At that point, they may need additional help with daily activities such as household chores, shopping, etc. They may also require home adaptations.

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Home Adaptations

The importance of making progressive adaptations in the home of a person with Alzheimer’s lies in preventing accidents, mitigating cognitive difficulties, and reducing physical limitations. These changes not only serve the purpose of maintaining a safe environment but also contribute to preserving a familiar and cozy space. By adapting the living space, a friendlier and more accessible environment is created, allowing the person with dementia to maintain a sense of familiarity and comfort in their daily surroundings. This approach not only helps reduce the anxiety and stress associated with the disease but also enhances the quality of life for the affected individual and facilitates the work of caregivers.

Keeping the home organized and comfortable, with spatiotemporal references, benefits both the patient and the caregiver. These adjustments will be implemented gradually as specific issues arise. Measures to reduce risks include removing carpets, getting rid of lightweight furniture, being cautious with slippery floors, and securing doors and windows. It’s also important to ensure good lighting, and mark stairs.

In the kitchen, it’s suggested to label cabinets and use safe utensils. In the bathroom, replacing the bathtub with a shower, using non-slip mats, and installing support bars are recommended. In the bedroom, organizing commonly used items, securing items that can fall, and using appropriate lighting are essential. As the disease progresses, railings can be incorporated into the bed.

Ensuring a safe environment in the home of a person with dementia involves careful adjustments.

Here are some recommendations to help you adjust to your new destination:

  • Integrate visual indicators of time and space, such as clocks and calendars in plain sight, along with opening blinds to distinguish between day and night.
  • Signal rooms and label cabinets with visual aids.
  • Maintain good visibility with proper lighting and install handrails and lighting on stairs.
  • Remove rugs and cables that may cause tripping.
  • Install locks on doors and windows.
  • Exercise caution with hazardous items like stoves and fireplaces. Secure sharp and small objects. Monitor medications, matches, lighters, and cleaning products, ensuring they are stored in safe places.
  • In the kitchen, clearly mark the off position on controls, install smoke detectors, and use durable tableware.
  • In the bathroom, replace the bathtub with a shower, use non-slip mats, and install support bars.
  • In the bedroom, place switches and guiding lights toward the bathroom. Install a bell near the bed and consider railings as the disease progresses.
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Aids for Daily Life:

Aids for daily life are key elements to assist people with dementia in their everyday activities. These include:

  • Clocks displaying day, date, and time: Facilitate orientation.
  • Phones with large buttons: Programmable with frequently used numbers.
  • GPS devices: Provide patients with freedom to encourage their autonomy in safety, offering caregivers real-time location.
  • Specialized dementia applications: Include cognitive stimulation exercises, digital photo albums, and aids for reminiscence. Some also offer features like alarms, note-taking, and reminders, assisting in medication management and appointment alerts.
  • Voice-controlled virtual assistants: Promote independence by providing medication reminders and answers to questions about the weather or train schedules.
  • Teleassistance button.

Seeking Support According to Needs:

In Spain, there are various social services and resources available for people with dementia and their families. Some of these resources include:

Associations:

Organizations such as the Spanish Confederation of Associations of Family Members of People with Alzheimer’s and other Dementias or the Alzheimer Spain Foundation provide information, support, and resources for people with dementia and their families.

Recognition of the degree of disability and of the situation of dependency:

It is important to consider that access to measures, rights, benefits, resources, aids, adaptations, and other benefits for people with dementia and their family caregivers is subject to compliance with certain «access requirements.» These requirements may cover aspects such as age, gender, income level, years of previous contributions, among others, depending on the scope and type of provision or resource.

  • Recognition of the degree of disability: Allows obtaining certification of the degree of disability. If this is 33% or more, it officially grants the status of a "person with a disability." This enables access to benefits, aids, and resources in different systems, such as Health, Education, Employment, Social Services, Transport, Housing, Taxation, among others, as long as the other specific access requirements for each case are met (age, gender, etc.).
  • Recognition of the situation of dependency: This procedure determines whether the person is dependent and to what degree (moderate, severe, or high dependency). The recognition of a specific degree, along with other access requirements established for each case, allows access to specific benefits and services of the System for Autonomy and Care for Dependency, as established in Law 39/2006 on the Promotion of Personal Autonomy and Care for people in a situation of dependency. These services include residence, home care, daytime care, economic benefits linked to services, economic benefit for care in the family environment, support for non-professional caregivers, economic benefit for personal assistance, among others.

Teleassistance:

The red teleassistance button is not limited to being a simple emergency device; it serves as the assistant for older people, playing a crucial role in promoting autonomy and preventing dependence.

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Day Centers

Many localities have day centers specialized in caring for people with dementia. These centers offer activities and care during the day, allowing families to balance care with other responsibilities.

Respite Care

Some Day Centers and Care Homes offer respite programs for caregiver family members, providing temporary relief through professional caregivers.

Care Homes

There are nursing homes specialized in the care of people with dementia. These homes offer 24-hour care, medical services, and adapted activities.

It is important to consult with local social services and specialized associations for specific information on available aids in each region. Additionally, social workers can provide guidance on resources available to meet individual needs.

Dementia challenges autonomy in various aspects, such as driving and daily life at home. It is necessary to find the right balance between safety and autonomy. Home adaptation becomes essential to create a safe and familiar environment, allowing the person to maintain their functioning. The use of aids for daily life, such as adapted clocks and teleassistance devices, stands out as support to maintain independence. Finding support through associations and local services is essential to provide guidance and support to both patients and their families. This support emerges as an essential pillar to address the disease with greater support and understanding, while simultaneously promoting the patient’s autonomy.

About the author

María Isabel Zamora is a physician with a double specialty in Psychiatry and Neurology. She has experience in the care of patients in general psychiatry consultations, and in a more specialized way, in the care of patients who combine psychiatric and neurological symptoms. She has worked with psychogeriatric patients and patients with functional diversity. She has experience in cognitive impairment, psychological and behavioral symptoms of dementia, psychiatric symptoms related to neurological disorders or chronic pain, autism, ADHD, adaptive disorders, depression, anxiety, addictions, bipolar disorder, obsessive-compulsive disorder, sleep disorders, eating disorders, etc.

Dra. María Isabel Zamora
Division of Medicine
Dra. María Isabel Zamora
Psychiatrist
Adults and adolescents
Languages: English, French and Spanish
See Resumé

Psychological and behavioral symptoms of dementia

Psychological and behavioral symptoms of dementia

People are living for longer, and it is therefore increasingly likely to know someone affected by dementia. In Spain there are more than 700,000 cases and this number is expected to rise in the coming years, due to the aging of the population.

Cognitive impairment (dementia) is disabling for those affected by it, and is devastating for the family members and caregivers. It is one of the main causes of disability and dependence in the elderly.

It is easy to suspect dementia when there are memory lapses or disorientation, but it is more challenging when the main symptoms are only changes are in character or in behavior.

Behavioral and Psychological Symptoms of Dementia

The term Behavioral and Psychological Symptoms of Dementia (BPSD) is used to define the behavioral reactions and psychological symptoms that occur in people with cognitive impairment of any origin. They are frequent and may be due to the cognitive impairment itself, or they can be the consequence of intercurrent medical, psychological or environmental condition.

Behavioral symptoms can be identified through observation, while psychological symptoms are identified through interaction with the affected person. It is typically the caregiver or the family member who identifies the psychological symptoms.

Different Behavioral and Psychological Symptoms of Dementia are described below:

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  • Depression: Individuals appear sad and dull, and may express feelings of being a burden.
  • Irritability: Individuals may be moody, impatient and intolerant. They may overreact or lose temper with trivial things.
  • Fear: Individuals feel unconfident, apprehensive, or insecure
  • Anxiety: Internal tension, which does not allow to be calm.
  • Restlessness: Inability to stand still due to anxiety and internal tension.
  • Nervousness: Restlessness as a consequence of anxiety and internal tension.
  • Agitation: Individuals feel intensely restless and worried, and are unable to calm down. They may react aggressively.

Aggression

  • Verbal: They may insult, threaten or raise their tone.
  • Physical
    • Against people: They may hit, push or spit on other people.
    • Against objects: They may throw things, slam the door, hit furniture or other objects, etc.
  • Oppositionism: They present aggressive resistance to basic activities such as grooming, eating or dressing.
  • Apathy: Loss of interest and motivation. There is lack of excitement and enthusiasm.
  • Changes in eating behavior:
    • Loss of appetite: Loss of the drive to eat.
    • Increased appetite: There is an increased desire for food.
    • Hyperphagia: Eating more food than necessary. Binge eating. Individuals may put excessive food into their mouth, which can induce choking.
    • Hyperorality: Individuals have hyperphagia and may want to eat unhealthy foods, limited food groups (typically carbohydrates), or even inedible material.
  • Sleep changes: Different sleep changes may appear in people with dementia.
    • Hypersomnia: There is excessive sleepiness.
    • Insomnia: There is lack of sleep.
    • Fragmented sleep: Sleep is interrupted and discontinuous due to awakenings.
    • Loss of sleep-wake cycle: This is when the biological clock is not synchronized with the environment. In the extreme case in which there is a total inversion of the biological rhythm, the individuals are sleepy during the day and active at night.
    • REM sleep behavioral disturbance: Affected individuals move, talk and live out their dreams, sometimes in a violent manner (kicking, punching or screaming). Unintentional harm to the bed partner or self harm can occur. REM sleep behavioral disturbance is usually suspected by a third party.
  • Personality or character change: Individuals may lose their essence, and act in a way that is different to the old self. They can appear more fearful and insecure or, on the contrary, more impolite and ruder. Being more impatient, distrustful, rigid, insensitive, or apathetic than usual are other possible personality changes.
  • Cognitive rigidity: Individuals become less and less mentally flexible and show little ability to adapt to circumstances or changes of routine. They want things to be done their way.
  • Loss of empathy: Individuals lose interest in the feelings of others and may show superficial emotion.
  • Loss of social cognition: Individuals lose the sense of social values and the ability to adapt to the social world. They may steal food from other people’s plate, or may use their fingers to eat. They may appropriate other people’s belonging.
  • Impulsivity: Lack of foresight or social tact in language, body language or other behaviors.

Disinhibition

  • Behavioral disinhibition:
    • Repetitive compulsive behaviors.
    • Sexual disinhibition behaviors: Increased sexual behavior with loss of modesty.
  • Disinhibition of thoughts:
    • Becoming more extroverted and impulsive.
    • Making comments that are out of place or socially inappropriate.
    • Using inappropriate language.
  • Lack of judgment: Loss of the ability to make decisions. Individuals lose the capacity to take into account and to evaluate different factors that are necessary for decision making.

Delusions

Erroneous beliefs that are tenaciously hold without evidence to support them. Things are not perceived as they are.

  • Persecutory delusion: Individuals are preoccupied that they are being conspired against, followed or harmed.
  • Delusion of poisoning: Believing that they are being poisoned, typically through food or medication.
  • Delusional misidentification:
    • Typically believing that the identity of a loved one has been supplanted by an impostor. This type of misidentification is called Capgras syndrome.
    • Not identifying their home as theirs, and thinking it is someone else's home.
  • Jealousy delusion: Believing that the partner or lover is unfaithful.
  • Delusion of theft: Individuals believe they are being robbed because they cannot locate their belongings.

Hallucinations

Perceptions that involve the senses, in the absence of external stimuli. They are felt like real, but cannot be confirmed by anyone else. They can cause positive or negative experiences. There are different types of hallucinations:

  • Visual: Individuals perceive images of something that is not there. Misidentifying an object for a person or for an animal can be a mistake instead of a hallucination, typically in the context of low vision.
  • Auditory: The person hears something that is not real. It can be a voice, a sound, a melody...
  • Olfactory: The person perceives a smell that cannot be confirmed by anyone else.
  • Tactile: Individuals experience tactile sensations through the body without anything touching them. They may feel bugs crawling around them or feel pressure on their skin or organs.
  • Childish attitude: Seemingly childish behaviors: tantrums, outbursts, opposition, irrationality, manipulation.
  • Follower behaviors of the caregiver: Following the caregiver like a shadow. Search for constant attention, security and comfort.
  • Wandering: Individuals roam around and can potentially get lost. In people with physical or balance limitations, there is also a risk of fall.
  • Repeated and stereotyped actions
    • Vocalizations: utterances that are typically repetitive and loud. They can consist of sounds, words or small phrases.
    • Repeated actions such as repeatedly taking off the belt or moving things around.
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It is important to acknowledge that dementia is not only memory loss and disorientation. There are in fact many other symptoms that are very frequent and can be even more disabling than amnesia itself.

Recognizing the Behavioral and Psychological Symptoms of Dementia is key to early identification of cognitive impairment and to prompt intervention. It is also essential to guide and support family members and caregivers in the management of the affected persons.

About the author

María Isabel Zamora is a physician with a double specialty in Psychiatry and Neurology. She has experience in the care of patients in general psychiatry consultations, and in a more specialized way, in the care of patients who combine psychiatric and neurological symptoms. She has worked with psychogeriatric patients and patients with functional diversity. She has experience in cognitive impairment, psychological and behavioral symptoms of dementia, psychiatric symptoms related to neurological disorders or chronic pain, autism, ADHD, adaptive disorders, depression, anxiety, addictions, bipolar disorder, obsessive-compulsive disorder, sleep disorders, eating disorders, etc.

Dra. María Isabel Zamora
Division of Medicine
Dra. María Isabel Zamora
Psychiatrist
Adults and adolescents
Languages: English, French and Spanish
See Resumé

Cefalea tensional- ¿Por estrés o problema neurológico?

Tension-type headaches: Stress or neurological problem?

Tension-type headaches are common and can significantly decrease one’s quality of life. Although it is a neurological condition, it has been related to stress, anxiety, and depression. In the last decades, an increase in frequency has been observed. It is therefore useful to learn more about them in order to treat them early and prevent them.

This article will help you recognise the typical features and learn about the possible causes, the treatment options and the way to prevent them through stress management.

What is a tension-type headache?

It is the most common type of headache amongst people. It has been related to stress and anxiety, although its exact mechanism is still yet to be understood. Other name: Stress headache.

How does a tension-type headache hurt? The pain feels like a pressure on both sides of the head, as if an elastic band were squeezing the entire head. Unlike a migraine, the pain is not so much throbbing, but rather continuous and persistent. The intensity may be mild to moderate, and the duration is variable, lasting from hours to days.

Depending on their frequency and duration, they are divided into two subtypes. Episodic headaches, which occur for less than 15 days in a month, and chronic headaches, which are present for more than 15 days in a month.

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Causes of tension-type headaches:

  • They have been related to anxiety, stress, and depression, but psychological disorders are not the only possible explanation, as they have also been related to local problems and genetic factors.
  • It is therefore reasonable to wonder if they are of neurological nature or, instead, if they are due to psychological origin.
  • The reasonable answer would be that, behind the neurological mechanisms implicated, there is most certainly a strong influence of the underlying psychological factors.
  • In tension-type headaches, the muscles surrounding the skull are characteristically tense, and this is typically due to internal psychological tension. As the muscles are constantly activated, they end up becoming more sensitive to stimuli and, by this, previously innocuous stimuli can become painful.
  • Other times, muscle tension is due to visual fatigue or to local issues such as neck pain or temporomandibular joint disorders. In these cases, something similar occurs. From the sustained tension due to overexertion or discomfort, the pain receptors of the muscles end up being sensitized, resulting in an increased perception of pain.
  • On the other hand, there are also pain processing centers in the brain that are implicated in pain regulation. It is suspected that affective disorders can alter the functioning of these control centers and, thereby, pain sensitivity may also increase.

Some of the triggers of tension-type headaches: Fatigue, hunger, poor sleep, neck pain, bruxism (teeth grinding), maintained inadequate postures, insufficient hydration, toxic substances such as tobacco, alcohol, or caffeine.

How is tension-type headache diagnosed?

Physicians are generally able to diagnose tension-type headache through medical history. Physical and neurological examination helps them rule out other conditions, and brain imagery such as Computed Tomography or MRI can help clarify uncertain cases. Doctors ask over features, location, duration, intensity and frequency of pain. They also ask for symptoms of other conditions such as vision problems, language, sensitivity, and mobility disturbances, which are not typical of tension-type headache.

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When to consult a doctor?

Call 112 in case of headache of sudden and severe onset. Also, if it comes with weakness or numbness of the face, arm, or leg, or if there is difficulty in walking, seeing, speaking or understanding.

It is recommended to schedule an appointment when headaches are not relieved with usual medication, when they interfere with daily life, or when there are changes in the features. In most cases, General Practitioners are familiar with tension-type headaches, although the specialists are the Neurologists. When major affective disorders are suspected at the origin, an assessment by a psychiatrist or a psychologist is advised, to treat them. At Sinews, we can help you with specialized care aimed at solving the underlying emotional disorder.

Treatment of acute episodes of tension headache:

Over-the-counter medications are available to treat acute episodes. For episodic headache, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin or naproxen are indicated. For those who do not tolerate NSAIDs or who have allergies, paracetamol is recommended. It is very important to limit the use of analgesics to prevent the headache from becoming chronic and transforming into analgesia abuse headache, which appears when these drugs are taken regularly. Patients suffering from chronic tension headache (for more than 15 days per month) should consult a physician for preventive treatment. Amitriptyline is usually recommended for those cases.

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When a tension headache occurs, in addition to analgesics, other non-pharmacological measures can help to manage the pain. In an acute episode, irritants (such as coffee, nicotine, alcohol or other intoxicants) should be avoided and environmental irritants (noise) should be minimized. Home remedies: Isolate yourself in a quiet room. Lying in bed. Close your eyes and focuse on your breathing, which should be slow and deep. Apply light pressure on the temples with the tips of the fingers. In case of muscular tension in the neck or shoulders, a physiotherapist can help to treat the contractures and soreness. If this is not possible, gentle heat can be applied to the most tense area with a seed bag or simply with water from the shower. Also, one can gently massage the painful area of the shoulders and back of the neck, by gently pressing with the fingers in circles.

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Prevention of tension headache

To improve the quality of life, the most important thing is to prevent headaches so that they become less frequent and limiting. Tips to prevent tension headaches:

  • Maintain proper posture when working, writing or reading.
  • Hydrate sufficiently.
  • Perform neck exercises and stretching when holding fixed postures for long hours.
  • Ventilate the room.
  • If you need glasses, wear them. If you spend a lot of time in front of a screen, do exercises to rest your eyes by looking away from the screen for a few seconds.

Reduce tension headache by managing stress. To prevent headaches from becoming prolonged or chronic, it is essential to address the stress and anxiety that facilitate them.

Managing stress to reduce tension headaches

It is difficult to avoid and completely isolate yourself from the stressors of daily life, but what you can do is learn to manage stress. This will reduce the impact of stress on mental and physical health and improve headaches. These are 15 recommendations to reduce stress:

  1. Make physical exercise a habit. Consult your doctor to find out what exercise is best suited to your health.
  2. Go for walks and outdoor activities.
  3. Eat a healthy and balanced diet, including fresh foods.
  4. Adopt healthy lifestyle habits avoiding caffeine, alcohol and other toxins.
  5. Sleep enough hours at night and avoid oversleeping.
  6. Avoid overexposure to electronic devices and social networks.
  7. Organize your time.
  8. Simplify your life. Make realistic plans and avoid overloading yourself.
  9. Recognize your achievements and reduce self-demand.
  10. Allow yourself to rest throughout the day.
  11. Set your limits.
  12. Ask for help and learn to delegate.
  13. Change your routine. Sometimes a change in routine is necessary.
  14. Change your perspective. Consider that the glass may be half full. Adopt a positive attitude.
  15. Don't lose your sense of humor. Laughing relieves tension.
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Tension headache is very common and can limit the quality of life of those who suffer from it. Although the causes are not fully understood, neurological sensitization to pain may in part be explained by underlying anxiety, depression and stress. There are different ways to treat acute episodes, although if the response is not as expected, it may be necessary to consult a physician. It is important to treat underlying emotional problems to prevent tension headaches. An assessment by psychiatry or psychology may be necessary if you are unable to manage your anxiety or depression on your own. At Sinews we can offer you targeted psychological or psychiatric treatment to help you overcome your discomfort.

About the author

María Isabel Zamora is a physician with a double specialty in Psychiatry and Neurology. She has experience in the care of patients in general psychiatry consultations, and in a more specialized way, in the care of patients who combine psychiatric and neurological symptoms. She has worked with psychogeriatric patients and patients with functional diversity. She has experience in cognitive impairment, psychological and behavioral symptoms of dementia, psychiatric symptoms related to neurological disorders or chronic pain, autism, ADHD, adaptive disorders, depression, anxiety, addictions, bipolar disorder, obsessive-compulsive disorder, sleep disorders, eating disorders, etc.

Dra. María Isabel Zamora
Division of Medicine
Dra. María Isabel Zamora
Psychiatrist
Adults and adolescents
Languages: English, French and Spanish
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