Tension-type headache

Primary headaches are classified as migraine, tension-type, or cluster and other trigeminal autonomic cephalalgias. 

Tension-type headache (TTH) is the most common primary headache disorder. It is often underrepresented in clinical practice, as many patients do not present for care.6 The term tension-type headache is used to describe all headache syndromes in which muscle contraction is the most significant factor in the pathogenesis of pain. The 1-year prevalence of TTH in the population ranges from 30% to 90%.6 It is more common in adult females. Environmental factors, as opposed to genetic predisposition, play a more central role in their development. Tension-type headaches can be further divided into episodic or chronic the mean frequency of attacks is 3 days per month in episodic disorders, and chronic TTH is defined as 15 or more attacks in a 1-month period.7 The estimated prevalence of chronic TTH is less than 5%.6 Some researchers believe that chronic TTHs represent a continuum of headache severity with migraine headache.8 When severe headaches are difficult to differentiate clinically, treatment should initially target TTH. 

Clinical Presentation and Diagnosis of Tension-Type Headache ... 

Patients experiencing tension-type headache may display the following headache symptoms and characteristics ... 

Ruoff G, Urban G. Treatment of primary headache episodic tension-type headache. In Standards of care for headache diagnosis and treatment. Chicago National Headache Foundation, 2004 53-58. 

Headache Migraine and Tension-Type CHAPTER 53 LABORATORY TESTS ... 

Tension-type headache is the most common type of primary headache and is more common in women than men. Pain is usually mild to moderate and nonpulsatile. Episodic headaches may become chronic. 

Pain is thought to originate from myofascial factors and peripheral sensitization of nociceptors. Central mechanisms are also involved. Mental stress, nonphysiologic motor stress, a local myofascial release of irritants, or a combination of these may be the initiating stimulus. In predisposed individuals, chronic, tension-type headache can evolve. 

Acute medication for episodic headache should be taken no more often than 2 days/wk to prevent development of chronic tension-type headache. 

There is no evidence to support the efficacy of muscle relaxants for tension-type headache. 

The TCAs are used most often for prophylaxis of tension headache. Injection of botulinum toxin into pericranial muscles has demonstrated efficacy in prophylaxis of chronic tension-type headache in two studies. 

Neuropathic and functional pain is often described in terms of chronic pain. Neuropathic pain (e.g., postherpetic neuralgia, diabetic neuropathy) is a result of nerve damage, but functional pain (e.g., fibromyalgia, irritable bowel syndrome, tension-type headache) refers to abnormal operation of the nervous system. Pain circuits may rewire themselves and produce spontaneous nerve stimulation. 

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