Tension-type headache chronic

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. 

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. 

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. 

Manna V, Bolino F, Di Cicco L Chronic tension-type headache, mood depression and serotonin therapeutic effects of fluvoxamine and mi-anserine. Headache 34 44-49, 1994... 

Nitric oxide inhibition has an analgesic effect in patients with chronic tension-type headache, probably due to a reduction in central sensitization at the level of the spinal dorsal horn, trigeminal nucleus or both (Ashina, 2002). 

Ashina, M. Nitric oxide synthase inhibitors for the treatment of chronic tension-type headache, Exp. Op. Pharm. 2002, 3, 395-399. 

Tekle Haimanot R, Seraw B, Forsgren L, Ekbom K, Ekstedt J. Migraine, chronic tension-type headache, and cluster headache in an Ethiopian rural community. Cephalagia 1995 15 482-8. 

Chronic headaches—recurrent migraine or tension-type headaches are prevalent in about half of those with FM. 

Probable migraine without aura Probable migraine with aura Probable chronic migraine Tension-type headache... 

Tension-type headache is the most common type of primary headache, with an estimated 1-year prevalence of 63% in men and 86% in women. First onset of tension-type headache typically is early in life (before age 20 in 40% of patients), and prevalence peaks between the ages of 20 and 50 years. It is more common among women in adulthood, with a female-to-male ratio of 4 3. The mean frequency of attacks is 2.9 days per month, with most sufferers experiencing fewer than one attack per month. The prevalence of chronic tension-type headache (defined as > 180 headache days per year) is estimated at 2% to 3%. Although an estimated 60% of tension-type headache sufferers experience some degree of functional impairment during their attacks, only 16% of patients have consulted a general practitioner for their headaches. ... 

Premonitory symptoms and aura are absent with tension-type headache. The pain usually is mild to moderate in intensity and often is described as a duU, nonpulsatile tightness or pressure. Bilateral pain is most common, but the location can vary (frontal and temporal pain are most common occipital and parietal regions also may be affected). The pain is classically described as having a hatband pattern. Associated symptoms generally are absent, but mild photophobia or phonophobia may be reported. The disability associated with tension-type headache typically is minor in comparison with migraine headache, and routine physical activity does not affect headache severity. Palpation of the pericranial or cervical muscles may reveal tender spots or localized nodules in some patients. Tension-type headache is classified as either episodic (infrequent or frequent) or chronic based on the frequency and dmation of the attacks. ... 

ADP-ribosylation reactions such as DNA repair, calcium mobilization and deacetylation (Kirkland 2009). In addition, at pharmacological concentrations, niacin is an effective agent for the treatment of dislipidemias and atherosclerosis (Prousky et al. 2011). Furthermore, evidence exists that niacin ameliorates acute migraine, chronic tension-type headaches, depression and schizophrenia (Prousky et al. 2011). This chapter focuses on chemical and biochemical aspects of the vitamin. 

The pathophysiology of tension-type headache is incompletely understood. Experimental studies suggest that it may be caused by increased excitability of the CNS generated by repetitive and sustained pericranial myofacial input [3]. Peripheral nociceptive factors may play a role in the episodic form of tension headache, whereas central sensitization predominates in the chronic form. Epidemiological studies report an increased familial risk in tension-type headaches [4]. 

Russel MB, et al. Inheritance of chronic tension-type headache investigated by complex segregation analysis. Hum Genet 1998 102 138-140. 

Larsson, B., Carlsson, J. (1996). A school-based, nurse-administered relaxation training for children with chronic tension-type headache. Journal of Pediatric Psychology, 21, 603-614. 

Prevalence rates for a variety of different types of pain have been described. The annual incidence of moderate-intensity back pain is 10% to 15% in the adult population with a point prevalence of 15% to 30%.3 Migraine affects more than 25 million Americans, and 90% of Americans report some other types of headaches (e.g., tension or sinus) each year.4 Pain resulting from fibromyalgia affects 4 million Americans.5 Cancer is commonly associated with both acute and chronic pain, and about 70% of those diagnosed with cancer will experience significant pain.6... 

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