Episodic tension-type headache

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. 

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. 

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. 

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

Packman, B. Packman, E. Doyle, G. Cooper, S. Ashraf, E. Koronkiewicz, K. Jayawardena, S. Solubilized ibuprofen evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache. Headache 2000, 40 (7), 561-567. 

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. ... 

The vast majority of episodic tension-type headache sufferers self-medicate with over-the-counter medications and do not... 

Solomons, NewmanLC. Episodic tension-type headaches. In Silberstein SD, Lipton RB, Dalessio DJ, eds. Wolffs Headache and Other Head Pain, 7th ed. New York, Oxford University Press, 2001 238-246. 

Abbreviations AEA anandamide 2-AG 2-arachidonoylglycerol AMT anandamide membrane transporter AS amidase signature AD Alzheimer s disease CBIR type 1 cannabinoid receptor CB2R type 2 cannabinoid receptor DAG l-acyl-2-arachidonoylglycerol DAGLs diacylglycerol lipases EAE autoimmune encephalomyelitis ECS endocannabinoid system ETTH episodic tension-type headache FAAH fatty acid amide hydrolase FAAs fatty acid amides HAEAs hydroxyanandamides HD Huntington s... 

Besides lymphocytes, other blood cells express an ECS that plays an important role in human pathologies. For instance, in platelets isolated from humans with headache, Cupini et al. (2006) found an increase in the activity of FAAH in two groups of headache subjects migraine without aura (MoA) or episodic tension-type headache (FTTH) patients. In particular, this FAAH dysfunction was found in female but not male migraineurs. Furthermore, in a recent paper it has been reported a decrease of AEA and 2-AG levels in other two types of headache disorders (Rossi et ah, 2007). 

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]. 

Steiner TJ, et al. Aspirin in episodic tension-type headache placebo-controlled dose-ranging comparison with paracetamol. Cephalgia 2003 23 59-66. 

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