Tension-type headache

This page was originally based on the International Classification of Headache Disorders from the International Headache Society

Original Editor - Rachael Lowe

Top Contributors - Laure Lievens, Admin, Fasuba Ayobami, Emma Guettard, Vanessa Rhule, Astrid Lahousse, Kim Jackson, Kapil Narale, Elaine Lonnemann, Vidya Acharya, Jacquelyn Brockman, Jonathan Wong, Ahmed M Diab, Grite Apanaviciute and Anouk Van den Bossche  

Search strategy

Search on Pubmed and Pedro with keywords: “Tension-type headache management”, “TTH medical treatment”, “muscle tension TTH”, “tension type headache” AND “physiotherapy”, “manual therapy tension type headache”, “differential diagnosis TTH”
Search books and medical magazines with same keywords

Definition/Description

Tension-type headache is a neurological disorder characterized by a predisposition to attacks of mild to moderate headache with few associated symptoms.(level of evidence 1A)1 The criteria for tension-type headache outlined in the IHS classification will be mentioned in the subtitle ‘Diagnostic Procedures’.
This is the most common type of primary headache: its lifetime prevalence in the general population ranges in different studies from 30 to 78%. At the same time, it is the least studied of the primary headache disorders, despite the fact that it has the highest socio-economic impact.
Tension-type headaches are divided into infrequent episodic, frequent episodic and chronic tension-type headaches. The infrequent subtype has episodes less than once per month and has very little impact on the individual. The pain is typically bilateral, pressing, or tightening in quality and mild to moderate intensity. It does not worsen with physical activity. There is no nausea, but photophobia or phonophobia may be present. However, frequent sufferers(between one and fifteen days a month) can encounter considerable disability that sometimes warrants expensive drugs and prophylactic medication. This frequent form is a physiologic response to stress, anxiety, depression, emotional conflicts, fatigue or repressed hostility. The chronic subtype evolves over time from episodic tension-type headache and causes greatly decreased quality of life and high disability. It is diagnosed if headaches occur 15 days a month (180 or more days a year).2,18
The exact mechanisms of tension-type headache are not known. Peripheral pain mechanisms are most likely to play a role in Infrequent episodic tension-type headache and Frequent episodic tension-type headache whereas central pain mechanisms play a more important role in Chronic tension-type headache. 1,2

Clinically Relevant Anatomy

The underlying cause of tension-type headache is uncertain. The most probably explanation for Infrequent episodic tension-type headache is activation of hyperexcitablehyper excitable peripheral afferent neurons from head and neck muscles. Muscle tenderness and psychological tension are associated with and aggravate tension-type headache but are not clearly its cause. Abnormalities in central pain processing and generalisedgeneralized increased pain sensitivity are present in some patients with tension-type headache, often the chronical type. Susceptibility to tension-type headache is influenced by genetic factors. (level of evidence 1A)1

Chronic tension-type headache

A disorder evolving from episodic tension-type headache, with daily or very frequent episodes of headache lasting minutes to days. The pain is typically bilateral, pressing or tightening in quality and of mild to moderate intensity, and it does not worsen with routine physical activity. There may be mild nausea, photophobia or phonophobia.

Differentiation between this and Chronic migrane can be difficult. It should be remembered that some patients with chronic tension-type headache develop migraine-like features if they have severe pain and , conversely, some migraine patients develop increasingly frequent tension-type-like interval headaches, the nature of which remains unclear.

Diagnostic criteria

1. Headache occurring on ≥15 days per month on average for >3 months (≥180 days per year)1 and fulfilling criteria 2-4
2. Headache lasts hours or may be continuous
3. Headache has at least two of the following characteristics:
   • bilateral location
   • pressing/tightening (non-pulsating) quality
   • mild or moderate intensity
   • not aggravated by routine physical activity such as walking or climbing stairs
4. Both of the following:
   • no more than one of photophobia, phonophobia or mild nausea
   • neither moderate or severe nausea nor vomiting
5. Not attributed to another disorder

Recent Related Research (from Pubmed)

Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=10EkZzEWYAtdFatE7nhxpTgINKtpFT_97TXmhh69SkUgNT150|charset=UTF-8|short|max=10: Error parsing XML for RSS

References

References will automatically be added here, see adding references tutorial.