Tension-type headache: Difference between revisions

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== Infrequent episodic tension-type headache<br>  ==
== Infrequent episodic tension-type headache<br>  ==


Infrequent 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 is no nausea but photophobia or phonophobia may be present.
Infrequent 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 is no nausea but photophobia or phonophobia may be present.<br>  
 
Increased pericranial tenderness recorded by manual palpation is the most significant abnormal finding in patients with tension-type headache. The tenderness increases with the intensity and frequency of headache and is further increased during actual headache. Pericranial tenderness is easily recorded by manual palpation by small rotating movements and a firm pressure (preferably aided by use of a palpometer) with the second and third finger on the frontal, temporal, masseter, pterygoid, sternocleidomastoid, splenius and trapezius muscles. A local tenderness score from 0-3 on each muscle can be summated to yield a total tenderness score for each individual. It has been demonstrated that, using a pressure sensitive device that allows palpation with a controlled pressure, this clinical examination becomes more valid and reproducible. However, such equipment is not generally available to clinicians and it is advised that clinicians simply perform the manual palpation as a traditional clinical examination.&nbsp; Palpation is a useful guide for the treatment strategy. It also adds value and credibility to the explanations given to the patient.<br>


==== Diagnostic criteria  ====
==== Diagnostic criteria  ====


#At least 10 episodes occurring on &lt;1 day per month on average (&lt;12 days per year) and fulfilling criteria 2-4
#At least 10 episodes occurring on &lt;1 day per month on average (&lt;12 days per year) and fulfilling criteria 2-4  
#Headache lasting from 30 minutes to 7 days
#Headache lasting from 30 minutes to 7 days  
#Headache has at least two of the following characteristics:
#Headache has at least two of the following characteristics:  
#*bilateral location
#*bilateral location  
#*pressing/tightening (non-pulsating) quality
#*pressing/tightening (non-pulsating) quality  
#*mild or moderate intensity
#*mild or moderate intensity  
#*not aggravated by routine physical activity such as walking or climbing stairs
#*not aggravated by routine physical activity such as walking or climbing stairs  
#Both of the following:
#Both of the following:  
#*no nausea or vomiting (anorexia may occur)<br>  
#*no nausea or vomiting (anorexia may occur)<br>  
#*no more than one of photophobia or phonophobia
#*no more than one of photophobia or phonophobia  
#Not attributed to another disorder
#Not attributed to another disorder


<br>  
<br>


== Frequent episodic tension-type headache<br>  ==
== Frequent episodic tension-type headache<br>  ==

Revision as of 14:48, 21 June 2009

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.

Whilst this type of headache was previously considered to be primarily psychogenic, a number of studies have appeared after the first edition of The International Classification of Headache Disorders that strongly suggest a neurobiological basis, at least for the more severe subtypes of tension-type headache.

Tension-type headaches are divided into infrequebt, frequent and chronic. The chronic subtype is a serious disease causing greatly decreased quality of life and high disability. The infrequent subtype has very little impact on the individual and does not deserve much attention from the medical profession. However, frequent sufferers can encounter considerable disability that sometimes warrants expensive drugs and prophylactic medication.

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.

Infrequent episodic tension-type headache
[edit | edit source]

Infrequent 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 is no nausea but photophobia or phonophobia may be present.

Diagnostic criteria[edit | edit source]

  1. At least 10 episodes occurring on <1 day per month on average (<12 days per year) and fulfilling criteria 2-4
  2. Headache lasting from 30 minutes to 7 days
  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 nausea or vomiting (anorexia may occur)
    • no more than one of photophobia or phonophobia
  5. Not attributed to another disorder


Frequent episodic tension-type headache
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Chronic tension-type headache
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