Tension-type headache

Description, Causes and Risk Factors:Headache associated with nervous tension, anxiety, etc., often related to chronic contraction of the scalp muscles.Tension-type headache (TTH) is the most costly and common form of headache and what many people consider a normal headache, in contrast to migraine. At the same time, it is the least studied type of headache, although scientific acceptance and interest have amplified within the past decade. Although TTH previously was considered primarily psychogenic, a neurobiologic basis has been demonstrated. Current epidemiologic and pathophysiologic knowledge and treatment strategies for TTH are reviewed.Tension-type headache generally are reported to occur in relation to emotional conflict and psychosocial stress, but the cause-and-effect relationship is not clear. A recent review concluded that there is no increase in anxiety or depression in patients who had infrequent TTH whereas frequent TTH was associated with higher rates of anxiety and depression. As in other chronic pain disorders, psychologic abnormalities in TTH may be viewed as secondary rather than primary. Maladaptive coping strategies (eg, catastrophizing and avoidance) seem to be common in TTH. In addition, it recently was demonstrated that depression increases vulnerability to TTH in patients who have frequent headaches during and after a laboratory stress test and that the induced headache was associated with elevated pericranial muscle tenderness. The investigators suggested that depression may aggravate existing central sensitization (discussed later) in patients who have frequent headaches. Thus, there may be a bidirectional relationship between depression and frequent TTH.The origin of pain in TTH traditionally has been attributed to increased contraction and ischemia of head and neck muscles. Many laboratory-based electromyographic (EMG) studies, however, have reported normal or only slightly increased muscle activity in TTH, and it has been demonstrated that muscle lactate levels are normal during static muscle exercise in patients who have chronic TTH, ruling out muscle ischemia as a cause of the pain. Many studies have consistently shown that the pericranial myofascial tissues are considerably more tender in patients who have TTH than in healthy subjects, and that the tenderness is positively associated with the intensity and the frequency of TTH. It also has been demonstrated that the consistency of pericranial muscles is increased and that patients who have TTH are more liable to develop shoulder and neck pain in response to static exercise than healthy controls. Moreover, infusion of hypertonic saline into various pericranial muscles elicits referred pain that is perceived as head pain in healthy subjects, and recent studies reported an increased number of active trigger points in pericranial muscles in patients who have frequent episodic TTH and in patients who have chronic TTH.Other Risk Factors:
  • Inadequate rest.
  • Poor posture.
  • Emotional or mental stress, including depression.
  • Having problems at home.
  • Having no close friends.
  • Returning to school or training; preparing for tests or exams.
  • Going on a vacation.
  • Starting a new job.
  • Losing a job.
  • Being overweight.
  • Deadlines at work.
  • Competing in sports or other activities.
  • Not getting enough sleep.
  • Being over-extended; involved in too many activities/organizations.
About 30% to 80% percent of the adult U.S. population suffers from occasional tension headaches. Chronic daily tension headaches affect approximately 3% of the population. Women are twice as likely to suffer from tension-type headaches as men.Most people with episodic tension headaches have them no more than once or twice a month, but the headaches can occur more frequently.Chronic tension headaches tend to be more common in females. Many patients with chronic tension headaches have usually had the headaches for more than 60 to 90 days. For many headache sufferers, these headaches impair their daily activities.Chronic tension headaches may co-exist in adults who already have a medical history of migraines.Symptoms:Tension-type headache is defined by the absence of features of a migraine. It requires at least 2 of the following:
  • Pressing or tightening that does not pulsate (vise-like).
  • Present on both sides of the forehead, temples, or back of the head.
  • Mild to moderate degree.
  • Not worsened by physical activity.
Diagnosis:Tension-type headache is diagnosed when at least 2 of the main headache symptoms are present; there is no nausea, vomiting, or both photophobia a morbid fear of lightand phonophobia (a morbid fear of sounds including your own voicetogether; and other causes of headache have been excluded. This may require a neurological examination and, rarely, imaging studies of the head such as MRI (magnetic resonance imaging).Treatment:Tension-type headaches are treated with several different strategies, including: stress management/relaxation training, counseling, biofeedback, medications and self-care treatments. Treatment for chronic tension headaches usually involves stress management, counseling, biofeedback, and possibly the use of antidepressant or anxiety-reducing medications.Regardless of the treatment, tension-type headaches are best treated when the symptoms first appear and are mild, before they become more frequent and painful.Some people with tension headaches don't seek medical attention and try to treat the pain on their own. The problem with that is that repeated use of over-the-counter (OTC) pain relievers can actually cause overuse headaches.A variety of medications, both OTC and prescription, are available to stop or reduce the pain of an existing headache attack, including:Pain relievers: Simple OTC pain relievers are usually the first line of treatment for reducing headache pain. These include the drugs aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Prescription medications include naproxen (Naprosyn), indomethacin (Indocin) and ketorolac (Ketorolac Tromethamine). Acetaminophen (Tylenol, others) may be less effective in treating tension headache pain, and more likely to cause medication overuse headaches.Combination medications: Aspirin or acetaminophen or both are often combined with caffeine or a sedative drug in a single medication. For example, Excedrin combines aspirin, acetaminophen and caffeine. Combination drugs may be more effective than are single-ingredient pain relievers. Although many combination drugs are available OTC, those containing sedatives can be obtained only by prescription because they may be addictive and can lead to chronic daily headache. Use them only with careful monitoring by your doctor.Triptans and narcotics: For people who experience both migraines and episodic tension headaches, a triptan can effectively relieve the pain of both headaches. Studies have shown that the injectable form of sumatriptan (Imitrex, Sumavel Dosepro), a common migraine medication, may also relieve symptoms of chronic tension headache. Opiates, or narcotics, are rarely used because of their side effects and potential for dependency.Other Treatment Options:
  • Relax. Taking a break, having a massage or a warm bath, going for a walk or taking exercise to get you away from the normal routine may help.
  • Cope with stress. If you have a stressful job, or are faced with a stressful situation that you cannot avoid, try breathing and relaxation exercises to prevent a possible headache. There are many audiotapes to guide you in these exercises.
  • Take regular exercise. Tension-type headache is more common in people who do not take much exercise compared with those who do. Try walking wherever possible, or take stairs rather than the lift, so that exercise becomes a routine part of your life.
  • Treat depression. If you feel that you are depressed more often than not, it is important to ask for medical advice and get effective treatment.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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