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| MedlinePlus = 000797
| MedlinePlus = 000797
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| eMedicineTopic =
| eMedicineTopic = 1142908
| MeshID = D018781
| MeshID = D018781
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A '''tension headache''' (renamed a '''tension-type headache''' by the [[International Headache Society]] in 1988) is the most common type of primary [[headache]]. The [[pain]] can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches.<ref>Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol. 1991;44(11):1147-57.</ref>
A '''tension headache''' (renamed a '''tension-type headache''' by the [[International Headache Society]] in 1988) is the most common type of primary [[headache]]. The [[pain]] can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches.<ref>{{cite journal |author=Rasmussen BK, Jensen R, Schroll M, Olesen J |title=Epidemiology of headache in a general population—a prevalence study |journal=J Clin Epidemiol |volume=44 |issue=11 |pages=1147–57 |year=1991 |pmid=1941010 |url=http://linkinghub.elsevier.com/retrieve/pii/0895-4356(91)90147-2}}</ref>


== Signs and symptoms ==
== Signs and symptoms ==
Line 22: Line 22:
=== Frequency and duration ===
=== Frequency and duration ===


Tension-type headaches can be [[episodic]] or [[chronic (medicine)|chronic]].<ref>The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004, 24 Suppl 1:9-160.</ref> Episodic tension-type headaches are defined as tension-type headaches occurring fewer than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months. Tension-type headaches can last from minutes to days, months or even years, though a typical tension headache lasts 4–6 hours.
Tension-type headaches can be [[episodic]] or [[chronic (medicine)|chronic]].<ref>{{Cite journal|title=The International Classification of Headache Disorders: 2nd edition |journal=Cephalalgia |volume=24 |issue=Suppl 1 |pages=9–160 |year=2004 |pmid=14979299 |doi=10.1111/j.1468-2982.2004.00653.x |author1= Headache Classification Subcommittee of the International Headache Society}} [http://www.i-h-s.org/upload/ct_clas/ihc_II_main_no_print.pdf as PDF]</ref> Episodic tension-type headaches are defined as tension-type headaches occurring fewer than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months. Tension-type headaches can last from minutes to days, months or even years, though a typical tension headache lasts 4–6 hours.


== Cause ==
== Cause ==


Various precipitating factors may cause TTH in susceptible individuals:<ref>{{cite web|url=http://www.emedicine.com/neuro/topic231.htm |title=Muscle Contraction Tension Headache: eMedicine Neurology |publisher=Emedicine.com |date=2008-09-18 |accessdate=2010-03-22}}</ref>
Various precipitating factors may cause TTH in susceptible individuals:<ref>{{EMedicine|article|1142908|Muscle Contraction Tension Headache}}</ref>


* Stress: usually occurs in the afternoon after long stressful work hours or after an exam
* Stress: usually occurs in the afternoon after long stressful work hours or after an exam
Line 38: Line 38:
Tension headaches may be caused by [[muscle tension]] around the head and neck. One of the theories says that the main cause for tension type headaches and [[migraine]] is teeth clenching which causes a chronic contraction of the [[temporalis muscle]].{{Citation needed|date=November 2010}}
Tension headaches may be caused by [[muscle tension]] around the head and neck. One of the theories says that the main cause for tension type headaches and [[migraine]] is teeth clenching which causes a chronic contraction of the [[temporalis muscle]].{{Citation needed|date=November 2010}}


Another theory is that the pain may be caused by a malfunctioning pain filter which is located in the brain stem. The view is that the brain misinterprets information, for example from the temporal muscle or other muscles, and interprets this signal as pain. One of the main neurotransmitters which is probably involved is [[serotonin]]. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as [[amitriptyline]]. However, the analgesic effect of amitriptyline in chronic tension-type headache is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved. Recent studies of [[nitric oxide]] (NO) mechanisms suggest that NO may play a key role in the pathophysiology of CTTH.<ref>Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J. Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomized crossover trial. Lancet. 1999 Jan 23;353:287-9</ref> The sensitization of pain pathways may be caused by or associated with activation of nitric oxide synthase (NOS) and the generation of NO. Patients with chronic tension-type headache have increased muscle and skin pain sensitivity, demonstrated by low mechanical, thermal and electrical pain thresholds. Hyperexcitability of central [[nociception|nociceptive]] neurons (in [[trigeminal nucleus|trigeminal spinal nucleus]], [[thalamus]], and [[cerebral cortex]]) is believed to be involved in the pathophysiology of chronic tension-type headache.<ref>Ashina S, Bendtsen L, Ashina M. Pathophysiology of tension-type headache. Curr Pain Headache Rep, 2005 Dec; 9:415-22.</ref> Recent evidence for generalized increased pain sensitivity or [[hyperalgesia]] in CTTH strongly suggests that pain processing in the central nervous system is abnormal in this primary headache disorder. Moreover, a dysfunction in pain inhibitory systems may also play a role in the pathophysiology of chronic tension-type headache.<ref>Pielsticker A, Haag G, Zaudig M, Lautenbacher S. Impairment of pain inhibition in chronic tension-type headache. Pain. 2005 Nov;118:215-23.</ref>
Another theory is that the pain may be caused by a malfunctioning pain filter which is located in the brain stem. The view is that the brain misinterprets information, for example from the temporal muscle or other muscles, and interprets this signal as pain. One of the main neurotransmitters which is probably involved is [[serotonin]]. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as [[amitriptyline]]. However, the analgesic effect of amitriptyline in chronic tension-type headache is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved. Recent studies of [[nitric oxide]] (NO) mechanisms suggest that NO may play a key role in the pathophysiology of CTTH.<ref>{{cite journal |author=Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J |title=Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomised crossover trial |journal=Lancet |volume=353 |issue=9149 |pages=287–9 |year=1999 |month=January |pmid=9929022 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673698010794}}</ref> The sensitization of pain pathways may be caused by or associated with activation of nitric oxide synthase (NOS) and the generation of NO. Patients with chronic tension-type headache have increased muscle and skin pain sensitivity, demonstrated by low mechanical, thermal and electrical pain thresholds. Hyperexcitability of central [[nociception|nociceptive]] neurons (in [[trigeminal nucleus|trigeminal spinal nucleus]], [[thalamus]], and [[cerebral cortex]]) is believed to be involved in the pathophysiology of chronic tension-type headache.<ref>{{cite journal |author=Ashina S, Bendtsen L, Ashina M |title=Pathophysiology of tension-type headache |journal=Curr Pain Headache Rep |volume=9 |issue=6 |pages=415–22 |year=2005 |month=December |pmid=16282042 }}</ref> Recent evidence for generalized increased pain sensitivity or [[hyperalgesia]] in CTTH strongly suggests that pain processing in the central nervous system is abnormal in this primary headache disorder. Moreover, a dysfunction in pain inhibitory systems may also play a role in the pathophysiology of chronic tension-type headache.<ref>{{cite journal |author=Pielsticker A, Haag G, Zaudig M, Lautenbacher S |title=Impairment of pain inhibition in chronic tension-type headache |journal=Pain |volume=118 |issue=1-2 |pages=215–23 |year=2005 |month=November |pmid=16202520 |doi=10.1016/j.pain.2005.08.019 |url=http://linkinghub.elsevier.com/retrieve/pii/S0304-3959(05)00418-5}}</ref>


==Prevention==
==Prevention==
Line 44: Line 44:


== Treatment ==
== Treatment ==
Episodic tension-type headaches generally respond well to over-the-counter [[analgesic]]s such as ibuprofen, paracetamol/acetaminophen, and aspirin. Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations like Syndol, Mersyndol and Percogesic, analgesic/barbiturate combinations such as Fiorinal). Frequent use of analgesics may, however, lead to [[medication overuse headache]]. The first-line treatment for chronic tension type headache is [[amitriptyline]], whereas [[mirtazapine]] and [[venlafaxine]] are second-line treatment options.<ref name="pmid21247362">{{cite journal |author=Bendtsen L, Jensen R |title=Treating tension-type headache -- an expert opinion |journal=Expert Opin Pharmacother |volume=12 |issue=7 |pages=1099–109 |year=2011 |month=May |pmid=21247362 |doi=10.1517/14656566.2011.548806 }}</ref> Other medication options include [[topiramate]] and [[sodium valproate]] (as [[prophylaxis]]).<ref name="pmid18231713">{{cite journal |author=Yurekli VA, Akhan G, Kutluhan S, Uzar E, Koyuncuoglu HR, Gultekin F |title=The effect of sodium valproate on chronic daily headache and its subgroups |journal=J Headache Pain |volume=9 |issue=1 |pages=37–41 |year=2008 |month=February |pmid=18231713 |doi=10.1007/s10194-008-0002-5 |url=}}</ref> [[Biofeedback]] techniques may also help.<ref>{{cite journal |author=Nestoriuc Y, Rief W, Martin A |title=Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators |journal=J Consult Clin Psychol |volume=76 |issue=3 |pages=379–96 |year=2008 |month=June |pmid=18540732 |doi=10.1037/0022-006X.76.3.379 }}</ref><ref name="pmid18471128">{{cite journal |author=Rains JC |title=Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache |journal=Headache |volume=48 |issue=5 |pages=735–6; discussion 736–7 |year=2008 |month=May |pmid=18471128 |doi=10.1111/j.1526-4610.2008.01119_1.x |url=}}</ref>
Episodic tension-type headaches generally respond well to over-the-counter [[analgesic]]s such as ibuprofen, paracetamol/acetaminophen, and aspirin. Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations like Syndol, Mersyndol and Percogesic, analgesic/barbiturate combinations such as Fiorinal). Frequent use of analgesics may, however, lead to [[medication overuse headache]]. The first-line treatment for chronic tension type headache is [[amitriptyline]], whereas [[mirtazapine]] and [[venlafaxine]] are second-line treatment options.<ref name="pmid21247362">{{cite journal |author=Bendtsen L, Jensen R |title=Treating tension-type headache — an expert opinion |journal=Expert Opin Pharmacother |volume=12 |issue=7 |pages=1099–109 |year=2011 |month=May |pmid=21247362 |doi=10.1517/14656566.2011.548806 }}</ref> Other medication options include [[topiramate]] and [[sodium valproate]] (as [[prophylaxis]]).<ref name="pmid18231713">{{cite journal |author=Yurekli VA, Akhan G, Kutluhan S, Uzar E, Koyuncuoglu HR, Gultekin F |title=The effect of sodium valproate on chronic daily headache and its subgroups |journal=J Headache Pain |volume=9 |issue=1 |pages=37–41 |year=2008 |month=February |pmid=18231713 |doi=10.1007/s10194-008-0002-5 |url=}}</ref> [[Biofeedback]] techniques may also help.<ref>{{cite journal |author=Nestoriuc Y, Rief W, Martin A |title=Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators |journal=J Consult Clin Psychol |volume=76 |issue=3 |pages=379–96 |year=2008 |month=June |pmid=18540732 |doi=10.1037/0022-006X.76.3.379 }}</ref><ref name="pmid18471128">{{cite journal |author=Rains JC |title=Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache |journal=Headache |volume=48 |issue=5 |pages=735–6; discussion 736–7 |year=2008 |month=May |pmid=18471128 |doi=10.1111/j.1526-4610.2008.01119_1.x |url=}}</ref>


[[Botulinum toxin]] is a treatment trialled by some people with tension-type headache, though results are varied. {{Citation needed|date=April 2012}}
[[Botulinum toxin]] is a treatment trialled by some people with tension-type headache, though results are varied. {{Citation needed|date=April 2012}}
Line 65: Line 65:
*[http://www.headaches.org National Headache Foundation]
*[http://www.headaches.org National Headache Foundation]
*[http://www.w-h-a.org World Headache Alliance]
*[http://www.w-h-a.org World Headache Alliance]
*[http://www.emedicine.com/neuro/topic231.htm Article on eMedicine about tension-type headache]


{{Diseases of the nervous system}}
{{Diseases of the nervous system}}

Revision as of 13:05, 22 May 2012

Tension headache
SpecialtyNeurology Edit this on Wikidata
Frequency89.1% (Denmark)

A tension headache (renamed a tension-type headache by the International Headache Society in 1988) is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches.[1]

Signs and symptoms

Tension-type headache pain is often described as a constant pressure, as if the head were being squeezed in a vise. The pain is frequently bilateral which means it is present on both sides of the head at once. Tension-type headache pain is typically mild to moderate, but may be severe.

Frequency and duration

Tension-type headaches can be episodic or chronic.[2] Episodic tension-type headaches are defined as tension-type headaches occurring fewer than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months. Tension-type headaches can last from minutes to days, months or even years, though a typical tension headache lasts 4–6 hours.

Cause

Various precipitating factors may cause TTH in susceptible individuals:[3]

  • Stress: usually occurs in the afternoon after long stressful work hours or after an exam
  • Sleep deprivation
  • Uncomfortable stressful position and/or bad posture
  • Irregular meal time (hunger)
  • Eyestrain

One half of patients with TTH identify stress or hunger as a precipitating factor.[citation needed]

Tension headaches may be caused by muscle tension around the head and neck. One of the theories says that the main cause for tension type headaches and migraine is teeth clenching which causes a chronic contraction of the temporalis muscle.[citation needed]

Another theory is that the pain may be caused by a malfunctioning pain filter which is located in the brain stem. The view is that the brain misinterprets information, for example from the temporal muscle or other muscles, and interprets this signal as pain. One of the main neurotransmitters which is probably involved is serotonin. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as amitriptyline. However, the analgesic effect of amitriptyline in chronic tension-type headache is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved. Recent studies of nitric oxide (NO) mechanisms suggest that NO may play a key role in the pathophysiology of CTTH.[4] The sensitization of pain pathways may be caused by or associated with activation of nitric oxide synthase (NOS) and the generation of NO. Patients with chronic tension-type headache have increased muscle and skin pain sensitivity, demonstrated by low mechanical, thermal and electrical pain thresholds. Hyperexcitability of central nociceptive neurons (in trigeminal spinal nucleus, thalamus, and cerebral cortex) is believed to be involved in the pathophysiology of chronic tension-type headache.[5] Recent evidence for generalized increased pain sensitivity or hyperalgesia in CTTH strongly suggests that pain processing in the central nervous system is abnormal in this primary headache disorder. Moreover, a dysfunction in pain inhibitory systems may also play a role in the pathophysiology of chronic tension-type headache.[6]

Prevention

Tricyclics have been found to be more effective than SSRIs but have greater side effects.[7] Evidence is insufficient for the use of propranolol and muscle relaxants for prevention of tension headaches.[8]

Treatment

Episodic tension-type headaches generally respond well to over-the-counter analgesics such as ibuprofen, paracetamol/acetaminophen, and aspirin. Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations like Syndol, Mersyndol and Percogesic, analgesic/barbiturate combinations such as Fiorinal). Frequent use of analgesics may, however, lead to medication overuse headache. The first-line treatment for chronic tension type headache is amitriptyline, whereas mirtazapine and venlafaxine are second-line treatment options.[9] Other medication options include topiramate and sodium valproate (as prophylaxis).[10] Biofeedback techniques may also help.[11][12]

Botulinum toxin is a treatment trialled by some people with tension-type headache, though results are varied. [citation needed]

Acupuncture

A 2009 cochrane review concluded that acupuncture could be a valuable non-pharmacological option in patients with frequent episodic or chronic tension-type headaches.[13]

Manual therapy

People with tension-type headache often use manual therapy, such as spinal manipulation, soft tissue therapy, and myofascial trigger point treatment. A 2006 systematic review found no rigorous evidence supporting manual therapies for tension headache.[14] A 2005 structured review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[15] A 2004 Cochrane review found that spinal manipulation may be effective for migraine and tension headache, and that spinal manipulation and neck exercises may be effective for cervicogenic headache.[16] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of spinal manipulation.[17]

Prognosis

Tension headaches that do not occur as a symptom of another condition may be painful, but are not harmful. It is usually possible to receive relief through treatment. Tension headaches that occur as a symptom of another condition are usually relieved when the underlying condition is treated. Frequent use of pain medications in patients with tension-type headache may lead to the development of medication overuse headache or rebound headache.

References

  1. ^ Rasmussen BK, Jensen R, Schroll M, Olesen J (1991). "Epidemiology of headache in a general population—a prevalence study". J Clin Epidemiol. 44 (11): 1147–57. PMID 1941010.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  2. ^ Headache Classification Subcommittee of the International Headache Society (2004). "The International Classification of Headache Disorders: 2nd edition". Cephalalgia. 24 (Suppl 1): 9–160. doi:10.1111/j.1468-2982.2004.00653.x. PMID 14979299. as PDF
  3. ^ Muscle Contraction Tension Headache at eMedicine
  4. ^ Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J (1999). "Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomised crossover trial". Lancet. 353 (9149): 287–9. PMID 9929022. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  5. ^ Ashina S, Bendtsen L, Ashina M (2005). "Pathophysiology of tension-type headache". Curr Pain Headache Rep. 9 (6): 415–22. PMID 16282042. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  6. ^ Pielsticker A, Haag G, Zaudig M, Lautenbacher S (2005). "Impairment of pain inhibition in chronic tension-type headache". Pain. 118 (1–2): 215–23. doi:10.1016/j.pain.2005.08.019. PMID 16202520. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  7. ^ Jackson JL, Shimeall W, Sessums L; et al. (2010). "Tricyclic antidepressants and headaches: systematic review and meta-analysis". BMJ. 341: c5222. doi:10.1136/bmj.c5222. PMC 2958257. PMID 20961988. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  8. ^ Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW (2010). "Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review". Fam Pract. 27 (2): 151–65. doi:10.1093/fampra/cmp089. PMID 20028727. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  9. ^ Bendtsen L, Jensen R (2011). "Treating tension-type headache — an expert opinion". Expert Opin Pharmacother. 12 (7): 1099–109. doi:10.1517/14656566.2011.548806. PMID 21247362. {{cite journal}}: Unknown parameter |month= ignored (help)
  10. ^ Yurekli VA, Akhan G, Kutluhan S, Uzar E, Koyuncuoglu HR, Gultekin F (2008). "The effect of sodium valproate on chronic daily headache and its subgroups". J Headache Pain. 9 (1): 37–41. doi:10.1007/s10194-008-0002-5. PMID 18231713. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. ^ Nestoriuc Y, Rief W, Martin A (2008). "Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators". J Consult Clin Psychol. 76 (3): 379–96. doi:10.1037/0022-006X.76.3.379. PMID 18540732. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  12. ^ Rains JC (2008). "Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache". Headache. 48 (5): 735–6, discussion 736–7. doi:10.1111/j.1526-4610.2008.01119_1.x. PMID 18471128. {{cite journal}}: Unknown parameter |month= ignored (help)
  13. ^ Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR (2009). "Acupuncture for tension-type headache". Cochrane Database Syst Rev. 1: CD007587. PMID 19160338.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". Clin J Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ Biondi DM (2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
  16. ^ Bronfort G, Nilsson N, Haas M; et al. (2004). Brønfort, Gert (ed.). "Cochrane Database of Systematic Reviews". Cochrane Database Syst Rev (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. {{cite journal}}: |chapter= ignored (help); Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  17. ^ Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMC 1420782. PMID 16574972.

External links

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