Headache, Tension

BASICS

DESCRIPTION

A bilateral mild to moderate, nonthrobbing head pain or pressure, without other associated symptoms
Tension-type headache (TTH) replaced the older terms muscle contraction headache; stress, ordinary, or essential headache; idiopathic headache; and psychogenic headache.

EPIDEMIOLOGY

It is the most common type of primary headache, and the second-most prevalent headache disorder in the world.

Prevalence

Peak age of prevalence in the United States is in the 4th decade.
Prevalence of episodic TTH decreases with age, whereas the prevalence of chronic TTH increases with age.

ETIOLOGY AND PATHOPHYSIOLOGY

Not well understood, multifactorial etiology with both peripheral and central nervous system mechanisms triggering TTH
Activation of peripheral nociceptors leads to myofascial pain in episodic TTH.
Prolonged stimulation of nociceptors sensitizes the central pain pathways leading to chronic TTH.
Nitric oxide may play an important role in TTH.

RISK FACTORS

Associated with triggers/precipitating factors:

Stress (mental or physical)
Change in sleep regimen
Skipping meals, dehydration
Certain foods (caffeine, alcohol, chocolate)
Environmental factors (sun glare, odors, smoke, noise, lighting)
Female hormonal changes
Medications (e.g., nitrates, SSRIs, antihypertensives)
Overuse of abortive headache medication

GENERAL PREVENTION

Lifestyle factors to promote headache prevention include avoiding triggers, increasing exercise, keeping regular sleep patterns, decreasing caffeine and alcohol, and staying adequately hydrated.

COMMONLY ASSOCIATED CONDITIONS

83% of patients with migraine headaches also suffer from TTHs.
Possible increased prevalence of comorbid anxiety and depression

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