Headache, Tension



  • 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.


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


  • Peak age of prevalence in the United States: 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, regular sleep patterns, decreasing caffeine and alcohol intake, 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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