- A bilateral mild to moderate, nonthrobbing head pain or pressure, without other associated symptoms. Three types of tension-type headache (TTH):
- Infrequent episodic TTH: <1 day per month
- Frequent episodic TTH: ≥1 but <15 days per month
- Chronic TTH: ≥15 days per month for >3 months
- TTHs replaced older terms: muscle contraction headache, stress or tension headache, and psychogenic headache.
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
- Lifetime prevalence: men (69%); women (88%)
- Prevalence of episodic TTH decreases with age, whereas the prevalence of chronic TTH increases with age.
Etiology and Pathophysiology
- Multifactorial: peripheral and/or central mechanisms
- 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.
Associated with triggers/precipitating factors:
- Stress (mental or physical): the most common
- Change in sleep regimen
- Skipping meals
- Certain foods (caffeine, alcohol, chocolate)
- Physical exertion
- Environmental factors (sun glare, odors, smoke, noise, lighting)
- Poor or sustained posture
- Female hormonal changes
- Medications (e.g., nitrates, SSRIs, antihypertensives)
- Overuse of abortive headache medication
- Identify and avoid triggers/precipitating factors.
- Minimize physical and emotional stress.
- Relaxation techniques: biofeedback, relaxation therapy, and physical therapy
Commonly Associated Conditions
- 83% of patients with migraine headaches also suffer from TTHs.
- Debatable: increased prevalence of comorbid anxiety and depression
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Domino, Frank J., et al., editors. "Headache, Tension." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache__Tension.
Headache, Tension. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache__Tension. Accessed June 10, 2023.
Headache, Tension. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache__Tension
Headache, Tension [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 10]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache__Tension.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Headache, Tension ID - 1688872 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688872/all/Headache__Tension PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -