Description

• 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.

Epidemiology

The most common type of primary headache, and the second-most prevalent disorder in the world

Prevalence

• 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.

Risk Factors

Associated with triggers/precipitating factors:

• Stress (mental or physical): the most common
• Change in sleep regimen
• Skipping meals
• Certain foods (caffeine, alcohol, chocolate)
• Dehydration
• 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

General Prevention

• 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