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| {{Tension headache}} | | {{Tension headache}} |
| | '''For patient information, click [[Tension headache (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}} |
| ==Overview==
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| '''Tension headaches''', which were renamed '''tension-type headaches''' by the [[International Headache Society]] in 1988, are the most common type of primary [[headache]]s. The pain can radiate from the neck, back, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of population suffers from chronic-tension type headache.<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>
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| == Frequency and duration == | | {{SK}} Muscle contraction headache; headache - benign; headache - tension; chronic headaches - tension; rebound headaches - tension; stress headache |
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| | ==[[Tension headache overview|Overview]]== |
| | ==[[Tension headache historical perspective|Historical Perspective]]== |
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| 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 less 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 or even months, though a typical tension headache lasts 4-6 hours.
| | ==[[Tension headache classification|Classification]]== |
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| == Pain and possible symptoms == | | ==[[Tension headache pathophysiology|Pathophysiology]]== |
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| 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. In contrast to [[migraine]], the pain does not increase during exercise.
| | ==[[Tension headache causes|Causes]]== |
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| == Cause and pathophysiology == | | ==[[Tension headache differential diagnosis|Differentiating Tension Headache from other Diseases]]== |
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| Various precipitating factors may cause TTH in susceptible individuals [http://www.emedicine.com/neuro/topic231.htm]. One half of patients with TTH identify stress or hunger as a precipitating factor;
| | ==[[Tension headache epidemiology and demographics|Epidemiology and Demographics]]== |
| * Stress - Usually occurs in the afternoon after long stressful work hours
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| * Sleep deprivation
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| * Uncomfortable stressful position and/or bad posture
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| * Irregular meal time ([[hunger]])
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| * Eyestrain
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| The exact cause of tension-type headaches is still unknown. It is suggested that abnormalities in the peripheral and central nervous systems may be involved in the pathophysiology of TTH. It has long been believed that they are caused by [[muscle tension]] around the head and neck and the restriction of blood flow to those areas as a result, the cause of which is often the presence of an unresolved subconscious [[emotional conflict]] and [[anxiety]]. 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]]. Although muscle tension may be involved, scientists now believe there is not one single cause for this type of headache. 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 molecules 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 randomised 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 [[Pain and 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>
| | ==[[Tension headache risk factors|Risk Factors]]== |
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| | ==[[Tension headache natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| | ==Diagnosis== |
| | [[Tension headache history and symptoms|History and Symptoms]] | [[Tension headache physical examination|Physical Examination]] | [[Tension headache laboratory findings|Laboratory Findings]] | [[Tension headache CT|CT]] | [[Tension headache MRI|MRI]] | [[Tension headache other imaging findings|Other Imaging Findings]] | [[Tension headache other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| | [[Tension headache medical therapy|Medical Therapy]] | [[Tension headache primary prevention|Primary Prevention]] | [[Tension headache secondary prevention|Secondary Prevention]] | [[Tension headache cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Tension headache future or investigational therapies|Future or Investigational Therapies]] |
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| Episodic tension-type headaches generally respond well to over-the-counter [[analgesic]]s, such as [[paracetamol]], [[ibuprofen]] or [[aspirin]]. The effect of the analgesic is boosted if either caffeine (such as a cup of coffee) or a dose of the sedative antihistamine [[diphenhydramine]] (Benadryl, 25mg) is taken at the same time. However, these medications should be avoided in cases of chronic tension-type headache, due to the risk of [[Rebound headache|medication overuse headaches]].
| | == Case Studies == |
| | | [[Tension headache case study one|Case #1]] |
| Chronic tension-type headaches are more difficult to treat. Some therapies that are suggested for chronic tension-type headaches include:
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| ;Pharmacological therapy:
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| *[[Amitriptyline]]<ref>Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001 May 2;285(17):2208-15.</ref>
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| *[[Mirtazapine]]<ref>Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology. 2004 May 25;62(10):1706-11.</ref>
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| ;Non-pharmacological therapy:
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| *Cranial chiropractic
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| *Exercise such as [[swimming]] two to three times a week
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| *[[Acupuncture]]
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| *[[Biofeedback]]
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| *[[Massage]]
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| *Heat pillow
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| *[[Relaxation technique]]s like:
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| **[[Jacobson's Progressive Muscle Relaxation]]
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| **[[Autogenic training]]
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| ;Avoiding triggers
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| Tension headaches are exacerbated by states or activities that induce muscle tension, such as [[stress (psychology)|stress]]. Avoiding such states can lessen the frequency of tension headaches. Tension headaches can also be provoked by other conditions, such as an [[upper respiratory infection]].
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| Often the best treatment for a mild tension headache that does not impair a person's ability to function is simple endurance. Many tension headache sufferers receive relief from [[sleep]]. However, it is always best to see your physician for a full work-up of the headaches.
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| == Prognosis ==
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| 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 from 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]].
| | ==Related Chapters== |
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| == References == | |
| {{Reflist|2}}
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| == See also ==
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| *[[Migraine]] | | *[[Migraine]] |
| *[[Cluster headache]] | | *[[Cluster headache]] |
| *[[Rebound headache]] | | *[[Rebound headache]] |
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| ==External links== | | ==External Links== |
| *[http://www.achenet.org American Council for Headache Education] | | *[http://www.achenet.org American Council for Headache Education] |
| *[http://www.headaches.org National Headache Foundation] | | *[http://www.headaches.org National Headache Foundation] |
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| {{Diseases of the nervous system}} | | {{Diseases of the nervous system}} |
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| [[Category:Headaches]] | | [[Category:Headaches]] |
| [[Category:Neurology]] | | [[Category:Neurology]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
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