Diagnostic and Management

of Tension Type Headache

Abstract
Headaches are considered one of the most common types of pain and one of the most
frequent causes of presentation to physician offices and clinics . Nearly 50 million adults
seek treatment from physicians each year related to headache pain. As a result, headaches
represent a significant cause of morbidity. It is estimated that headaches result in billions
of dollars in expenses, job absenteeism and decreased annual productivity. They also
result in decreased quality of life. A clear understanding of the types and causes of
headache pain is essential for physicians and other healthcare providers to adequately
address and manage the patient with headaches.
The International Headache Society recognizes two general groups of headache
primary and secondary. Primary headaches are typically recurrent without known
pathology or cause. The three basic categories of primary headache are tension,migraine
and cluster. Secondary headaches are associated with a recognized medical condition.
Tension Type Headache (TTH) is the most featureless of the primary headaches, and
because many secondary headaches may mimic TTH,
a diagnosis of TTH requires
exclusion of other organic disorders. There are no diagnostic test of the primary headache
disorder. The diagnosis of TTH is based on the typical patients history and a normal
neurological examination. It is important to consider which mechanisms that may be
important for the individual patient and to tailor the treatment accordingly. Acute drug
therapy refers to the treatment of individual attacks of headache in patients with episodic
and chronic TTH. Most headaches in patients with episodic TTH are mild to moderate
and the patients can often self-manage by using simple analgesics. The efficacy of simple
analgesics tends to decrease with increasing frequency of the headaches. In patients with
chronic TTH, the headaches are often associated with tress, anxiety and depression. The
tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment
of chronic TTH. The efficacy is modest and treatment is often hampered by side effects.
It is important that patients are informed that this is an antidepressant agent but has an
independent action on pain.
The establishment of an accurate diagnosis is important before the initiation of any
treatment