Tension headache

From Wikipedia, the free encyclopedia

Tension headache

A woman experiencing a tension headache

Classification and external resources

Specialty Neurology

ICD-10 G44.2

ICD-9-CM 307.81, 339.1

DiseasesDB 12554

MedlinePlus 000797

eMedicine article/1142908
 MeSH D018781

[edit on Wikidata]

Tension headache, also known as tension-type headache, is the most common type of
primary headache. The pain can radiate from the lower back of the head, the neck, eyes, or other
muscle groups in the body typically affecting both sides of the head. Tension-type headaches
account for nearly 90% of all headaches.
Pain medication such as aspirin and ibuprofen, are effective for the treatment of tension
headache.[1][2] Tricyclic antidepressants appear to be useful for prevention.[3] Evidence is poor
for SSRIs, propranolol, and muscle relaxants.[4][5]
As of 2013 tension headaches affect about 1.6 billion people (20.8% of the population)[6] and are
more common in women than men (23% to 18% respectively).[7]

Contents
[hide]

1Signs and symptoms

o 1.1Frequency and duration

2Cause

3Prevention

o 3.1Lifestyle

o 3.2Medications

4Treatment

o 4.1Medications

o 4.2Manual therapy

5Epidemiology

6Prognosis

7References

8External links

Signs and symptoms[edit]

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 present on both sides of the head at the same time.
Tension-type headache pain is typically mild to moderate, but may be severe.
Frequency and duration[edit]
Tension-type headaches can be episodic or chronic.[8] Episodic tension-type headaches are
defined as tension-type headaches occurring fewer 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, months or even years, though a typical tension
headache lasts 46 hours.

Cause[edit]
Various precipitating factors may cause tension-type headaches in susceptible individuals: [9]

Stress: usually occurs in the afternoon after long stressful work hours or after an exam

Sleep deprivation

Uncomfortable stressful position and/or bad posture

Irregular meal time (hunger)

Eyestrain
Tension-type headaches may be caused by muscle tension around the head and neck.
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 informationfor example from the
temporal muscle or other musclesand interprets this signal as pain. One of the main
neurotransmitters that 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 nortriptyline. However, the analgesic effect of nortriptyline 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.[10] 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 nociceptive neurons (in trigeminal spinal nucleus, thalamus, and cerebral cortex) is
believed to be involved in the pathophysiology of chronic tension-type headache. [11] 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.[12]
If other treatment is not working, a health care provider may use an MRI to confirm a more
complicated diagnosis (i.e. New daily persistent headache).[13]

Prevention[edit]
Lifestyle[edit]
Drinking water and avoiding dehydration helps in preventing tension headache.[13] Using stress
management and relaxing often makes headaches less likely.[13] Drinking alcohol can make
headaches more likely or severe.[13] Good posture might prevent headaches if there is neck pain.
[13]
People who have jaw clenching might develop headaches, and getting treatment from a
dentist might prevent those headaches.[13] Biofeedback techniques may also help.[14][15]
Medications[edit]
People who have 15 or more headaches in a month may be treated with certain types of daily
antidepressants which act to prevent continued tension headaches from occurring. [13] In those
who are predisposed to tension type headaches the first-line preventative treatment
is amitriptyline, whereas mirtazapine and venlafaxine are second-line treatment options.
[16]
Tricyclic antidepressants appear to be useful for prevention.[3] Tricyclic antidepressants have
been found to be more effective than SSRIs but have greater side effects.[3] Evidence is poor for
the use of SSRIs, propranolol, and muscle relaxants for prevention of tension headaches.[4][5]

Treatment[edit]
Treatment for a current tension headache is to drink water and confirm that there is
no dehydration.[13] If symptoms do not resolve within an hour for a person who has had water,
then stress reduction might resolve the issue.[13]
Medications[edit]
Over-the-counter drugs, like acetaminophen, aspirin, or ibuprofen, can be effective but tend to
only be helpful as a treatment for a few times in a week at most.[13][1][17]Analgesic/sedative
combinations are widely used (e.g., analgesic/antihistamine combinations like Syndol, Mersyndol
and Percogesic, analgesic/barbiturate combinations such as Fiorinal). Frequent use of
analgesics may, however, lead to medication overuse headache.[2][16]
Botulinum toxin does not appear to be helpful.[18]
Manual therapy[edit]
Though evidence for acupuncture is slight, some suggest it may be useful in those with frequent
or chronic tension headaches.[19]
People with tension-type headache often use spinal manipulation, soft tissue therapy,
and myofascial trigger point treatment. Studies of effectiveness are mixed. A 2006 systematic
review found no rigorous evidence supporting manual therapies for tension headache. [20] A 2005
structured review found only weak evidence for the effectiveness of chiropractic manipulation for
tension headache, and that it was probably more effective for tension headache than for
migraine.[21] A 2004 Cochrane review found that spinal manipulation may be effective for migraine
and tension headache, and that spinal manipulation and neck exercises may be effective
for cervicogenic headache.[22] Two other systematic reviews published between 2000 and May
2005 did not find conclusive evidence in favor of spinal manipulation. [23] A 2012 systematic review
of manual therapy found that hands-on work may reduce both the frequency and the intensity of
chronic tension-type headaches.[24]

Epidemiology[edit]
As of 2013 tension headaches affect about 1.6 billion people (20.8% of the population)[6] and are
more common in women than men (23% to 18% respectively).[7] Despite its benign character,
tension-type headache, especially in its chronic form, can impart significant disability on patients
as well as burden on society at large.[25]

Prognosis[edit]
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 through 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.

References[edit]
1. ^ Jump up to:a b Derry, S; Wiffen, PJ; Moore, RA; Bendtsen, L (31 July 2015). "Ibuprofen
for acute treatment of episodic tension-type headache in adults.". The Cochrane database of
systematic reviews. 7: CD011474. doi:10.1002/14651858.CD011474.pub2. PMID 26230487.
2. ^ Jump up to:a b Loder, E; Rizzoli, P (12 January 2008). "Tension-type headache". BMJ
(Clinical research ed.). 336 (7635): 8892. doi:10.1136/bmj.39412.705868.AD. PMC 2190284
. PMID 18187725.

3. ^ Jump up to:a b c Jackson JL, Shimeall W, Sessums L, et al. (2010). "Tricyclic

antidepressants and headaches: systematic review and meta-analysis". BMJ. 341:
c5222. doi:10.1136/bmj.c5222. PMC 2958257 . PMID 20961988.

4. ^ Jump up to:a b Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW (April 2010).
"Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic
review". Fam Pract. 27 (2): 15165. doi:10.1093/fampra/cmp089. PMID 20028727.

5. ^ Jump up to:a b Banzi, R; Cusi, C; Randazzo, C; Sterzi, R; Tedesco, D; Moja, L (1 May

2015). "Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake
inhibitors (SNRIs) for the prevention of tension-type headache in adults.". The Cochrane database
of systematic reviews. 5: CD011681. doi:10.1002/14651858.CD011681. PMID 25931277.

6. ^ Jump up to:a b Global Burden of Disease Study 2013, Collaborators (22 August
2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301
acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the
Global Burden of Disease Study 2013.". Lancet (London, England). 386 (9995): 743
800. doi:10.1016/s0140-6736(15)60692-4. PMC 4561509 . PMID 26063472.

7. ^ Jump up to:a b Vos, T; Flaxman, A. D.; Naghavi, M; Lozano, R; Michaud, C; Ezzati, M;

Shibuya, K; Salomon, J. A.; Abdalla, S; Aboyans, V; Abraham, J; Ackerman, I; Aggarwal, R; Ahn,
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9. Jump up^ Muscle Contraction Tension Headache at eMedicine

10. Jump up^ Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J; Lassen; Bendtsen;
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13. ^ Jump up to:a b c d e f g h i j Consumer Reports (28 April 2016). "Tension Headache
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14. Jump up^ Nestoriuc Y, Rief W, Martin A; Rief; Martin (June 2008). "Meta-analysis of
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17. Jump up^ Derry, S; Wiffen, PJ; Moore, RA (13 January 2017). "Aspirin for acute
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18. Jump up^ Simpson, D. M.; Hallett, M.; Ashman, E. J.; Comella, C. L.; Green, M. W.;
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20. Jump up^ Fernndez-de-las-Peas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC,

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