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Tension Headache
Aka: Tension Headache, Occipital Headache, Tension Type Headache, Episodic TTH, Chronic TTH- See Also
- Pathophysiology
- Pain associated with myofascial (muscular) cause
- Causes
- Stress or worry
- Anxiety
- Major Depression
- Overwork
- Lack of sleep
- Incorrect Posture
- Marital and family dysfunction
- Post-Concussion (<3 months)
- Conversion
- Malingering
- Types
- Episodic Tension Headache
- Recurrent Tension Headaches may progress to chronic Tension Headache (due to Headache Central Sensitization)
- Increased risk of chronic tension headach with longer duration Headaches and associated Nausea
- Chronic Tension Headache
- See Chronic Daily Headache
- Present at least half the days of the month
- Persists for 6 months or more
- Episodic Tension Headache
- Symptoms
- Characteristics
- Pressing, tightening or vice-like gripping Headache
- Location
- Band of pain extending from forehead back to occiput
- Usually affects bilateral forehead
- Radiation into trapezius Muscle and posterior neck
- Timing
- Mild to moderate intensity for more than 30 minutes
- Provocative
- Not provoked by low level activity
- Migraine Headache symptoms absent
- Characteristics
- Evaluation
- Diagnosis
- Characteristics: All must be present
- Headache lasts 30 minutes to 7 days
- No significant Nausea and no Vomiting (although Anorexia may be present)
- Photophobia OR phonophobia (but not both)
- Headache has at least 2 of the following features
- Bilateral distribution
- Pressing or tightening (non-pulsating quality)
- Mild to moderate intensity
- Not worse with routine Physical Activity (e.g. walking, climbing stairs)
- Timing
- Infrequent, Episodic Tension Type Headache
- Ten episodes or more and
- Episodes occur <1 day per month on average (<12 per year)
- Frequent Tension Type Headache
- Ten episodes or more and
- Episodes occur 1-14 days per month for at least 3 months (12 to 180 episodes per year)
- Chronic Tension Type Headache
- Episodes occur >15 days per month for at least 3 months (>180 episodes per year)
- Infrequent, Episodic Tension Type Headache
- References
- Characteristics: All must be present
- Management: General Measures
- See Nonpharmacologic Headache Treatment
- Reassurance
- Tobacco Cessation
- Modify or eliminate stressors
- Biofeedback
- Relaxation Therapy
- Yoga
- Coping strategies
- Counseling (Psychotherapy)
- Acupuncture
- Growing evidence of benefit (see Acupuncture)
- Vickers (2004) BMJ 328:744 [PubMed]
- Spinal Manipulation
- Physical Therapy
- Management: Medications
- Myofascial injections
- Trigger Point Injection at affected occiput or
- Lower Cervical Intramuscular Injection
- Selective C1-C2 lateral Joint Injection
- Analgesics
- Consider Antidepressants for Headache prophylaxis
- Myofascial injections
- References
- Millea (2002) Am Fam Physician 66(5):797-805 [PubMed]
- Redillas (2000) Headache 40(2): 83-102 [PubMed]
- Ryan (1996) Am Fam Physician 54(3):1051-7 [PubMed]
- Stevens (1993) Am Fam Physician 47(4):799-804 [PubMed]
- Trachtenbarg (1994) Postgrad Med 95(6):44-56 [PubMed]
- Hainer (2013) Am Fam Physician 87(10): 682-7 [PubMed]