Headache

Tension Headache

search

Tension Headache, Occipital Headache, Tension Type Headache, Episodic TTH, Chronic TTH

  • Pathophysiology
  1. Pain associated with myofascial (muscular) cause
  • Causes
  1. Stress or worry
  2. Anxiety
  3. Major Depression
  4. Overwork
  5. Lack of sleep
  6. Incorrect Posture
  7. Marital and family dysfunction
  8. Post-Concussion (<3 months)
  9. Conversion
  10. Malingering
  • Types
  1. Episodic Tension Headache
    1. Recurrent Tension Headaches may progress to chronic Tension Headache (due to Headache Central Sensitization)
    2. Increased risk of chronic tension headach with longer duration Headaches and associated Nausea
  2. Chronic Tension Headache
    1. See Chronic Daily Headache
    2. Present at least half the days of the month
    3. Persists for 6 months or more
  • Symptoms
  1. Characteristics
    1. Pressing, tightening or vice-like gripping Headache
  2. Location
    1. Band of pain extending from forehead back to occiput
    2. Usually affects bilateral forehead
    3. Radiation into trapezius muscle and posterior neck
  3. Timing
    1. Mild to moderate intensity for more than 30 minutes
  4. Provocative
    1. Not provoked by low level activity
  5. Migraine Headache symptoms absent
    1. No Nausea or Vomiting
    2. No photophobia and phonophobia
    3. Headache is not pulsating
  • Diagnosis
  1. Characteristics: All must be present
    1. Headache lasts 30 minutes to 7 days
    2. No significant Nausea and no Vomiting (although Anorexia may be present)
    3. Photophobia OR phonophobia (but not both)
    4. Headache has at least 2 of the following features
      1. Bilateral distribution
      2. Pressing or tightening (non-pulsating quality)
      3. Mild to moderate intensity
      4. Not worse with routine Physical Activity (e.g. walking, climbing stairs)
  2. Timing
    1. Infrequent, Episodic Tension Type Headache
      1. Ten episodes or more and
      2. Episodes occur <1 day per month on average (<12 per year)
    2. Frequent Tension Type Headache
      1. Ten episodes or more and
      2. Episodes occur 1-14 days per month for at least 3 months (12 to 180 episodes per year)
    3. Chronic Tension Type Headache
      1. Episodes occur >15 days per month for at least 3 months (>180 episodes per year)
  3. References
    1. (2018) Cephalgia 38(1):1-211 [PubMed]
  • Management
  • General Measures
  1. See Nonpharmacologic Headache Treatment
  2. Reassurance
  3. Tobacco Cessation
    1. Headache is related to amount of Tobacco used
    2. Headaches increase with Cigarette use per day
  4. Modify or eliminate stressors
  5. Biofeedback
  6. Relaxation Therapy
  7. Yoga
  8. Coping strategies
  9. Counseling (Psychotherapy)
  10. Acupuncture
    1. Growing evidence of benefit (see Acupuncture)
    2. Vickers (2004) BMJ 328:744 [PubMed]
  11. Spinal Manipulation
  12. Physical Therapy
    1. Hammill (1996) Headache 36:149-53 [PubMed]