Tension-Type Headache

Abstract

Tension-type headache is the second most common cause of chronic pain in the Global Burden of Disease, affecting an estimated population of nearly 900 million new cases per year. The estimated prevalence of tension-type headache is enormous, with a very high variability from 10% up to 86% in young subjects. The global prevalence of the chronic form is equally important because it covers about two 3% of the global population. Despite such an important epidemiological economic impact, tension-type headache causes less disability than migraine. In terms of years of life lived with disabilities the comorbidities of tension-type headache are often similar to those of migraine such as anxiety, depression, sleep disturbances and other pain disorders including migraine itself. The physiopathology of the tension-type headache is mainly based on genetic factors, myofascial mechanisms and chronicization mechanisms such as sensitization, therefore peripheral mechanisms and vascular factors are mostly unimportant. The central factors are important in the transformation from the episodic form to the chronic one. Unfortunately, the non-exact definition of the pathophysiology and the moderate burden impact and even a modest economic impact has left the tension-type headache, from a therapeutic point of view, still with old generation drugs, with no new compounds dedicated to this pathology for many decades. However, being a pathology with a great impact in the general population, it is useful to know the most important lines of research and any updates also in the field of complementary medicine that can guide the clinician in his/her daily practice.