Skip to main content
SpringerLink
Log in

Kopfschmerz vom Spannungstyp

Quo vadis?

Tension type headaches

Quo vadis?

  • Schwerpunkt
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Der episodische Kopfschmerz vom Spannungstyp (eSK) gilt als die häufigste Kopfschmerzform. Tritt der Kopfschmerz vom Spannungstyp an mehr als 15 Tagen im Monat in mindestens 3 aufeinanderfolgenden Monaten auf, spricht man vom chronischen Kopfschmerz vom Spannungstyp (cSK). In den letzten Jahren zeigte sich, dass gerade die Abgrenzung einer eSK-Attacke von einer leichten Migräneattacke und die Abgrenzung eines cSK von einer chronischen Migräne schwierig ist. Im Folgenden sollen Kriterien zur leichteren Abgrenzung sowie die Therapie des Kopfschmerzes vom Spannungstyp diskutiert werden. Im Weiteren werden Befunde vorgestellt, die für oder gegen eine gemeinsame Pathophysiologie (im Sinne der Konvergenzhypothese) von Kopfschmerzen vom Spannungstyp und Migräne sprechen.

Abstract

Episodic tension type headache is considered to be the most prevalent primary headache. If tension type headache occurs on more than 15 days per month for at least 3 consecutive months, it is classified as chronic tension type headache. In recent years, it has become obvious that it is difficult to distinguish between episodic tension type headache and a moderate migraine attack and also between chronic tension type headache and chronic migraine. In the paper, we discuss how the differential diagnosis can be more specific and which therapy is supported by the literature. In addition, we discuss differences and similarities of tension type headache and migraine and a possible similar pathophysiology of both (convergence hypothesis).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Allais G, Chiarle G, Sinigaglia S, Mana O, Benedetto C (2019) Migraine during pregnancy and in the puerperium. Neurol Sci 40(Suppl 1):81–91

    PubMed  Google Scholar 

  2. Andrasik F (2010) Biofeedback in headache: an overview of approaches and evidence. Cleve Clin J Med 77(Suppl 3):72–76

    Google Scholar 

  3. Bendtsen L (2000) Central sensitization in tension-type headache-possible pathophysiological mechanisms. Cephalalgia 20:486–508

    CAS  PubMed  Google Scholar 

  4. Bendtsen L, Jensen R (2004) Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology 62(10):1706–1711

    CAS  PubMed  Google Scholar 

  5. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB (2008) Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache 48:1157–1168

    PubMed  Google Scholar 

  6. Brennum J, Kjeldsen M, Olesen J (1992) The 5‑HT1-like agonist sumatriptan has a significant effect in chronic tension-type headache. Cephalalgia 12(6):375–379

    CAS  PubMed  Google Scholar 

  7. Breslau N, Schultz LR, Stewart WF, Lipton RB, Lucia VC, Welch KM (2000) Headache and major depression: is the association specific to migraine? Neurology 54(2):308–313

    CAS  PubMed  Google Scholar 

  8. Cady RK (2007) The convergence hypothesis. Headache 47(Suppl 1):44–51

    Google Scholar 

  9. Castien RF, van der Windt DA, Grooten A, Dekker J (2011) Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial. Cephalalgia 31(2):133–143

    PubMed  Google Scholar 

  10. Chen WT, Chou KH, Lee PL et al (2018) Comparison of gray matter volume between migraine and “strict-criteria” tension-type headache. J Headache Pain 19(1):4. https://doi.org/10.1186/s10194-018-0834-6

    Article  PubMed  PubMed Central  Google Scholar 

  11. Couch JR, Amitriptyline Versus Placebo Study Group (2011) Amitriptyline in the prophylactic treatment of migraine and chronic daily headache. Headache 51(1):33–51

    PubMed  Google Scholar 

  12. Castien RF, van der Wouden JC, De Hertogh W (2018) Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis. J Headache Pain 19(1):9

    PubMed  PubMed Central  Google Scholar 

  13. Chitsaz A, Ghorbani A, Dashti M, Khosravi M, Kianmehr M (2017) The prevalence of osmophobia in migranous and episodic tension type headaches. Adv Biomed Res 2017(6):44

    Google Scholar 

  14. Diener HC, Bussone G, Van Oene JC, Lahaye M, Schwalen S, Goadsby PJ (2007) Topiramate reduces headache days in chronic migraine: a randomized, double-blind, placebo-controlled study. TOPMAT-MIG-201(TOP-CHROME) Study Group. Cephalalgia 27(7):814–823

    PubMed  Google Scholar 

  15. Diener HC, Pfaffenrath V, Pageler L, Peil H, Aicher B (2005) The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Cephalalgia 25(10):776–787

    CAS  PubMed  Google Scholar 

  16. Do TP, Heldarskard GF, Kolding LT, Hvedstrup J, Schytz HW (2018) Myofascial trigger points in migraine and tension-type headache. J Headache Pain 19(1):84

    PubMed  PubMed Central  Google Scholar 

  17. Dodick DW, Turkel CC, DeGryse RE, Aurora SK, Silberstein SD, Lipton RB, Diener HC, Brin MF, PREEMPT Chronic Migraine Study Group (2010) Onabotulinumtoxin A for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache 50(6):921–936

    PubMed  Google Scholar 

  18. Fernández-de-Las-Peñas C, Fernández-Muñoz JJ, Palacios-Cena M, Parás-Bravo P, Cigarán-Méndez M, Navarro-Pardo E (2018) Sleep disturbances in tension-type headache and migraine. Ther Adv Neurol Disord 11:1–6

    Google Scholar 

  19. Fernández-de-Las-Peñas C, Ge HY, Alonso-Blanco C, González-Iglesias J, Arendt-Nielsen L (2010) Referred pain areas of active myofascial trigger points in head, neck, and shoulder muscles, in chronic tension type headache. J Bodyw Mov Ther 14(4):391–396

    PubMed  Google Scholar 

  20. Ferrari MD, Roon KI, Lipton RB, Goadsby PJ (2001) Oral triptans (serotonin 5‑HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet 358(9294):1668–1675

    CAS  PubMed  Google Scholar 

  21. Fuller-Thomson E, Hodgins GA (2019) Suicide attempts among those with migraine: findings from a nationally representative Canadian study. Arch Suicide Res 4:1–20

    Google Scholar 

  22. Fumal A, Schoenen J (2008) Tension-type headache: current research and clinical management. Lancet Neurol 7(1):70–83

    CAS  PubMed  Google Scholar 

  23. Gaul C, van Doorn C, Webering N, Dlugaj M, Katsarava Z, Diener HC, Fritsche G (2011) Clinical outcome of a headache-specific multidisciplinary treatment program and adherence to treatment recommendations in a tertiary headache center: an observational study. J Headache Pain 12(4):475–483

    PubMed  PubMed Central  Google Scholar 

  24. Göbel H, Fresenius J, Heinze A, Dworschak M, Soyka D (1996) Effectiveness of Oleum menthae piperitae and paracetamol in therapy of headache of the tension. Nervenarzt 67:672–681

    PubMed  Google Scholar 

  25. Haag G, Diener HC, May A, Meyer C, Morck H, Straube A, Wessely P, Evers S (2011) Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migräne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft für Neurologie (DGN), the Österreichische Kopfschmerzgesellschaft (ÖKSG) and the Schweizerische Kopfwehgesellschaft (SKG). J Headache Pain 12(2):201–217

    PubMed  Google Scholar 

  26. Hagen K, Stovner LJ, Zwart JA (2020) Time trends of major headache diagnoses and predictive factors. Data from three Nord-Trøndelag health surveys. J Headache Pain 21(1):24

    PubMed  PubMed Central  Google Scholar 

  27. Headache Classification Committee of the International Headache Society (2018) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38(1):1–211

    Google Scholar 

  28. Holroyd KA, O’Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW (2001) Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy and their combination. JAMA 285:2208–2215

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Honningsvåg LM, Håberg AK, Hagen K, Kvistad KA, Stovner LJ, Linde M (2018) White matter hyperintensities and headache: a population-based imaging study (HUNT MRI). Cephalalgia 38(13):1927–1939. https://doi.org/10.1177/0333102418764891

    Article  PubMed  Google Scholar 

  30. Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O’Malley PG (2010) Tricyclic antidepressants and headaches: systematic review and meta-analysis. BMJ 341:c5222. https://doi.org/10.1136/bmj.c5222

    Article  PubMed  PubMed Central  Google Scholar 

  31. Jackson JL, Mancuso JM, Nickoloff S, Bernstein R, Kay C (2017) Tricyclic and tetracyclic antidepressants for the prevention of frequent episodic or chronic tension-type headache in adults: a systematic review and meta-analysis. J Gen Intern Med 32(12):1351–1358

    PubMed  PubMed Central  Google Scholar 

  32. Jensen R (1999) Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia 19:602–621

    CAS  PubMed  Google Scholar 

  33. Juang KD, Wang SJ, Fuh JL, Lu SR, Su TP (2000) Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache 40:818–823

    CAS  PubMed  Google Scholar 

  34. Kim J, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK (2017) Insomnia in tension-type headache: a population-based study. J Headache Pain 18(1):95

    PubMed  PubMed Central  Google Scholar 

  35. Kropp P, Meyer B, Dresler T, Fritsche G, Gaul C, Niederberger U, Förderreuther S, Malzacher V, Jürgens TP, Marziniak M, Straube A (2016) Entspannungsverfahren und verhaltenstherapeutische Interventionen zur Behandlung der Migräne. Leitlinie der DMKG. Nervenheilkunde 35:502–515

    Google Scholar 

  36. Kruit MC, van Buchem MA, Launer LJ, Terwindt GM, Ferrari MD (2010) Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia 30(2):129–136. https://doi.org/10.1111/j.1468-2982.2009.01904.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Láinez MJA, Monzón MJ (2001) Chronic daily headache. Curr Neurol Neurosci Rep 1:118–124

    PubMed  Google Scholar 

  38. Lampl C, Marecek S, May A, Bendtsen L (2006) A prospective, open-label, long-term study of the efficacy and tolerability of topiramate in the prophylaxis of chronic tension-type headache. Cephalalgia 26(10):1203–1208

    CAS  PubMed  Google Scholar 

  39. Landgraf MN, von Kries R, Heinen F, Langhagen T, Straube A, Albers L (2016) Self-reported neck and shoulder pain in adolescents is associated with episodic and chronic migraine. Cephalalgia 36(8):807–811

    PubMed  Google Scholar 

  40. Lee MJ, Park BY, Cho S, Kim ST, Park H, Chung CS (2019) Increased connectivity of pain matrix in chronic migraine: a resting-state functional MRI study. J Headache Pain 20(1):29. https://doi.org/10.1186/s10194-019-0986-z

    Article  PubMed  PubMed Central  Google Scholar 

  41. Liang Z, Galea O, Thomas L, Jull G, Treleaven J (2019) Cervical musculoskeletal impairments in migraine and tension type headache: a systematic review and meta-analysis. Musculoskelet Sci Pract 42:67–83

    PubMed  Google Scholar 

  42. Lieba-Samal D, Wöber C (2011) Sex Hormones and primary headache other than migraine. Curr Pain Headache Rep 15(5):407–414

    PubMed  Google Scholar 

  43. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR (2009) Acupuncture for tension-type headache. Cochrane Database Syst Rev 21(1):CD7587

    Google Scholar 

  44. Lipton RB, Cady RK, Stewart WF, Wilks K, Hall C (2002) Diagnostic lessons from the spectrum study. Neurology 58(9 Suppl 6):S27–S31

    CAS  PubMed  Google Scholar 

  45. Mathew NT, Reuveni U, Perez F (1987) Transformed or evolutive migraine. Headache 27(2):102–106

    CAS  PubMed  Google Scholar 

  46. Melchart D, Streng A, Hoppe A, Brinkhaus B, Wit C, Wagenpfeil S, Pfaffenrath V, Hammes M, Hummelsberger J, Irnich D, Weidenhamme W, Willich SN, Linde A (2005) Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ 331(7513):376–382

    PubMed  PubMed Central  Google Scholar 

  47. Merikangas KR, Cui L, Richardson AK, Isler H, Khoromi S, Nakamura E, Lamers F, Rössler W, Ajdacic-Gross V, Gamma A, Angst J (2011) Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study. BMJ 343:d5076

    PubMed  PubMed Central  Google Scholar 

  48. Min YW, Lee JH, Min BH, Lee JH, Kim JJ, Chung CS, Rhee PL (2013) Clinical predictors for migraine in patients presenting with nausea and/or vomiting. J Neurogastroenterol Motil 19(4):516–520

    PubMed  PubMed Central  Google Scholar 

  49. Müller B, Dresler T, Gaul C, Glass Ä, Jürgens TP, Kropp P, Ruscheweyh R, Straube A, Förderreuther S (2019) More attacks and analgesic use in old age: self-reported headache across the lifespan in a German sample. Front Neurol 10:1000

    PubMed  PubMed Central  Google Scholar 

  50. Oguz Akarsu E, Baykan B, Ertas M, Zarifoglu M, Orhan EK, Saip S, Siva A, Karli N, Turkish Headache Study Group (2020) The persistence versus interchangeability of migraine and tension-type headaches in a 5-year population-based validated survey. Cephalalgia 40(1):39–48

    PubMed  Google Scholar 

  51. Pfaffenrath V, Fendrich K, Vennemann M, Meisinger C, Ladwig KH, Evers S, Straube A, Hoffmann W, Berger K (2009) Regional variations in the prevalence of migraine and tension-type headache applying the new IHS criteria: the German DMKG Headache Study. Cephalalgia 29(1):48–57

    CAS  PubMed  Google Scholar 

  52. Rossi P, Vollono C, Valeriani M, Sandrini G (2011) The contribution of clinical neurophysiology to the comprehension of the tension-type headache mechanisms. Clin Neurophysiol 122(6):1075–1085

    PubMed  Google Scholar 

  53. Russell MB, Saltyte-Benth J, Levi N (2006) Are infrequent episodic, frequent episodic and chronic tension-type headache inherited? A population-based study of 11 199 twin pairs. J Headache Pain 7(3):119–126. https://doi.org/10.1007/s10194-006-0299-x

    Article  PubMed  PubMed Central  Google Scholar 

  54. Russell MB (2007) Genetics of tension-type headache. J Headache Pain 8(2):71–76. https://doi.org/10.1007/s10194-007-0366-y

    Article  PubMed  PubMed Central  Google Scholar 

  55. Scher AI, Stewart WF, Ricci JA, Lipton RB (2003) Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 106(1/2):81–89

    CAS  PubMed  Google Scholar 

  56. Schmidt-Wilcke T, Leinisch E, Straube A, Kampfe N, Draganski B, Diener HC, Bogdahn U, May A (2005) Gray matter decrease in patients with chronic tension type headache. Neurology 65(9):1483–1486

    CAS  PubMed  Google Scholar 

  57. Schulte-Mattler WJ, Krack P, BoNTTH Study Group (2004) Treatment of chronic tension-type headache with botulinum toxin A: a randomized, double-blind, placebo-controlled multicenter study. Pain 109(1/2):110–114

    CAS  PubMed  Google Scholar 

  58. Seo JG, Kim KT, Moon HJ, Kuk Do J, Kim SY, Park SP (2019) Suicidality and its risk factors in tension-type headache patients: a multicenter case-control study. J Clin Neurosci 69:21–25

    PubMed  Google Scholar 

  59. Sjaastad O (2011) Tension-type headache: one or more headaches? Funct Neurol 26:165–170

    PubMed  PubMed Central  Google Scholar 

  60. Stovner LJ, Andree C (2010) Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain 11(4):289–299

    PubMed  PubMed Central  Google Scholar 

  61. Straube A et al (2015) Therapie des episodischen und chronischen Kopfschmerzes vom Spannungstyp und anderer chronischer täglicher Kopfschmerzen (Herausgegeben von der Kommission Leitlinien der Deutschen Gesellschaft für Neurologie sowie der Deutschen Migräne und Kopfschmerz Gesellschaft März 2015; www.dgn.org; www.dmkg.org; www.awmf.de. Zugegriffen: 25. Juni 2020)

    Google Scholar 

  62. Straube A, Andreou A (2019) Primary headaches during lifespan. J Headache Pain 20(1):35

    PubMed  PubMed Central  Google Scholar 

  63. Straube A (2010) Botulinumtoxin bei Kopfschmerzen: Ende eines langen Weges? Akt Neurol 37:327–332

    Google Scholar 

  64. Torelli P, Jensen R, Olesen J (2004) Physiotherapy for tension-type headache: a controlled study. Cephalalgia 24(1):29–36

    CAS  PubMed  Google Scholar 

  65. Vuralli D, Boran HE, Cengiz B, Coskun O, Bolay H (2017) Somatosensory temporal discrimination remains intact in tension-type headache whereas it is disrupted in migraine attacks. Cephalalgia 37(13):1241–1247

    PubMed  Google Scholar 

  66. Wallasch TM, Kropp P (2012) Multidisciplinary integrated headache care: a prospective 12-month follow-up observational study. J Headache Pain 13(7):521–529

    PubMed  PubMed Central  Google Scholar 

  67. Wieckiewicz M, Grychowska N, Zietek M, Wieckiewicz G, Smardz J (2017) Evidence to use botulinum toxin injections in tension-type headache management: a systematic review. Toxins (Basel) 9(11):E370. https://doi.org/10.3390/toxins9110370

    Article  CAS  Google Scholar 

  68. Yoon MS, Katsarava Z, Obermann M, Fritsche G, Oezyurt M, Kaesewinkel K, Katsarova A, Santowski I, Diener H, Moebus S (2012) Prevalence of primary headaches in Germany: results of the German Headache Consortium Study. J Headache Pain 13(3):215–223

    PubMed  PubMed Central  Google Scholar 

  69. Yu S, Han X (2015) Update of chronic tension-type headache. Curr Pain Headache Rep 19(1):469

    PubMed  Google Scholar 

  70. Zissis NP, Harmoussi S, Vlaikidis N, Mitsikostas D, Thomaidis T, Georgiadis G, Karageorgiou KA (2007) A randomized, double-blind, placebo-controlled study of venlafaxine XR in out-patients with tension-type headache. Cephalalgia 27(4):315–324

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Neurologie, Oberbayerisches Kopfschmerzzentrum, Klinikum Großhadern, Ludwig-Maximilians-Universität, 81377, München, Deutschland

    Andreas Straube, Stefanie Förderreuther & Ozan Emre Eren

Authors
  1. Andreas Straube
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefanie Förderreuther
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ozan Emre Eren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Straube.

Ethics declarations

Interessenkonflikt

A. Straube: Persönliche Honorare für Fortbildungsvorträge und Advisory Boards von Allergan, AllergoSan, Bayer, Novartis, Lilly, Teva. Forschungsförderung durch Deutsche Forschungsgemeinschaft (DFG), Bundesministerium für Bildung und Forschung (BMBF), Universität München, Friedrich-Baur Stiftung. S. Förderreuther: Persönliche Honorare für Fortbildungsvorträge und Advisory Boards von Allergan, AstraZeneca, Novartis, Hormosan Pharma, Sanofi. O.E. Eren: Reiseunterstützung von Allergan, Lilly. Forschungsförderung durch Friedrich-Baur-Stiftung, BMBF.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Straube, A., Förderreuther, S. & Eren, O.E. Kopfschmerz vom Spannungstyp. Schmerz 34, 464–475 (2020). https://doi.org/10.1007/s00482-020-00495-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-020-00495-5

Schlüsselwörter

Keywords

Search

Navigation