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Current Pain and Headache Reports

, Volume 5, Issue 5, pp 454–462 | Cite as

Overview of tension-type headache

  • Elliott A. Schulman
Article

Abstract

Tension-type headache (TTH) is the most prevalent form of headache. Although it is not the most severe form of headache, it has a significant impact on society. In spite of this, little is known about its pathophysiology. Current International Headache Society classification has been called into question, and new classification approaches have been suggested. With reference to chronic TTH, the issue of analgesic rebound may confound the diagnosis. Transformed migraine and new persistent daily headaches are clarified and differentiated from chronic TTHs (CTTHs).

The best documented abnormality found in TTHs is the presence of pericranial tenderness. It is generally believed that pain is initiated by a peripheral mechanism, most likely increased input from the myofascial nociceptors. In CTTH, there may be an impaired supraspinal modulation of the incoming stimuli. Whether there is an overlap in the continuum between TTH and migraine is controversial. Abortive and prophylactic treatments are discussed and wellness and adjunct therapy are also emphasized. Lastly, special attention is paid to the doctor-patient relationship in patients with difficult headaches.

Keywords

Migraine Sumatriptan Chronic Daily Headache Tension Headache Muscle Hardness 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Jensen R: Pathophysiological mechanisms of tension-type headache. Cephalalgia 1999, 6:602–621. A very good review of TTHs that addresses such issues as classification, central and peripheral factors in TTH, as well as the impact of muscle activity, hardness, and tenderness as it relates to TTH.CrossRefGoogle Scholar
  2. 2.
    Friedman AP: Characteristics of tension headaches, a profile of 1420 cases. Psychosomatics 1979, 207:451–461.Google Scholar
  3. 3.
    Ad Hoc Committee on Classification of Headache: Classification of headaches. JAMA 1962, 179:717–718.Google Scholar
  4. 4.
    Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the IHS [no authors listed]. Cephalalgia 1988, 8:1–96.Google Scholar
  5. 5.
    Kudrow L: Paradoxical effects of frequent analgesic use. In Advances in Neurology, vol 33. Edited by Critchley M et al. New York: Raven Press; 1982:335–341.Google Scholar
  6. 6.
    Rapoport AM, Weeks RE, Sheftell FD: Analgesic rebound headache theoretical and practical implications. Cephalalgia 1985, 5(suppl_3):448–449.Google Scholar
  7. 7.
    Mathew NT: Chronic refractory headache. Neurology 1993, 43(suppl 3):S26-S33.PubMedGoogle Scholar
  8. 8.
    Lance E, Parkes C, Wilkinson M: Does analgesic abuse cause headache de novo? Headache 1988, 28:61–62.PubMedCrossRefGoogle Scholar
  9. 9.
    Mathew NT: Transformed migraine. Cephalalgia 1993, 13(suppl 12):78–83.PubMedGoogle Scholar
  10. 10.
    Mathew NT, Reuveni U, Perez F: Transformed or evolutive migraine. Headache 1987, 27:102–106.PubMedCrossRefGoogle Scholar
  11. 11.
    Srikiatkhachorn A, Govitrapong P, Limthavon C: Up-regulation of 5-HT2 serotonin receptor: a possible mechanism of transformed migraine. Headache 1994, 34:8–11.PubMedCrossRefGoogle Scholar
  12. 12.
    Mathew NT: Transformed migraine, analgesic rebound and other chronic daily headaches. Neurol Clin 1997, 15:167–186. A good overview of CDHs including TM, new persistent daily headaches, and analgesic rebound headaches. It also explains how CTTHs fit into the CDH spectrum. In addition, Dr. Mathew presents a proposed classification for CDH.PubMedCrossRefGoogle Scholar
  13. 13.
    Vanast WJ, Diaz-Mitoma F, Tyrrell DLJ: Hypothesis: chronic benign daily headache is an immune disorder with a viral trigger. Headache 1987, 27:138–142.PubMedCrossRefGoogle Scholar
  14. 14.
    Sjaastad O, Fredericksen TA: Chronic daily headache: “Is cervicogenic headache” one subgroup? Cephalalgia 1998, 18(suppl 21):27–40.Google Scholar
  15. 15.
    Silberstein SD, Lipton R, Sliwinski M: Classification of daily and near daily headaches. Neurology 1996, 47:871–875.PubMedGoogle Scholar
  16. 16.
    Pfaffenrath V, Isler H: Evaluation of the nosology of chronic tension-type headache. Cephalalgia 1993, 13(suppl 12):60–62.PubMedGoogle Scholar
  17. 17.
    Schwartz B, Stewart W, Simon D, Lipton R: Epidemiology of tension-type headache. JAMA 1998, 279:381–383. This concise article gives much information about the epidemiology of both ETTHs and CTTHs. It also discusses disability, and ends with the conclusion that although TTHs are less disabling than migraine, their overall prevalence causes a major impact on society at large.PubMedCrossRefGoogle Scholar
  18. 18.
    Jensen R, Rasmussen BK: Muscular disorder in tension-type headache. Cephalalgia 1996, 16:97–103.PubMedCrossRefGoogle Scholar
  19. 19.
    Crisp AH, Kalucy RS, McGuinness B, et al.: Some clinical, social and psychological characteristics of migraine subjects in the general population. Post Grad Med J 1997, 53:691–717.CrossRefGoogle Scholar
  20. 20.
    Rasmussen BK, Jensen R, Schroll M, Olesen J: Epidemiology of headache in a general population-A prevalent study. J Clin Epidemiol 1991, 44:1147–1157.PubMedCrossRefGoogle Scholar
  21. 21.
    Russell MB, Ostergaard S, Bendtsen L, Olesen J: Familial occurrences of chronic tension-type headache. Cephalalgia 1999, 19:207–210.PubMedCrossRefGoogle Scholar
  22. 22.
    Langemark M, Olesen J, Poulsen DL, Bech P: Clinical characterization of patients with chronic tension headache. Headache 1998, 28:590–616.CrossRefGoogle Scholar
  23. 23.
    Rasmussen BK: Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern, and relation to lifestyle. Pain 1993, 53:65–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Ulrich V, Russell MB, Jensen R, et al.: A comparison of tensiontype headache in migraineurs and in non-migraineurs: a population-based study. Pain 1996, 67:501–600.PubMedCrossRefGoogle Scholar
  25. 25.
    Clark GT, Sakai S, Merrill R, et al.: Cross-correlation between stress, pain, physical activity, and temporalis muscle EMG in tension-type headache. Cephalalgia 1995, 15:511–518; discussion 451.PubMedCrossRefGoogle Scholar
  26. 26.
    Jensen R, Olesen J: Initiating mechanisms of experimentally induced tension-type headache. Cephalalgia 1996, 16:175–182.PubMedCrossRefGoogle Scholar
  27. 27.
    Pikoff H: Is the muscular model of headache still viable? A review of conflicting data. Headache 1984, 24:186–198.PubMedCrossRefGoogle Scholar
  28. 28.
    Jensen R, Bendtsen L, Olesen J: Muscular factors are of importance in tension-type headache. Headache 1998, 38:10–17. This is a seminal article on the role of muscular factors in TTH. It also postulates the mechanisms whereby ETTHs may convert into CTTHs.PubMedCrossRefGoogle Scholar
  29. 29.
    Olesen J, Shoenen J: Synthesis of tension-type headache mechanisms. In The Headaches, edn 2. Edited by Olesen J et al. Philadelphia: Lippincott, Williams & Wilkins; 2000:615–618.Google Scholar
  30. 30.
    Sandrini G, Antonaci F, Pucci E, et al.: Comparative study with EMG, pressure algometry and manual palpitation in tensiontype headache and migraine. Cephalalgia 1994, 14:451–457; discussion 394–395.PubMedCrossRefGoogle Scholar
  31. 31.
    Ashina M, Bendtsen L, Jensen R, et al.: Muscle hardness in patients with chronic tension-type headache: relation to actual headache state. Pain 1999, 79:201–205.PubMedCrossRefGoogle Scholar
  32. 32.
    Sakai F, Ebihara S, Akiyama M, et al.: Pericranial muscle hardness in tension-type headache: a noninvasive measurement method and its clinical application. Brain 1995, 118(part 2):223–230.CrossRefGoogle Scholar
  33. 33.
    Neufeld JD, Holroyd KA, Lipchik GL: Dynamic assessment of abnormalities in central pain transmission and modulation in tension-type headache sufferers. Headache 2000, 40:142–151.PubMedCrossRefGoogle Scholar
  34. 34.
    Lipchik GL, Holroyd KA, Talbot F, et al.: Pericranial muscle tenderness and exteroceptivity suppression of temporalis muscle activity: a blind study of chronic tension-type headache. Headache 1997, 37:368–376.PubMedCrossRefGoogle Scholar
  35. 35.
    Schoenen J, Jamart B, Gerard P, et al.: Exteroceptive suppression of temporalis muscle activity in chronic headache. Neurology 1987, 37:1834–1836.PubMedGoogle Scholar
  36. 36.
    Raskin NH: Headache, edn 2. New York: Churchill Livingstone; 1988.Google Scholar
  37. 37.
    Jensen R: A tension-type headache: slternative peripheral pathophysiological mechanisms. Cephalalgia 1999, 19(suppl 25):9–10.PubMedGoogle Scholar
  38. 38.
    Moskowitz MA: The neurobiology of vascular head pain. Ann Neurol 1984, 16:157–168.PubMedCrossRefGoogle Scholar
  39. 39.
    Weiller C, May A, Limmroth V, et al.: Brainstem activation in spontaneous human migraine attacks. Nat Med 1995, 1:658–660.PubMedCrossRefGoogle Scholar
  40. 40.
    Olesen J: Clinical and pathophysiological observations in migraine and tension type headache explained by integration of vascular supraspinal and myofascial inputs. Pain 1991, 46:125–132.PubMedCrossRefGoogle Scholar
  41. 41.
    Bakal D, Kaganov J: Muscle contraction and migraine headache: psychophysiologic comparison. Headache 1977, 17:208–215.PubMedCrossRefGoogle Scholar
  42. 42.
    Featherstone HJ: Migraine and muscle contraction headaches: a continuum. Headache 1985, 25:194–198.PubMedCrossRefGoogle Scholar
  43. 43.
    Lipton RB, Stewart WF, Cady R, et al.: Sumatriptan for the range of headaches in migraine sufferers: result of the spectrum study. Headache 2000, 40:783–791.PubMedCrossRefGoogle Scholar
  44. 44.
    Ulrich V, Russell M, Jensen R, et al.: A comparison of tensiontype headaches in migraineurs and in non-migraineurs: a population based study. Pain 1996, 67:501–506.PubMedCrossRefGoogle Scholar
  45. 45.
    Holroyd K, Stensland M, Lipchik G, et al.: Psychosocial correlates and impact of chronic tension-type headaches. Headache 2000, 40:3–16.PubMedCrossRefGoogle Scholar
  46. 46.
    Lance JW, Curran DA: Treatment of chronic tension headache. Lancet 1964, 1:1236–1239.PubMedCrossRefGoogle Scholar
  47. 47.
    Lipton R, Stewart W, Stone A, et al.: Stratified care versus step care strategies for migraine. JAMA 2000, 284:2599–2605.PubMedCrossRefGoogle Scholar
  48. 48.
    Mathew N: Acute pharmacotherapy of tension-type headaches. In The Headaches, edn 2. Edited by Olesen J et al. Philadelphia: Lippincott, Williams & Wilkins; 2000:661–666.Google Scholar
  49. 49.
    Murray WJ: Evaluation of aspirin in treatment of headache. Clin Pharmacol Ther 1964, 5:21–25.PubMedGoogle Scholar
  50. 50.
    Peter BH, Fraim CJ, Masel BE: Comparison of 650 mg aspirin and 1,000 mg acetaminophen with each other, and with placebo in moderately severe headache. Am J Med 1983, 74:36–42.CrossRefGoogle Scholar
  51. 51.
    Schachtel BP, Thoden WR: Onset of action of ibuprofen in the treatment of muscle contraction headache. Headache 1988, 28:471–474.PubMedCrossRefGoogle Scholar
  52. 52.
    Vangerven JMA, Schoemaker RC, Jacobs LD, et al.: Selfmedication of a single headache episode with ketoprofen, ibuprofen or placebo, home-monitored with an electronic patient diary. Br J Clin Pharmacol 1996, 42:475–481.CrossRefGoogle Scholar
  53. 53.
    Miller DS, Talbot CA, Simpson W, et al.: A comparison of naproxen sodium, acetaminophen and placebo in the treatment of muscle contraction headache. Headache 1987, 27:392–396.PubMedCrossRefGoogle Scholar
  54. 54.
    Migliardi JR, Armellino JJ, Friedman M, et al.: Caffeine as an analgesic adjuvant in tension headache. Clin Pharmacol Ther 1994, 56:576–586.PubMedCrossRefGoogle Scholar
  55. 55.
    Friedman AP, DeSerio FJ: Symptomatic treatment of chronically recurring tension headache: a placebocontrolled, multicenter investigation of Fioricet and acetaminophen with codeine. Clin Ther 1987, 10:69–81.PubMedGoogle Scholar
  56. 56.
    Bombardier C, Laine L, Reicin A, et al.: Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med 2000, 343:1520–1528.PubMedCrossRefGoogle Scholar
  57. 57.
    Diamond S, Baltes BJ: Chronic tension headache-treated with amitriptyline-a double-blind study. Headache 1971, 11:110–116.PubMedCrossRefGoogle Scholar
  58. 58.
    Langemark M, Loldrup D, Bech P, et al.: Clomipramine and mianserin in the treatment of chronic tension headache: a double-blind, controlled study. Headache 1990, 30:118–121.PubMedCrossRefGoogle Scholar
  59. 59.
    Manna V, Bolino F, DiCicco L: Chronic tension-type headache, mood depression and serotonin; therapeutic effects of fluvoxamine and mianserin. Headache 1994, 34:44–49.PubMedCrossRefGoogle Scholar
  60. 60.
    Fogelholm R, Murros K: Tizanidine in chronic tension-type headache: a placebo controlled double-blind crossover study. Headache 1992, 32:509–513.PubMedCrossRefGoogle Scholar
  61. 61.
    Shimomura T, Awaki E, Kowa H, et al.: Treatment of tensiontype headache with tizanidine hydrochloride: its efficacy and relationship to plasma MHPG concentration. Headache 1991, 31:601–604.PubMedCrossRefGoogle Scholar
  62. 62.
    Smuts JA, Baker MK, Smuts HM, et al.: Prophylactic treatment of chronic tension-type headache using botulinum toxin type A. Eur J Neurol 1999, 6(suppl 2):S99-S102.Google Scholar
  63. 63.
    Relja M: Treatment of tension-type headache by local injection of botulinum toxin. Eur J Neurol 1997, 4(suppl 2):S71-S73.Google Scholar
  64. 64.
    Bogaards MC, Ter Kuile MM: Treatment of recurrent tension headache: a meta-analytic review. Clin J Pain 1994, 19:174–190.CrossRefGoogle Scholar
  65. 65.
    Holroyd KA, Lipchik GL, Penzien DB: Psychological management of recurrent headache disorders: empirical basis for clinical practice. In Best Practice: Developing and Promoting Empirically Supported Interventions. Edited by Dobson KS, Craig KD. Newbury Park, CA: Sage; 1998.Google Scholar
  66. 66.
    Rokicki LA, Holroyd KA, France CR, et al.: Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache. Appl Psychophysiol Biofeedback 1997, 22:21–41.PubMedCrossRefGoogle Scholar
  67. 67.
    Peters M, Turner S, Blachard E: The effects of aerobic exercise on chronic tension-type headache. Headache Q 1996, 7:330–334.Google Scholar
  68. 68.
    Mannix L, Chandurkar RS, Rybicki L, et al.: Guided imagery on quality of life for patients with chronic tension-type headache. Headache 1999, 39:326–334.PubMedCrossRefGoogle Scholar
  69. 69.
    Forssell H, Kirveskari P, Kangasniemi P: Changes in headache after treatment of mandibular dysfunction. Cephalalgia 1985, 5:229–236.PubMedCrossRefGoogle Scholar
  70. 70.
    Gorlin R, Zucker H: Physician’s reactions to patients: a key to humanistic medicine. N Engl J Med 1983, 308:1059–1063.PubMedCrossRefGoogle Scholar
  71. 71.
    Anstett R: The difficult patient and the physician-patient relationship. J Fam Prac 1980, 11:281–286.Google Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Elliott A. Schulman
    • 1
  1. 1.Neurological Associates of Delaware Valley, Ambulatory Care PavilionSuite 533, One Medical Center BoulevardUplandUSA

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