Skip to main content

Advertisement

SpringerLink
Log in

Taking Care of the Challenging Tension Headache Patient

  • Tension-type Headache (Katherine Henry, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Tension type headache (TTH) is the most common primary headache disorder, but it is a diagnosis for which patients infrequently present for evaluation in the outpatient setting. Performing a thorough evaluation and establishing the correct diagnosis is essential in formulating an effective treatment plan. There are many complex issues that, although not causative, may play an exacerbating role in TTH. This article reviews the epidemiology, diagnosis, and pharmacologic treatment of TTH. In addition, nonpharmacologic treatment approaches, sleep dysfunction, and temporomandibular dysfunction are reviewed.

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

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA. 1998;279(5):381–3.

    Article  PubMed  CAS  Google Scholar 

  2. •• Robbins MS, Lipton RB. The epidemiology of primary headache disorders. Semin Neurol. 2010;30(2):107–19. Epub 2010 Mar 29. This is an excellent article that reviews recent epidemiology data on various primary headache disorders.

    Article  PubMed  Google Scholar 

  3. Russell MB, Levi N, Saltyte-Benth J, Fenger K. Tension-type headache in adolescents and adults: a population based study of 33,764 twins. Eur J Epidemiol. 2006;21(2):153–60.

    Article  PubMed  Google Scholar 

  4. Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27(3):193–210.

    Article  PubMed  Google Scholar 

  5. Mathew P, Peterlin B. Tension-type headache. In: Jay GW, editor. Clinician’s guide to chronic headache and facial pain. New York: Informa Healthcare; 2010. p. 16–26.

    Google Scholar 

  6. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9–160.

    Google Scholar 

  7. Lyngberg AC, Rasmussen BK, Jørgensen T, Jensen R. Prognosis of migraine and tension-type headache: a population based follow-up study. Neurology. 2005;65(4):580–5.

    Article  PubMed  Google Scholar 

  8. Steiner TJ, Lange R, Voelker M. Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalalgia. 2003;23(1):59–66.

    Article  PubMed  CAS  Google Scholar 

  9. Prior MJ, Cooper KM, May LG, Bowen DL. Efficacy and safety of acetaminophen and naproxen in the treatment of tension-type headache. A randomized, double-blind, placebo-controlled trial. Cephalalgia. 2002;22(9):740–8.

    Article  PubMed  CAS  Google Scholar 

  10. Kubitzek F, Ziegler G, Gold MS, Liu JM, Ionescu E. Low dose diclofenac potassium in the treatment of episodic tension-type headache. Eur J Pain. 2003;7(2):155–62.

    Article  PubMed  CAS  Google Scholar 

  11. Mathew N, Ashina M. Acute pharmacotherapy of tension-type headaches. In: Olesen J, Goadsby PJ, Ramadan N, Tfelt-Hansen P, Welch KM, editors. The headaches. Philadelphia: Lippincott Williams Wilkins; 2005. p. 727–33.

    Google Scholar 

  12. Bendtsen L. Drug and nondrug treatment in tension-type headache. Ther Adv Neurol Disord. 2009;2(3):155–61.

    Article  PubMed  Google Scholar 

  13. •• Bigal ME, Lipton RB. Excessive acute migraine medication use and migraine progression. Neurology. 2008;71(22):1821–1828. This is an excellent article that reviews medication overuse headache in detail.

    Article  PubMed  CAS  Google Scholar 

  14. •• Mathew PG, Garza I. Headache. Semin Neurol. 2011;31(1):5–17. Epub 2011 Feb 14. This article reviews the evaluation, diagnosis, and treatment of multiple primary and secondary headache disorders. It also discusses when to considering further diagnostic testing, including imaging studies.

    Article  PubMed  Google Scholar 

  15. Cady RK, Gutterman D, Saiers JA, Beach ME. Responsiveness of non-IHS migraine and tension-type headache to sumatriptan. Cephalalgia. 1997;17(5):588–90.

    Article  PubMed  CAS  Google Scholar 

  16. Bendtsen L, Jensen R. Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia. 2000;20(6):603–10.

    Article  PubMed  CAS  Google Scholar 

  17. Goadsby T, Silberstein S, Dodick D. Chronic daily headache for clinicians. Hamilton: BC Decker Inc; 2005. p. 57–64.

    Google Scholar 

  18. Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology. 2004;62(10):1706–11.

    PubMed  CAS  Google Scholar 

  19. Bendtsen L, Mathew NT. Prophylactic pharmacotherapy of tension-type headache. In: Olesen J, Goadsby PJ, Ramadan N, Tfelt-Hansen P, Welch KM, editors. The headaches. Philadelphia: Lippincott Williams Wilkins; 2005. p. 735–41.

    Google Scholar 

  20. Zissis NP, Harmoussi S, Vlaikidis N, Mitsikostas D, Thomaidis T, Georgiadis G, et al. A randomized, double-blind, placebo-controlled study of venlafaxine XR in out-patients with tension-type headache. Cephalalgia. 2007;27(4):315–24.

    Article  PubMed  CAS  Google Scholar 

  21. Lampl C, Marecek S, May A, Bendtsen L. A prospective, open-label, long-term study of the efficacy and tolerability of topiramate in the prophylaxis of chronic tension-type headache. Cephalalgia. 2006;26(10):1203–8.

    Article  PubMed  CAS  Google Scholar 

  22. Leinisch-Dahlke E, Jürgens T, Bogdahn U, Jakob W, May A. Greater occipital nerve block is ineffective in chronic tension type headache. Cephalalgia. 2005;25(9):704–8.

    Article  PubMed  CAS  Google Scholar 

  23. Padberg M, de Bruijn SF, de Haan RJ, Tavy DL. Treatment of chronic tension-type headache with botulinum toxin: a doubleblind, placebo-controlled clinical trial. Cephalalgia. 2004;24(8):675–80.

    Article  PubMed  CAS  Google Scholar 

  24. Rozen D, Sharma J. Treatment of tension-type headache with botox: a review of the literature. Mt Sinai J Med. 2006;73(1):493–8.

    PubMed  Google Scholar 

  25. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009;(1):CD007587

  26. Ulrich V, Russell MB, Jensen R, Olesen J. A comparison of tension-type headache in migraineurs and in non-migraineurs: a population-based study. Pain. 1996;67(2–3):501–6.

    Article  PubMed  CAS  Google Scholar 

  27. Rasmussen BK, Jensen R, Schroll M, Olesen J. Interrelations between migraine and tension-type headache in the general population. Arch Neurol. 1992;49:914–8.

    PubMed  CAS  Google Scholar 

  28. Holroyd KA, Martin PR, Nash JM. Psychological treatments of tension-type headache. In: Olesen J, Goadsby PJ, Ramadan N, Tfelt-Hansen P, Welch KM, editors. The headaches. Philadelphia: Lippincott Williams Wilkins; 2005. p. 711–9.

    Google Scholar 

  29. Spierings EL, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine versus tension-type headache. Headache. 2001;41:554–8.

    Article  PubMed  CAS  Google Scholar 

  30. 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.

    Article  PubMed  CAS  Google Scholar 

  31. Kripke DF, Ancoli-Israel S, Klauber MR, Wingard DL, Mason WJ, Mullaney DJ. Prevalence of sleep-disordered breathing in ages 40–64 years: a population-based survey. Sleep. 1997;20:65–76.

    PubMed  CAS  Google Scholar 

  32. • Kristiansen HA, Kværner KJ, Akre H, Overland B, Russell MB. Tension-type headache and sleep apnea in the general population. J Headache Pain. 2011;12(1):63–9. Epub 2010 Dec 16. This article reviews the relationship between sleep apnea and headache.

    Article  PubMed  Google Scholar 

  33. Fava C, Montagnana M, Favaloro EJ, Guidi GC, Lippi G. Obstructive sleep apnea syndrome and cardiovascular diseases. Semin Thromb Hemost. 2011;37(3):280–97.

    Article  PubMed  Google Scholar 

  34. Odegård SS, Sand T, Engstrøm M, Stovner LJ, Zwart JA, Hagen K. The long-term effect of insomnia on primary headaches: a prospective population-based cohort study (HUNT-2 and HUNT-3). Headache. 2011;51(4):570–80. doi:10.1111/j.1526-4610.2011.01859.x.

    Article  PubMed  Google Scholar 

  35. Ballegaard V, Thede-Schmidt-Hansen P, Svensson P, Jensen R. Are headache and temporomandibular disorders related? a blinded study. Cephalalgia. 2008;28(8):832–41.

    Article  PubMed  CAS  Google Scholar 

  36. Özkan NC, Ozkan F. The relationship of temporomandibular disorders with headaches: a retrospective analysis. Agri. 2011;23(1):13–7.

    Article  PubMed  Google Scholar 

  37. Gonçalves DA, Bigal ME, Jales LC, Camparis CM, Speciali JG. Headache and symptoms of temporomandibular disorder: an epidemiological study. Headache. 2010;50(2):231–41.

    Article  PubMed  Google Scholar 

  38. Cooper BC, Kleinberg I. Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment. Cranio. 2009;27(2):101–8.

    PubMed  Google Scholar 

  39. Ekberg EC, Nilner M. Treatment outcome of short- and long-term appliance therapy in patients with TMD of myogenous origin and tension-type headache. J Oral Rehabil. 2006;33(10):713–21.

    Article  PubMed  CAS  Google Scholar 

  40. Wright EF, Jundt JS. The NTI appliance for TMD and headache therapy. Tex Dent J. 2006:1118–1124

  41. Freund BJ, Schwartz M. Relief of tension-type headache symptoms in subjects with temporomandibular disorders treated with botulinum toxin-A. Headache. 2002;42(10):1033–7.

    Article  PubMed  Google Scholar 

  42. Stapelmann H, Türp JC. The NTI-tss device for the therapy of bruxism, temporomandibular disorders, and headache—where do we stand? A qualitative systematic review of the literature. BMC Oral Health. 2008;8:22.

    Article  PubMed  Google Scholar 

Download references

Disclosures

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Neurology, John R. Graham Headache Center, Harvard Medical School, Brigham and Women’s/Faulkner Hospital, 1153 Centre Street, Suite 4970, Boston, MA, 02130, USA

    Paul G. Mathew

  2. Division of Neurology, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA, 02139, USA

    Paul G. Mathew

  3. Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA, 02111, USA

    Treasa Mathew

Authors
  1. Paul G. Mathew
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Treasa Mathew
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul G. Mathew.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mathew, P.G., Mathew, T. Taking Care of the Challenging Tension Headache Patient. Curr Pain Headache Rep 15, 444–450 (2011). https://doi.org/10.1007/s11916-011-0223-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-011-0223-1

Keywords

Search

Navigation