Tension-Type Headache

Tension-type headache (TTH) is the most common type of primary headache disorder, accounting for approximately 75% of all headaches.

Definition and Classification

Tension-type headache is characterized by a dull, aching, or pressing sensation in the head, neck, and scalp. The International Headache Society (IHS) classifies TTH into three subtypes:

• Infrequent episodic tension-type headache: fewer than 12 episodes per year
• Frequent episodic tension-type headache: 12-180 episodes per year
• Chronic tension-type headache: more than 180 episodes per year, or headache on more than 15 days per month for at least 3 months

Symptoms

The symptoms of TTH may include:

• Mild to moderate intensity headache
• Pressing or tightening sensation in the head, neck, and scalp
• Bilateral (on both sides) or unilateral (on one side) pain
• No significant worsening with routine physical activity
• No nausea or vomiting
• No sensitivity to light or sound

Causes and Triggers

The exact cause of TTH is not fully understood, but several factors may contribute to its development:

• Muscle tension in the neck and scalp
• Stress and anxiety
• Poor posture
• Lack of sleep or fatigue
• Caffeine withdrawal or overuse
• Hormonal changes
• Dental problems, such as temporomandibular joint (TMJ) disorders

Diagnosis

The diagnosis of TTH is based on a thorough medical history and physical examination. The IHS criteria for diagnosing TTH include:

• At least two of the following characteristics: pressing or tightening sensation, mild to moderate intensity, bilateral pain, no significant worsening with routine physical activity
• No evidence of other primary or secondary headache disorders
• No significant abnormalities on physical examination

Treatment and Management

The treatment of TTH typically involves a combination of lifestyle modifications, over-the-counter pain relievers, and stress management techniques:

• Rest and relaxation
• Over-the-counter pain relievers, such as acetaminophen or ibuprofen
• Stress management techniques, such as meditation, deep breathing, or yoga
• Physical therapy to improve posture and reduce muscle tension
• Cognitive-behavioral therapy (CBT) to address underlying psychological factors

Complications and Prognosis

If left untreated or poorly managed, TTH can lead to:

• Chronic pain and disability
• Medication overuse headache (MOH)
• Depression and anxiety disorders
• Sleep disturbances

The prognosis for TTH is generally good, with most people experiencing significant improvement in symptoms with proper treatment and lifestyle modifications.