Tension headache
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226011768
2008-07-16T12:57:39Z
24.124.71.66
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{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = 12554 |
ICD10 = {{ICD10|G|44|2|g|40}} |
ICD9 = {{ICD9|307.81}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = emerg|
eMedicineTopic = 231 |
MeshID = D018781 |
}}
'''Tension headaches''', which were renamed '''tension-type headaches''' by the [[International Headache Society]] in 1988, are the most common type of primary [[headache]]s. The pain can radiate from the neck, back, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population suffers from chronic-tension type headache.<ref>Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol. 1991;44(11):1147-57.</ref>
== Frequency and duration ==
Tension-type headaches can be [[episodic]] or [[chronic (medicine)|chronic]].<ref>The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004, 24 Suppl 1:9-160.</ref> Episodic tension-type headaches are defined as tension-type headaches occurring fewer than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months. Tension-type headaches can last from minutes to days, months or even years, though a typical tension headache lasts 4-6 hours.
== Pain and possible symptoms ==
Tension-type headache pain is often described as a constant pressure, as if the head were being squeezed in a [[Vise (tool)|vise]]. The pain is frequently [[bilateral]] which means it is present on both sides of the head at once. Tension-type headache pain is typically mild to moderate, but may be severe.
== Cause and pathophysiology ==
Various precipitating factors may cause TTH in susceptible individuals [http://www.emedicine.com/neuro/topic231.htm]. One half of patients with TTH identify stress or hunger as a precipitating factor .
* Stress - Usually occurs in the afternoon after long stressful work hours
* Sleep deprivation
* Uncomfortable stressful position and/or bad posture
* Irregular meal time ([[hunger]])
* Eyestrain
* Caffeine withdrawal
The exact cause of tension-type headaches is still unknown. It is suggested that abnormalities in the peripheral and central nervous systems may be involved in the pathophysiology of TTH. It has long been believed that they are caused by [[muscle tension]] around the head and neck. One of the theories says that the main cause for tension type headaches and [[migraine]] is teeth clenching which causes a chronic contraction of the [[temporalis muscle]]. Although muscle tension may be involved, scientists now believe there is not one single cause for this type of headache. Another theory is that the pain may be caused by a malfunctioning pain filter which is located in the brain stem. The view is that the brain misinterprets information, for example from the temporal muscle or other muscles, and interprets this signal as pain. One of the main molecules which is probably involved is [[serotonin]]. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as [[amitriptyline]]. However, the analgesic effect of amitriptyline in chronic tension-type headache is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved. Recent studies of [[nitric oxide]] (NO) mechanisms suggest that NO may play a key role in the pathophysiology of CTTH.<ref> Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J. Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomized crossover trial. Lancet. 1999 Jan 23;353:287-9</ref>. The sensitization of pain pathways may be caused by or associated with activation of nitric oxide synthase (NOS) and the generation of NO. Patients with chronic tension-type headache have increased muscle and skin pain sensitivity, demonstrated by low mechanical, thermal and electrical pain thresholds. Hyperexcitability of central [[Nociception|nociceptive]] neurons (in [[Trigeminal nucleus|trigeminal spinal nucleus]], [[thalamus]], and [[cerebral cortex]]) is believed to be involved in the pathophysiology of chronic tension-type headache.<ref>Ashina S, Bendtsen L, Ashina M. Pathophysiology of tension-type headache. Curr Pain Headache Rep, 2005 Dec; 9:415-22.</ref> Recent evidence for generalized increased pain sensitivity or [[hyperalgesia]] in CTTH strongly suggests that pain processing in the central nervous system is abnormal in this primary headache disorder. Moreover, a dysfunction in pain inhibitory systems may also play a role in the pathophysiology of chronic tension-type headache.<ref> Pielsticker A, Haag G, Zaudig M, Lautenbacher S. Impairment of pain inhibition in chronic tension-type headache. Pain. 2005 Nov;118:215-23.</ref>
== Treatment ==
Episodic tension-type headaches generally respond well to over-the-counter [[analgesic]]s. Other medications for chronic tension-type headaches include [[amitriptyline]]<ref>{{cite journal |author=Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW |title=Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial |journal=JAMA |volume=285 |issue=17 |pages=2208–15 |year=2001 |month=May |pmid=11325322 |pmc=2128735 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11325322}}</ref> [[mirtazapine]],<ref>{{cite journal |author=Bendtsen L, Jensen R |title=Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache |journal=Neurology |volume=62 |issue=10 |pages=1706–11 |year=2004 |month=May |pmid=15159466 |doi= |url=http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15159466}}</ref> [[botulinum toxin]] in certain patients,<ref>{{cite journal |author=de Ru JA, Buwalda J |title=Botulinum toxin A injection into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache |journal=J Laryngol Otol |volume= |issue= |pages=1–6 |year=2008 |month=June |pmid=18588738 |doi=10.1017/S0022215108003198 |url=}}</ref> [[biofeedback]],<ref>{{cite journal |author=Nestoriuc Y, Rief W, Martin A |title=Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators |journal=J Consult Clin Psychol |volume=76 |issue=3 |pages=379–96 |year=2008 |month=June |pmid=18540732 |doi=10.1037/0022-006X.76.3.379 |url=}}</ref><ref name="pmid18471128">{{cite journal |author=Rains JC |title=Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache |journal=Headache |volume=48 |issue=5 |pages=735–6; discussion 736–7 |year=2008 |month=May |pmid=18471128 |doi=10.1111/j.1526-4610.2008.01119_1.x |url=}}</ref> and [[sodium valproate]] (as [[prophylaxis]]).<ref name="pmid18231713">{{cite journal |author=Yurekli VA, Akhan G, Kutluhan S, Uzar E, Koyuncuoglu HR, Gultekin F |title=The effect of sodium valproate on chronic daily headache and its subgroups |journal=J Headache Pain |volume=9 |issue=1 |pages=37–41 |year=2008 |month=February |pmid=18231713 |doi=10.1007/s10194-008-0002-5 |url=}}</ref>
[[Acupuncture]] has not been demonstrated as an effective treatment for tension headaches.<ref name="pmid18499526">{{cite journal |author=Davis MA, Kononowech RW, Rolin SA, Spierings EL |title=Acupuncture for Tension-Type Headache: A Meta-Analysis of Randomized, Controlled Trials |journal=J Pain |volume= |issue= |pages= |year=2008 |month=May |pmid=18499526 |doi=10.1016/j.jpain.2008.03.011 |url=}}</ref>
== Prognosis ==
Tension headaches that do not occur as a symptom of another condition may be painful, but are not harmful. It is usually possible to receive relief from treatment. Tension headaches that occur as a symptom of another condition are usually relieved when the underlying condition is treated. Frequent use of pain medications in patients with tension-type headache may lead to the development of medication overuse headache or [[rebound headache]].{{Fact|date=August 2007}}
== References ==
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== See also ==
*[[Migraine]]
*[[Cluster headache]]
*[[Rebound headache]]
==External links==
*[http://www.achenet.org American Council for Headache Education]
*[http://www.headaches.org National Headache Foundation]
*[http://www.w-h-a.org World Headache Alliance]
*[http://www.emedicine.com/neuro/topic231.htm Article on eMedicine about tension-type headache]
{{Diseases of the nervous system}}
[[Category:Headaches]]
[[de:Spannungskopfschmerz]]
[[es:Cefalea tensional]]
[[fr:Céphalée de tension]]
[[hr:Tenzijska glavobolja]]