Tension headaches, which were renamed tension-type headaches by the International Headache Society The International Headache Society is a charity organization founded in 1981 for people from all professions that are working to treat headache disorders in 1988, are the most common type of primary headaches In medicine a headache or cephalalgia is a symptom of a number of different conditions of the head and sometimes neck. Some of the causes are benign while others are medical emergencies. It ranks among the most common pain complaints.[citation needed]. 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.^[1]

Frequency and duration

Tension-type headaches can be episodic or chronic In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and development. A chronic course is distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between. As an adjective, chronic can refer to a.^[2] 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 A vise or vice is a mechanical screw apparatus used for holding or clamping a work piece to allow work to be performed on it with tools such as saws, planes, drills, mills, screwdrivers, sandpaper, etc. Vises usually have one fixed jaw and another, parallel, jaw which is moved towards or away from the fixed jaw by the screw. 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 [1]. 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 or after an exam
• Sleep deprivation
• Uncomfortable stressful position and/or bad posture
• Irregular meal time (hunger Hunger is a feeling experienced when one has a desire to eat. The often unpleasant feeling originates in the hypothalamus and is released through receptors in the liver. Although an average nourished individual can survive weeks without food intake, the sensation of hunger typically begins after a couple of hours without eating and is generally)
• Eyestrain
• Caffeine Caffeine is a bitter, white crystalline xanthine alkaloid that is a psychoactive stimulant drug. Caffeine was discovered by a German chemist, Friedrich Ferdinand Runge, in 1819. He coined the term "kaffein", a chemical compound in coffee, which in English became caffeine. Caffeine is also part of the chemical mixtures and insoluble withdrawal

Until recently it was believed that tension headaches were caused by muscle tension In physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles. It helps maintain posture, and it declines during REM sleep. It is not to be confused with the concept of toning in physical exercise around the head and neck. One of the theories says that the main cause for tension type headaches and migraine Migraine is a neurological syndrome characterized by altered bodily perceptions, headaches, and nausea. Physiologically, the migraine headache is a neurological condition more common to women than to men. The word migraine was borrowed from Old French migraigne . The French term derived from a vulgar pronunciation of the Late Latin word hemicrania, is teeth clenching which causes a chronic contraction of the temporalis muscle It arises from the temporal fossa and the deep part of temporal fascia. It passes medial to the zygomatic arch and inserts onto the coronoid process of the mandible. Although muscle tension may be involved, many researchers now question this idea, and recent research has shown that tension headache patients do not have increased muscle tension.^[3]

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 neurotransmitters which is probably involved is serotonin Serotonin (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter. It is found extensively in the gastrointestinal tract of animals, and about 80 to 90 percent of the human body's total serotonin is located in the enterochromaffin cells in the gut, where it is used to regulate intestinal movements. The remainder is synthesized in. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as amitriptyline Amitriptyline hydrochloride (sold as Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl, Saroten, Triptyl, Redomex) is a tricyclic antidepressant drug. It is a white, odorless, crystalline compound which is freely soluble in water; it is usually dispensed in tablet form. In terms of its mechanism of action, amitriptyline inhibits. 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 Nitric oxide or nitrogen monoxide is a chemical compound with chemical formula N (NO) mechanisms suggest that NO may play a key role in the pathophysiology of CTTH.^[4]. 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 nociceptive Nociception is defined as "the neural processes of encoding and processing noxious stimuli." It is the afferent activity produced in the peripheral and central nervous system by stimuli that have the potential to damage tissue. This activity is initiated by nociceptors, (also called pain receptors), that can detect mechanical, thermal or neurons (in trigeminal spinal nucleus, thalamus The thalamus is a midline paired symmetrical structure within the brain of vertebrate animals, including humans. It is between the cerebral cortex and the midbrain, both in terms of its location and its neurological connections. Its function includes relaying sensation and special sense signals to the cerebral cortex, relaying motor signals from, and cerebral cortex The cerebral cortex is a structure within the brain that plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. It constitutes the outermost layer of the cerebrum. In preserved brains, it has a grey color, hence the name "grey matter". Grey matter is formed by neurons and their unmyelinated) is believed to be involved in the pathophysiology of chronic tension-type headache.^[5] Recent evidence for generalized increased pain sensitivity or hyperalgesia Hyperalgesia is an increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves. Temporary increased sensitivity to pain also occurs as part of sickness behavior, the evolved response to infection 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.^[6]

Treatment

Episodic tension-type headaches generally respond well to over-the-counter analgesics An analgesic is any member of the diverse group of drugs used to relieve pain (achieve analgesia). The word analgesic derives from Greek an- ("without") and algos ("pain"). Analgesic drugs act in various ways on the peripheral and central nervous systems; they include paracetamol (acetaminophen), the non-steroidal anti- such as ibuprofen, acetaminophen, and aspirin. Other medications for chronic tension-type headaches include amitriptyline Amitriptyline hydrochloride (sold as Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl, Saroten, Triptyl, Redomex) is a tricyclic antidepressant drug. It is a white, odorless, crystalline compound which is freely soluble in water; it is usually dispensed in tablet form. In terms of its mechanism of action, amitriptyline inhibits^[7] mirtazapine,^[8] biofeedback Biofeedback is a non-medical process that involves measuring a subject's specific and quantifiable bodily functions such as blood pressure, heart rate, skin temperature, sweat gland activity, and muscle tension, conveying the information to the patient in real-time. This raises the patient's awareness and therefore the possibility of conscious,^[9][10] and sodium valproate Sodium valproate or valproate sodium (USAN) is the sodium salt of valproic acid and is an anticonvulsant used in the treatment of epilepsy and bipolar disorder, as well as other psychiatric conditions requiring the administration of a mood stabilizer. The intravenous formulations are used when oral administration is not possible (as prophylaxis Prophylaxis is any medical or public health procedure whose purpose is to prevent, rather than treat or cure a disease. Roughly, prophylactic measures are divided between primary prophylaxis (to prevent the development of a disease) and secondary prophylaxis (whereby the disease has already developed and the patient is protected against worsening).^[11]

Botulinum toxin is a treatment trialled by some tension-type headache sufferers, though results are varied. There are some reports of Botulinum toxin having the opposite effect, increasing tension.^{[citation needed]}

Manual therapy

Headache sufferers often use manual therapy Physical treatments includes massage, soft tissue mobilization, various connective tissue techniques, myofascial release, craniosacral techniques, mobilization of joints, joint manipulation, mobilization of neural tissue, visceral mobilization, and strain and counterstrain, such as spinal manipulation, soft tissue therapy, and myofascial trigger point treatment. A 2006 systematic review found no rigorous evidence supporting manual therapies for tension headache.^[12] A 2005 structured review found that the evidence was weak for effectiveness of chiropractic D.D. Palmer founded chiropractic in the 1890s and his son B.J. Palmer helped to expand it in the early 20th century. It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider subluxations to be the leading cause of all disease; "mixers" are more open to manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.^[13] A 2004 Cochrane review The Cochrane Library is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration and other organisations. At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analyses which summarise and interpret the results of high-quality medical research. The Cochrane found that spinal manipulation may be effective for migraine and tension headache, and that spinal manipulation and neck exercises may be effective for cervicogenic headache.^[14] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of spinal manipulation.^[15]

Spinal manipulation is associated with frequent, mild and temporary adverse effects In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect, and may result from an unsuitable or incorrect dosage or procedure, which could be due to medical,^[16] including new or worsening pain or stiffness in the affected region.^[17] They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours.^[18] Spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death.^[16] The incidence Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator of these complications is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, a particular concern.^[16] Vertebrobasilar artery stroke Vertebral artery dissection is the development of dissection in the vertebral artery. It is commonly associated with physical trauma but may also develop spontaneously. It is a major cause of stroke in young people is statistically associated In statistics, an association is any relationship between two measured quantities that renders them statistically dependent. The term "association" refers broadly to any such relationship, whereas the narrower term "correlation" refers to a linear relationship between two quantities with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.^[19] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.^[20]

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 through 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 Medication overuse headaches , also known as rebound headaches usually occur when analgesics are taken frequently to relieve headaches. Rebound headaches frequently occur daily and can be very painful and are a common cause of chronic daily headache. They typically occur in patients with an underlying headache disorder such as migraines or tension.^{[citation needed]}

References

1. ^ 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.
2. ^ The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004, 24 Suppl 1:9-160.
3. ^ http://www.mayoclinic.com/health/tension-headache/DS00304
4. ^ 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
5. ^ Ashina S, Bendtsen L, Ashina M. Pathophysiology of tension-type headache. Curr Pain Headache Rep, 2005 Dec; 9:415-22.
6. ^ Pielsticker A, Haag G, Zaudig M, Lautenbacher S. Impairment of pain inhibition in chronic tension-type headache. Pain. 2005 Nov;118:215-23.
7. ^ Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW (May 2001). "Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial". JAMA 285 (17): 2208–15. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1001/jama.285.17.2208. PMID 11325322. PMC PubMed Central is a free digital database of full-text scientific literature in biomedical and life sciences: 2128735. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11325322.
8. ^ de Ru JA, Buwalda J (June 2008). "Botulinum toxin A injection into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache". J Laryngol Otol 123: 1–6. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1017/S0022215108003198. PMID 18588738.
9. ^ Nestoriuc Y, Rief W, Martin A (June 2008). "Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators". J Consult Clin Psychol 76 (3): 379–96. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1037/0022-006X.76.3.379. PMID 18540732.
10. ^ Rains JC (May 2008). "Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache". Headache 48 (5): 735–6; discussion 736–7. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1111/j.1526-4610.2008.01119_1.x. PMID 18471128.
11. ^ Yurekli VA, Akhan G, Kutluhan S, Uzar E, Koyuncuoglu HR, Gultekin F (February 2008). "The effect of sodium valproate on chronic daily headache and its subgroups". J Headache Pain 9 (1): 37–41. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1007/s10194-008-0002-5. PMID 18231713.
12. ^ Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". Clin J Pain 22 (3): 278–85. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.
13. ^ Biondi DM (2005). "Physical treatments for headache: a structured review". Headache 45 (6): 738–46. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
14. ^ Bronfort G, Nilsson N, Haas M et al. (2004). "Non-invasive physical treatments for chronic/recurrent headache". Cochrane Database Syst Rev (3): CD001878. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1002/14651858.CD001878.pub2. PMID 15266458.
15. ^ Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med 99 (4): 192–6. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1258/jrsm.99.4.192. PMID 16574972. http://www.jrsm.org/cgi/content/full/99/4/192.
16. ^ ^{a b c} Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med The Journal of the Royal Society of Medicine is one of the UK’s leading medical, peer-reviewed journals. JRSM is the flagship journal of the Royal Society of Medicine but has full editorial independence. JRSM has been published continuously since 1809, making it one of Britain’s oldest medical journals 100 (7): 330–8. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1258/jrsm.100.7.330. PMID 17606755. http://www.jrsm.org/cgi/content/full/100/7/330.
17. ^ Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine 32 (21): 2375–8. doi The Digital Object Identifier System is a managed system for persistent identification of content-related entities on digital networks. These entities may be content items (digital files, physical objects, abstract works), or any related entities in a content transaction (e.g. licenses, parties, etc.). "DOI" is sometimes used to mean the:10.1097/BRS.0b013e3181557bb1. PMID 17906581.
18. ^ Anderson-Peacock E, Blouin JS, Bryans R et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc 49 (3): 158–209. http://www.jcca-online.org/Client/cca/jcca.nsf/objects/jcca-v49-3-158/$file/jcca-v49-3-158.pdf. • Anderson-Peacock E, Bryans B, Descarreaux M et al. (2008). "A clinical practice guideline update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc 52 (1): 7–8. http://www.jcca-online.org/Client/cca/JCCA.nsf/objects/JCCA_March_2008_52_1/$file/jcca-v52-1-007.pdf.
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See also

• Migraine Migraine is a neurological syndrome characterized by altered bodily perceptions, headaches, and nausea. Physiologically, the migraine headache is a neurological condition more common to women than to men. The word migraine was borrowed from Old French migraigne . The French term derived from a vulgar pronunciation of the Late Latin word hemicrania,
• Cluster headache Cluster headache, nicknamed "suicide headache", is a neurological disease that involves, as its most prominent feature, an immense degree of pain. "Cluster" refers to the tendency of these headaches to occur periodically, with active periods interrupted by spontaneous remissions. The cause of the disease is currently unknown
• Rebound headache Medication overuse headaches , also known as rebound headaches usually occur when analgesics are taken frequently to relieve headaches. Rebound headaches frequently occur daily and can be very painful and are a common cause of chronic daily headache. They typically occur in patients with an underlying headache disorder such as migraines or tension

External links

• American Council for Headache Education
• National Headache Foundation
• World Headache Alliance
• Article on eMedicine about tension-type headache

Categories: Articles lacking ICHD information | Headaches

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• Tension Headache

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