Tension headaches are also known as tension-type headaches or TTH and stress headaches. They are a primary muscle-related headache disorder involving head pain.
Pathophysiology of tension headaches:
It may be due to:
- Particular myofascial tender points
- Some autonomic nervous system dysfunction
- Muscles and muscle-related release of particular substance
- Autonomic dysfunction
Tension headaches are very common they are actually the most common primary headache disorder. They are the most common cause of chronic recurring head pain. However, the mean age of onset of tension headaches is between the ages of 15 to 40 years old.
Risk Factors for tension headaches:
The risk factor for getting tension-type headaches is:
Females outnumber males with this condition by three to one or three to two. So female patients are more likely to have tension-type headaches than males.
- Depression and anxiety
- Insomnia or having difficulties getting to sleep
- Having temporomandibular joint disorder or TMJ disorder
- Having particular vitamin deficiencies, especially vitamin B12 and vitamin D deficiencies
So these risk factors are going to be triggers of these types of headaches.
Clinical Features of tension headaches:
Head pain or constant pain. It has a gradual onset and is not very severe. Headache is non-pulsatile. It’s described as a pressing or tightening or a fullness type of discomfort or pain. It may also be described as a band like a band around the head being pulled or pressed or tightened. The location of this pain is going to be bilateral it's going to occur on both sides of the head. This is different from cluster headaches and migraine headaches.
When they are unilateral or one-sided then the location for these types of headaches is occur in the frontal area. It can also occur in and around the eyes and in the nuchal occipital area. It lasts between 30 minutes to up to seven days but the average length of these headaches is between four to six hours. Some patients experience fewer headaches in the morning and worse headaches at night or in the evening.
Signs and symptoms of tension headaches:
Findings with regard to these headaches including
- Difficulty in concentration
- Stiff or tight muscles in the neck front and or back of the head
- Reduced appetite
- Sensitivity to light or sound
These headaches are different than migraine headaches.
Trigger factors of tension headaches:
The trigger that causes these types of headache are:
- Sleep deprivation may be due to autonomic nervous system dysfunction
- Anxiety and stress
- Poor posture especially excessive neck flexion
Diagnosis of tension headaches:
According to the international headache society or IHS, the clinical diagnosis of tension-type headaches requires at least two to four of the following characteristics to occur for at least 30 minutes to upwards of 7 days. Such as:
Bilateral non-pulsatile, pressing, tightening pain mild to moderate in severity and not worse with exertion There has to be no nausea or vomiting which is more specific to migraine.
Treatment of tension headaches:
Tension-type headaches it's important to identify and avoid triggers. This headache is avoided even without treatment. These types of headaches are self-limiting which means they will go away or resolve on their own by following these things such as:
- Use NSAIDs or non-steroidal anti-inflammatory drugs like ibuprofen
- Use caffeine
- Tricyclic antidepressants like amitriptyline
- Cognitive behavioral therapy or CBT