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Current Pain and Headache Reports Oct 2001The vast majority of people experience tension-type headache during their lifetimes. Boys experience tension-type headache slightly more than girls during preadolescent... (Review)
Review
The vast majority of people experience tension-type headache during their lifetimes. Boys experience tension-type headache slightly more than girls during preadolescent years. During adolescence and adult years, tension-type headache occurs more commonly in females. Tension-type headache changes in women occur in relation to gynecologic changes, including menses, pregnancy, and menopause. These changes are related to estrogen fluctuations. Estrogen fluctuations cause changes in neurochemicals important for pain signal transmission, including serotonin, gamma-aminobutyric acid, and enkephalins.
Topics: Age Factors; Estrogens; Female; Humans; Male; Sex Factors; Tension-Type Headache
PubMed: 11560810
DOI: 10.1007/s11916-001-0056-4 -
Current Pain and Headache Reports Dec 2010Tension type headache (TTH) is a primary headache disorder considered common in children and adolescents. It remains debatable whether TTH and migraine are separate... (Review)
Review
Tension type headache (TTH) is a primary headache disorder considered common in children and adolescents. It remains debatable whether TTH and migraine are separate biological entities. This review summarizes the most recent literature of TTH with regards to children and adolescents. Further studies of TTH are needed to develop a biologically based classification system that may be facilitated through understanding changes in the developing brain during childhood and adolescence.
Topics: Adolescent; Child; Humans; Tension-Type Headache
PubMed: 20927610
DOI: 10.1007/s11916-010-0149-z -
Current Pain and Headache Reports Dec 2009Tension-type headache (TTH) is the most common and most socioeconomically costly headache. Yet our knowledge regarding TTH pathophysiological mechanisms is still in its... (Review)
Review
Tension-type headache (TTH) is the most common and most socioeconomically costly headache. Yet our knowledge regarding TTH pathophysiological mechanisms is still in its early stages. Psychological stress and weak coping mechanisms may initiate and propagate physiological pain via activation of second messengers in downstream substrates involved in pain. It seems that peripheral mechanisms are predominant in the episodic type (ETTH), whereas central mechanisms are involved in the chronic type (CTTH) of tension headache. The conversion from ETTH to CTTH is most relevant to the clinician and the patient, as CTTH is the most debilitating. This paper focuses and summarizes our current understanding of central sensitization, the process by which this conversion occurs in TTH, and proposes an integrated model to explain how ETTH progresses into CTTH in genetically susceptible individuals.
Topics: Adaptation, Psychological; Animals; Central Nervous System; Disease Progression; Genetic Predisposition to Disease; Humans; Stress, Psychological; Tension-Type Headache
PubMed: 19889292
DOI: 10.1007/s11916-009-0078-x -
Expert Review of Neurotherapeutics Mar 2012Recent evidence suggests that active trigger points (TrPs) in neck and shoulder muscles contribute to tension-type headache. Active TrPs within the suboccipital, upper... (Review)
Review
Recent evidence suggests that active trigger points (TrPs) in neck and shoulder muscles contribute to tension-type headache. Active TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with chronic and episodic tension-type headache forms. It seems that the pain profile of this headache may be provoked by referred pain from active TrPs in the posterior cervical, head and shoulder muscles. In fact, the presence of active TrPs has been related to a higher degree of sensitization in tension-type headache. Different therapeutic approaches are proposed for proper TrP management. Preliminary evidence indicates that inactivation of TrPs may be effective for the management of tension-type headache, particularly in a subgroup of patients who may respond positively to this approach. Different treatment approaches targeted to TrP inactivation are discussed in the current paper, focusing on tension-type headache. New studies are needed to further delineate the relationship between muscle TrP inactivation and tension-type headache.
Topics: Head; Humans; Muscle, Skeletal; Myofascial Pain Syndromes; Neck Muscles; Pain, Referred; Physical Therapy Modalities; Shoulder; Tension-Type Headache; Trigger Points
PubMed: 22364330
DOI: 10.1586/ern.11.138 -
TheScientificWorldJournal Jun 2002In the last 10 years there has been increasing interest in the role of calcitonin gene-related peptide (CGRP) in primary headaches. Tension-type headache is one of the... (Review)
Review
In the last 10 years there has been increasing interest in the role of calcitonin gene-related peptide (CGRP) in primary headaches. Tension-type headache is one of the most common and important types of primary headaches, and ongoing nociception from myofascial tissues may play an important role in the pathophysiology of this disorder. CGRP sensory fibers are preferentially located in the walls of arteries, and nerve fibers containing CGRP accompany small blood vessels in human cranial muscles. It is well established that nociception may lead to release of CGRP from sensory nerve endings and from central terminals of sensory afferents into the spinal cord. It has also been shown that density of CGRP fibers around arteries is increased in persistently inflamed muscle. These findings indicate that ongoing activity in sensory neurons in the cranial muscles may be reflected in changes of plasma levels of neuropeptides in patients with chronic tension-type headache. To explore the possible role of CGRP in tension-type headache, plasma levels of CGRP were measured in patients with chronic tension-type headache. This study showed that plasma levels of CGRP are normal in patients and unrelated to headache state. However, the findings of normal plasma levels of CGRP do not exclude the possibility that abnormalities of this neuropeptide at the neuronal or peripheral (pericranial muscles) levels play a role in the pathophysiology of tension-type headache. Investigation of CGRP in other compartments with new sensitive methods of analysis is necessary to clarify its role in tension-type headache.
Topics: Animals; Calcitonin Gene-Related Peptide; Chronic Disease; Humans; Nociceptors; Tension-Type Headache
PubMed: 12806133
DOI: 10.1100/tsw.2002.808 -
Headache Feb 2011Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. Understanding of pathophysiology of TTH is paramount for development of... (Review)
Review
Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. Understanding of pathophysiology of TTH is paramount for development of effective treatments and prevention of chronification of TTH. Our aim was to review the findings from pain perception studies of pathophysiology of TTH as well as to review the research of pathophysiology of TTH. Pain perception studies such as measurement of muscle tenderness, pain detection thresholds, pain tolerance thresholds, pain response to suprathreshold stimulation, temporal summation and diffuse noxious inhibitory control (DNIC) have played a central role in elucidating the pathophysiology of TTH. It has been demonstrated that continuous nociceptive input from peripheral myofascial structures may induce central sensitization and thereby chronification of the headache. Measurements of pain tolerance thresholds and suprathreshold stimulation have shown presence of generalized hyperalgesia in chronic tension-type headache (CTTH) patients, while DNIC function has been shown to be reduced in CTTH. One imaging study showed loss of gray matter structures involved in pain processing in CTTH patients. Future studies should aim to integrate pain perception and imaging to confirm this finding. Pharmacological studies have shown that drugs like tricyclic anti-depressant amitriptyline and nitric oxide synthase inhibitors can reverse central sensitization and the chronicity of headache. Finally, low frequency electrical stimulation has been shown to rapidly reverse central sensitization and may be a new modality in treatment of CTTH and other chronic pain disorders.
Topics: Amitriptyline; Electric Stimulation Therapy; Humans; Muscle, Skeletal; Nitric Oxide Synthase; Pain Perception; Pain Threshold; Tension-Type Headache
PubMed: 21029081
DOI: 10.1111/j.1526-4610.2010.01768.x -
Current Pain and Headache Reports Dec 2011The tenderness of pericranial myofascial tissues and number of myofascial trigger points are considerably increased in patients with tension-type headache (TTH).... (Review)
Review
The tenderness of pericranial myofascial tissues and number of myofascial trigger points are considerably increased in patients with tension-type headache (TTH). Mechanisms responsible for the increased myofascial pain sensitivity have been studied extensively. Peripheral activation or sensitization of myofascial nociceptors could play a role in causing increased pain sensitivity, but firm evidence for a peripheral abnormality still is lacking. Peripheral mechanisms are most likely of major importance in episodic TTH. Sensitization of pain pathways in the central nervous system due to prolonged nociceptive stimuli from pericranial myofascial tissues seem to be responsible for the conversion of episodic to chronic TTH. Treatment directed toward muscular factors include electromyography biofeedback, which has a documented effect in patients with TTH, as well as physiotherapy and muscle relaxation therapy, which are most likely effective. Future studies should aim to identify the source of peripheral nociception.
Topics: Analgesics; Central Nervous System; Central Tolerance; Chronic Disease; Disease Progression; Facial Muscles; Humans; Muscle Contraction; Myofascial Pain Syndromes; Pain Management; Tension-Type Headache; Trigger Points
PubMed: 21735049
DOI: 10.1007/s11916-011-0216-0 -
Current Pain and Headache Reports Dec 2008The question of whether tension-type headache (TTH) and migraine represent two points on a continuum has been debated for decades. Skeptics of the continuum model... (Comparative Study)
Comparative Study Review
The question of whether tension-type headache (TTH) and migraine represent two points on a continuum has been debated for decades. Skeptics of the continuum model support their view by noting that the characteristics of these two headaches and the demographics of the individuals who suffer from them are undeniably distinct. In the clinical setting, however, these disorders exhibit more similarities than differences. TTH and migraine may exhibit similar associated features (even within the constraints of diagnostic criteria), respond effectively to similar medications, share similar demographics among certain age groups, and may each have genetic influences. These findings suggest that TTH and migraine may be more intimately related than would be suggested by their diagnostic criteria.
Topics: Disease Progression; Humans; Migraine Disorders; Tension-Type Headache; Time Factors
PubMed: 18973736
DOI: 10.1007/s11916-008-0073-7 -
Postgraduate Medicine Apr 2002Tension-type headache is the most prevalent headache type, affecting most women and men at some time in their lives, and can impair job productivity and interfere with... (Review)
Review
Tension-type headache is the most prevalent headache type, affecting most women and men at some time in their lives, and can impair job productivity and interfere with family and social time. However, despite its impact, tension-type headache is also the most misunderstood headache type. Because of these misperceptions, many affected people are reluctant to seek medical treatment. In this article, Dr Mueller discusses possible triggers of tension-type headache, appropriate evaluation, and management with pharmacologic, nonpharmacologic, and alternative therapies.
Topics: Diagnosis, Differential; Female; Humans; Male; Tension-Type Headache
PubMed: 11985132
DOI: 10.3810/pgm.2002.04.1165 -
Current Pain and Headache Reports Dec 2012Tension-type headache is the most common headache disorder, affecting approximately 40 % of Americans within a one-year span. Although the most common form, episodic... (Review)
Review
Tension-type headache is the most common headache disorder, affecting approximately 40 % of Americans within a one-year span. Although the most common form, episodic tension-type headache, is rarely impairing, more frequent tension-type headache can occur with significant disability and psychological comorbidity. Appreciating the psychological impact, assessing the associated biopsychosocial issues, and understanding patients' coping styles are important in forming an appropriate treatment plan and maximizing treatment outcomes. A range of psychological therapies including relaxation training, cognitive behavioral therapy, biofeedback and mindfulness have demonstrated utility in treating chronic pain conditions and reducing the associated disability. This may be particularly applicable to special populations, including pediatric patients, pregnant patients and geriatric. Psychological assessment and treatment may be done conjointly with medication management and expands treatment options. There is great need to continue researching the effects of psychological treatments, standardizing interventions and making them available to the wider population.
Topics: Adaptation, Psychological; Aged; Biofeedback, Psychology; Child; Cognitive Behavioral Therapy; Comorbidity; Female; Humans; Pregnancy; Psychotherapy; Relaxation Therapy; Tension-Type Headache
PubMed: 23054980
DOI: 10.1007/s11916-012-0301-z