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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 -
Brain : a Journal of Neurology Sep 1999
Review
Topics: Chronic Disease; Humans; Muscle, Skeletal; Nitric Oxide Synthase; Tension-Type Headache
PubMed: 10468501
DOI: 10.1093/brain/122.9.1611 -
Drug and Therapeutics Bulletin Jun 1999Tension-type headache is now the term used to describe headaches that have previously been grouped under various ill-defined headings such as 'tension headache', 'stress... (Review)
Review
Tension-type headache is now the term used to describe headaches that have previously been grouped under various ill-defined headings such as 'tension headache', 'stress headache' and 'muscle contraction headache'. Tension-type headaches are characterized by pain that is mild or moderate in severity, bilateral in distribution, pressing or tightening in quality, and unaccompanied by major systemic disturbance or neurological signs. While many people have mild, infrequent tension-type headaches which they do not regard as an illness, a minority have chronic and often daily symptoms. Here we review the management of tension-type headaches in adults.
Topics: Antidepressive Agents, Tricyclic; Humans; Tension-Type Headache
PubMed: 10692710
DOI: 10.1136/dtb.1999.37641 -
Current Pain and Headache Reports Dec 2008The diagnosis of tension-type headache (TTH) is divided into two categories: episodic TTH and chronic TTH. It is important to differentiate TTH from other headaches,... (Review)
Review
The diagnosis of tension-type headache (TTH) is divided into two categories: episodic TTH and chronic TTH. It is important to differentiate TTH from other headaches, including primary and secondary headaches. Significant overlap in the diagnostic criteria makes it difficult to differentiate TTH from other headache disorders and, in particular, migraine. A controversy exists about whether TTH and migraine represent a continuum of the same pathophysiological process.
Topics: Humans; Tension-Type Headache
PubMed: 18973737
DOI: 10.1007/s11916-008-0074-6 -
Clinical Evidence Jun 2002
Comparative Study Review
Topics: Amitriptyline; Chronic Disease; Humans; Randomized Controlled Trials as Topic; Tension-Type Headache; Treatment Outcome
PubMed: 12230733
DOI: No ID Found -
Neurological Sciences : Official... May 2008The role of psychological factors related to headache, particularly tension-type headache (TTH), has long been a focus of investigation. The subject at issue is a... (Review)
Review
The role of psychological factors related to headache, particularly tension-type headache (TTH), has long been a focus of investigation. The subject at issue is a complex one, with some aspects that are still being debated by experts. In episodic TTH, it is possible to hypothesise that headache is not only a "primary" headache that causes gratuitous pain to sufferers. In fact, it might represent an improper mode of communicating the sufferers' intimate discomfort, caused by an inadequate relationship between their personality profiles and events in their lives. As in migraine, in TTH, too, evidence has been found of comorbidity between headache and psychiatric disorders, including depression and anxiety disorder. Such evidence will have to be confirmed by further studies on the general population. As regards behaviour and personality traits, subjects with TTH had significantly higher scores than healthy controls on measures of automatic thoughts and alexithymia, and lower scores on assertiveness. Patients with chronic TTH had higher automatic thoughts scores than patients with episodic TTH. These findings suggest that people with TTH may have difficulty in expressing their emotions. Finally, psychological factors and emotional disturbances have been indicated as risk factors for TTH. Indeed, stress and mental tension are the most common factors that cause TTH.
Topics: Humans; Psychology; Stress, Psychological; Tension-Type Headache
PubMed: 18545906
DOI: 10.1007/s10072-008-0896-3 -
Current Pain and Headache Reports Dec 2007Pathologies currently defined as temporomandibular disorders may be different in nature. Temporomandibular joint (TMJ) disorders and craniofacial and cervical myogenous... (Review)
Review
Pathologies currently defined as temporomandibular disorders may be different in nature. Temporomandibular joint (TMJ) disorders and craniofacial and cervical myogenous pain (MP) are distinct pathologies but may be superimposed and share some etiologic factors. Tension-type headache (TTH) may often be associated with craniofacial and cervical pain, and the same pharmacologic and nonpharmacologic treatment may be efficacious for both. Psychiatric comorbidity (depression and/or anxiety disorder) is less frequent in sheer TMJ disorders, compared with MP and TTH. A screening for the presence of an underlying psychiatric disorder should be part of the clinical evaluation in patients suffering from headache and facial pain.
Topics: Adult; Anxiety; Comorbidity; Depression; Female; Humans; Male; Mental Disorders; Temporomandibular Joint Disorders; Tension-Type Headache
PubMed: 18173983
DOI: 10.1007/s11916-007-0235-z -
Journal of Child Neurology Jul 2021The International Headache Society criteria were written in order to help physicians establish a headache diagnosis. However, sometimes children with headache do not...
INTRODUCTION
The International Headache Society criteria were written in order to help physicians establish a headache diagnosis. However, sometimes children with headache do not seem to fit any diagnosis. The purpose of our study was to assess the application of the criteria in a clinical setting.
METHODS
Medical records of children referred for primary headache to the pediatric neurology clinic at Bnai Zion Medical Center from 2008 to 2017 were assessed.
RESULTS
A total of 989 patients (range 6-18 years; 53% female) were assessed at our neurology clinic. Twenty-four percent (n = 241) were diagnosed with tension-type headache, 26% (n = 256) with migraine, and 4.5% (45) with mixed headache. In 41.5% (410), we were unable to reach a specific diagnosis. No differences in gender or age were found between the groups. Children in the migraine group used more analgesic treatments to stop the headache attacks compared with the tension-type headache group (50% vs 38%, = .001). Patients diagnosed with tension-type headache reported having more emotional difficulties ( = .001). No significant differences were found in headache characteristics (ie, location, sidedness, character), frequency, or intensity between the younger children (ages 6-11) and the adolescents (ages 12-18) within either the tension-type headache or migraine groups.
CONCLUSIONS
Retrospective application of International Headache Society criteria in a large cohort of children with headaches failed to diagnose a specific type of headache in 41.5% of children. Migraine and tension-type headache were equally prevalent, and both constituted a major burden on our patients' everyday lives. We found no major differences in frequency, intensity, and characteristics of pain between younger children and adolescents.
Topics: Adolescent; Analgesia; Child; Cohort Studies; Female; Humans; Male; Migraine Disorders; Retrospective Studies; Tension-Type Headache
PubMed: 33507829
DOI: 10.1177/0883073820988417 -
Current Pain and Headache Reports Dec 2005Tension-type headache (TTH) is the most prevalent form of primary headache in the general population. In this article, the diagnostic challenges of TTH are discussed.... (Review)
Review
Tension-type headache (TTH) is the most prevalent form of primary headache in the general population. In this article, the diagnostic challenges of TTH are discussed. The classification of these headaches according to the second edition of the International Classification of Headache Disorders (ICHD-2) and the main differences between the ICHD-2 and the first edition of the classification (ICHD-1, 1988) are discussed. The typical features of TTH also are highlighted. Finally, the differential diagnosis of episodic and chronic TTH, emphasizing the situations more likely to raise doubts, is discussed. The wide clinical spectrum of TTH frequently challenges the physician's diagnostic acumen. A structured approach to the patient and a better comprehension of this variability of presentation should translate into better quality of care and a more specific diagnosis for TTH sufferers.
Topics: Acute Disease; Chronic Disease; Diagnosis, Differential; Headache; Headache Disorders; Humans; International Classification of Diseases; Tension-Type Headache
PubMed: 16282043
DOI: 10.1007/s11916-005-0022-7 -
Cephalalgia : An International Journal... Jun 2000The aim of the present thesis was to investigate the pathophysiology of chronic tension-type headache with special reference to central mechanisms. Increased tenderness... (Review)
Review
The aim of the present thesis was to investigate the pathophysiology of chronic tension-type headache with special reference to central mechanisms. Increased tenderness to palpation of pericranial myofascial tissues is the most apparent abnormality in patients with tension-type headache. A new piece of equipment, a so-called palpometer, that makes it possible to control the pressure intensity exerted during palpation, was developed. Thereafter, it was demonstrated that the measurement of tenderness could be compared between two observers if the palpation pressure was controlled, and that the Total Tenderness Scoring system was well suited for the scoring of tenderness during manual palpation. Subsequently, it was found that pressure pain detection and tolerance thresholds were significantly decreased in the finger and tended to be decreased in the temporal region in chronic tension-type headache patients compared with controls. In addition, the electrical pain threshold in the cephalic region was significantly decreased in patients. It was concluded that the central pain sensitivity was increased in the patients probably due to sensitization of supraspinal neurones. The stimulus-response function for palpation pressure vs. pain was found to be qualitatively altered in chronic tension-type headache patients compared with controls. The abnormality was related to the degree of tenderness and not to the diagnosis of tension-type headache. In support of this, the stimulus-response function was found to be qualitatively altered also in patients with fibromyalgia. It was concluded that the qualitatively altered nociception was probably due to central sensitization at the level of the spinal dorsal horn/trigeminal nucleus. Thereafter, the prophylactic effect of amitriptyline, a non-selective serotonin (5-HT) reuptake inhibitor, and of citalopram, a highly selective 5-HT reuptake inhibitor, was examined in patients with chronic tension-type headache. Amitriptyline reduced headache significantly more than placebo, while citalopram had only a slight and insignificant effect. It was concluded that the blockade of 5-HT reuptake could only partly explain the efficacy of amitriptyline in tension-type headache, and that also other actions of amitriptyline, e.g. reduction of central sensitization, were involved. Finally, the plasma 5-HT level, the platelet 5-HT level and the number of platelet 5-HT transporters were found to be normal in chronic tension-type headache. On the basis of the present and previous studies, a pathophysiological model for tension-type headache is presented. According to the model, the main problem in chronic tension-type headache is central sensitization at the level of the spinal dorsal horn/trigeminal nucleus due to prolonged nociceptive inputs from pericranial myofascial tissues. The increased nociceptive input to supraspinal structures may in turn result in supraspinal sensitization. The central neuroplastic changes may affect the regulation of peripheral mechanisms and thereby lead to, for example, increased pericranial muscle activity or release of neurotransmitters in the myofascial tissues. By such mechanisms the central sensitization may be maintained even after the initial eliciting factors have been normalized, resulting in the conversion of episodic into chronic tension-type headache. Future basic and clinical research should aim at identifying the source of peripheral nociception in order to prevent the development of central sensitization and at ways of reducing established sensitization. This may lead to a much needed improvement in the treatment of chronic tension-type headache and other chronic myofascial pain conditions.
Topics: Central Nervous System; Equipment Design; Humans; Models, Neurological; Myofascial Pain Syndromes; Pain Threshold; Palpation; Serotonin; Stress, Psychological; Tension-Type Headache
PubMed: 11037746
DOI: 10.1046/j.1468-2982.2000.00070.x