Overview
Reviewed by Dr. Emma Foster
Tension-type headache (TTH) is one of the most common (prevalent) forms of headache. The pain is typically felt on both sides of the head (bilateral) rather than just occurring on one side of the head and causes a sensation of pressing or tightening. The headaches are of mild to moderate intensity and are not aggravated by routine exercise such as walking. While tension headaches do not cause nausea, they may cause some sensitivity to light or sound. They last between 30 minutes to seven days. Frequent episodic TTH is categorised when a person experiences headaches between 1 to 14 days of every month.
Chronic tension-type headache (TTH) causes the same symptoms as episodic TTH (pressing/tightening sensation, mild to moderate intensity, possible sensitivity to light & sound), however it can also cause some mild nausea in addition to other symptoms. Chronic TTH is distinguished from an episodic disorder by headache frequency. Chronic TTH is when the person experiences headache on more than 15 days every month.
Prevalence
Prepared by Dr. Louise Alexander. Reviewed by Professor James Lance.
Tension-type headache is the most widespread headache disorder. Recent international studies have shown the average prevalence as 36% for men and 42% for women (cf migraine: 6% for men and 18% for women). This means that about 7 million Australians are likely to have tension-type headaches. A recent WHO report states that ‘onset is often in teenage years and prevalence peaks in fourth decade then declines’ and ‘60% of those with tension-type headache experience reductions in social activities and work capacity’.
Data from a study at a Sydney Clinic into age, onset and duration of tension-type headache showed that onset can be at any age: 15% of patients were under 10 and some were 50 years or over at onset. 40% of patients with tension-type headache had a close relative with some form of chronic headache. Many people had a periodic upsurge of pain like a miniature migraine referred to as tension-vascular headache. Around 10% had definite migraine in addition to their tension-type headaches. About 50% of patients had a headache every day of their lives that may persist for 10-30 years or more.
Symptoms
Symptoms may include
- dull and persistent pain that may vary in intensity (mild to moderate) and is usually felt on both sides of the head or neck (some however experience jabs of sudden pain in the head)
- a constant, tight, heavy or pressing sensation on or around the head
- tautness and tenderness of scalp, neck and shoulder muscles
- neck movements (active or passive) restricted by muscular stiffness and discomfort
- ache in the back or over the left side of the chest
- recurrent and episodic pain (often in association with stress) that can last for minutes, hours, days, months or even years
- mild sensitivity to light and noise (may occur in severe attacks)
- nausea and indigestion
- trouble concentrating and difficulty sleeping
- depression and anxiety (common).
Triggers
Tension-type headaches, despite the name, are not necessarily caused by tension or stress. Triggers can includeexcessive muscle contraction such as frowning or jaw-clenching
- poor posture at work, home and when driving
- bright lights, prolonged reading, loud noise
- medication overuse
- stress, anxiety
- fatigue, emotional upsets, depression.
Diagnosis
- no specific test
- determined by symptoms, medical history and physical examination by doctor
- a CT scan or MRI may be needed if constant pain or unusual symptoms.
Treatment and prevention
Depending on symptoms and precipitating factors, treatment and prevention can include
- taking time away from stress
- having a balance of work and leisure, having fun and enough rest, sleep and regular exercise
- achieving a state of mental and physical relaxation
- psychological treatment to uncover anxieties or emotional pressures
- physiological treatment such as relaxation techniques such as deep breathing exercises, biofeedback, acupuncture, compress, heat pad, neck and shoulder massage
- over-the-counter medications such as aspirin, paracetamol, ibuprofen, combination analgesics with codeine (caution- avoid taking OTC medication every day as this in itself could precipitate a Chronic Daily Headache)
- prescription medicines such as antidepressants or stronger analgesics.
Call your doctor if your headache:
- is a thunderclap headache or a headache associated with a loss of consciousness
- can not be relieved with medication or requires daily use of medication
- occurs after a head injury
- is associated with blurred vision, difficulty speaking or numbness of arms or legs
- is accompanied by fever or vomiting.
You can read more about tension-type headaches at Virtual Medial Centre.
References
Headache Disorders and Public Health, WHO 2000
Migraine and Other Headaches 2000 Professor James Lance
Wolff’s Headache and Other Head Pain 7th ed Silberstein, Lipton & Dalessio
Critical Decisions in Headache Management Giammarco, Edmeads, Dodick
Harvard Medical School Consumer Health Info, www.health.harvard.edu
