Tension-type headaches have been called by various names over the years including tension headache, muscle contraction headache, psychomyogenic headache, stress headache, ordinary headache, essential headache, idiopathic headache and psychogenic headache. Of those, only "tension headaches" is still used with any frequency.
If tension-type headaches occur frequently or are severe enough to disrupt regular activities, a doctor should be consulted to confirm that they are TTH and assist with effective treatment. Fortunately, TTH is usually easy to treat. However, many people self-medicate, and when even over-the-counter pain medications are used frequently, medication overuse headaches, aka rebound headaches, can become an issue.
Symptoms and diagnostic criteria
Tension-type headaches most commonly last from 30 minutes to seven days. The pain is commonly described as "a band around the head" or vise-like. The headache has at least two of these characteristics:- mild to moderate in intensity
- occurs on both sides of the head
- is not made worse by routine activity such as bending over or climbing stairs
- the pain has a pressing or tightening quality, not throbbing or pulsing
Types of tension-type headaches
TTH is broken down into three types:
- Infrequent episodic type TTH: one or fewer episodes per month
- Frequent episodic type TTH: more than one, but fewer than 15 episodes per month for three or more months
- Chronic TTH: more than 15 episodes per month for three or more months. There may be mild nausea with this type of TTH.
Diagnosing tension-type headaches
There are no diagnostic tests to confirm TTH. Diagnosis is accomplished by reviewing the patient's personal and family medical history, studying their symptoms, and conducting an examination. TTH is then diagnosed by ruling out other causes for the symptoms.
At times, it can be difficult to distinguish between tension-type headache and a migraine attack. TTH is not made worse by physical activity. It is not accompanied by vomiting, and if nausea is present, it is mild. A migraine attack may be accompanied by increased sensitivity to both light and sound; TTH is accompanied by one or neither. It is, however, possible for a TTH to trigger a migraine attack.
Treatment of tension-type headaches
Infrequent episodic TTH needs only treatment for the individual episodes. If the number of episodes falls into the higher end of the frequent episodic range or into the chronic range, both episodic and preventive treatment are recommended.
Treatment for TTH episodes include:
- aspirin (for adults)
- acetaminophen
- ibuprofen
- aspirin/acetaminophen/caffeine combinations
- muscle relaxants
- combination prescription medications with aspirin, acetaminophen, codeine, hydrocodone, butalbital, caffeine, or other ingredients
The most commonly used preventive medications are:
- antidepressants such as amitriptyline
- muscle relaxants
- botox
Complementary methods are often employed to treat TTH, including:
- physical therapy
- massage therapy
- biofeedback
- acupuncture
- relaxation exercises
Summary
Tension-type headaches may be more of an annoyance than a big problem, though for some patients they can be quite debilitating. Most of the time, they can be treated with an over-the-counter medication and a bit of rest. Still, headaches should always be diagnosed by a doctor to be sure they are treated appropriately. More frequent TTH may require daily preventive medications or complementary therapies to restore health and quality of life.
Sources:
"The International Classification of Headache
Disorders, 2nd Edition." Cephalalgia 24 (s1).
doi: 10.1111/j. 1468-2982.2003.00824.x
Young, William B., MD; Silberstein, Stephen D.,
MD. "Migraine and Other Headaches." New York: AAN Press. 2004.
Tepper, Stewart J., MD. "Understanding Migraine
and Other Headaches." University Press of Mississippi. 2004.
"Headache Disorders and Public Health." Geneva: World Health Organization. 2000.
