section name header

Information

Editors

Marja-LiisaSumelahti

Tension Headache

Essentials

  • Tension headache (or tension-type headache, TTH) includes headaches caused by both muscle tension and mental stress.
  • Tension headache may occur concomitantly with migraine.
  • Physical activity and relaxation alleviate symptoms.
  • Unlike in migraine, physical exertion does not exacerbate symptoms.
  • Non-pharmacological treatment methods have a central role.

Symptoms

  • The headache is steady and worsens gradually towards the evening.
  • There is a tight, squeezing pain in the head, like a band around the head.
  • Localized to the temples, occiput or top of the head; may be unilateral.
  • Tingling, stabbing, excruciating pains may be felt on the top of the head.
  • Muscular tension in the neck area may be associated with pain in the nuchal muscles and night-time numbness of the upper extremities.
  • There may be dizziness and a sense of loss of balance.

Diagnosis

  • Based on typical symptoms and clinical examination (ICHD-3 Classification: Tension-type headache http://ichd-3.org/2-tension-type-headache/).
  • Neurological status is normal.
  • On palpation, tenderness may be detected in the temporal or occipital areas as well as in the neck and shoulders.
  • Tension headache is divided to episodic (< 15 headache days/month) and chronic (> 15 headache days/month) types.

Differential diagnosis

  • Keeping a headache diary helps to make the right diagnosis, especially in the case of suspected mixed headache.
  • Migraine without aura where physical exertion typically makes the headache worse, and where prodromal symptoms and associated symptoms occur
  • Malocclusion (bruxism) Malocclusion and Headache
  • Occipital nerve compression, where trigger tenderness can be found at the point where the nerve exits the cranial base and the pain follows its innervation boundaries
  • SinusitisAcute Maxillary Sinusitis
  • Giant cell arteritis where a palpable temporal artery can be found in physical examination, often unilateral Giant Cell (Temporal) Arteritis, in laboratory tests SR often elevated.
  • Endocrinological cause, such as hyperthyroidism Hyperthyroidism or hyperparathyroidism Hypercalcaemia and Hyperparathyroidism
  • Brain tumour, the symptoms and signs of which often include morning nausea, progressively worsening headache, abnormal findings in physical examination Brain and Spinal Cord Tumours

Imaging

  • Imaging of the head is indicated only if the neurological status is abnormal or if a suspicion of a severe disease arises.
  • Indications for head computed tomography or magnetic resonance imaging in headache
    • Suspicion of subarachnoidal haemorrhage
    • Progressively worsening headache
    • Recurring or continuous vomiting associated with the headache
    • Abnormal neurological status in association with headache
    • Headache occurring only in connection with coughing or physical exertion
    • An episode of unconsciousness associated with the headache
    • Position-dependent headache
    • An endocrine disturbance associated with the headache
    • Neurofibromatosis in the patient's history or in his/her family history

Treatment Ssris and Snris for Preventing Tension-Type Headaches and Migraine, Biofeedback for Tension-Type Headache

Episodic tension headache

Chronic tension headache

  • Stopping excess use (continuous > 15 days per month) of analgesics
  • Physical exercise, avoiding exercise forms that increase symptoms
  • Muscle care and relaxation
  • Check ergonomics: sleep and workplace ergonomics
  • Identification of stress factors
  • Physiotherapy, orthopaedic manual physical therapy (OMT)
  • Acupuncture Acupuncture for Tension-Type Headache
  • Injections of local anaesthetics and/or glucocorticoids to trigger points
  • Pharmacotherapy

    References

    • Stephens G, Derry S, Moore RA. Paracetamol (acetaminophen) for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev 2016;(6):CD011889. [PubMed]
    • Linde K, Allais G, Brinkhaus B et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev 2016;(4):CD007587. [PubMed]
    • Veys L, Derry S, Moore RA. Ketoprofen for episodic tension-type headache in adults. Cochrane Database Syst Rev 2016;(9):CD012190. [PubMed]
    • Banzi R, Cusi C, Randazzo C et al. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults. Cochrane Database Syst Rev 2015;(5):CD011681. [PubMed]

Related Keywords

ATC Code:

M03CA01

N06AA09

N05BA01

N05BA02

N05BA04

N05BA05

N05BA06

N05BA08

N05BA12

N06AA10

N06CA01

M01AB01

M01AB02

M01AB05

M01AB08

M01AB15

M01AB51

M01AB55

M01AC01

M01AC02

M01AC06

M01AE01

M01AE02

M01AE03

M01AE11

M01AE17

M01AE51

M01AE52

M01AG01

M01AG02

M01AX01

M01AX17

N02AJ08

N02BA01

N02BA51

N02BA57

N02BE01

M03BX02

Primary/Secondary Keywords