Tension-type headache is the most common type of headache, present in about seventy percent of individuals, while migraine is present in thirty percent. Ninety nine percent of all headaches are either Tension-type headache or migraine with 1-2 percent being something else.

The cause of Tension-type headache is poorly understood, and the pathophysiology is said to be “neurobiological.” Tension-type headache pain is mild to moderate and described as “tight, tense, or pressure.”

It has none of the features of migraine, such as severity, throbbing, nausea or vomiting, or sensitivity to light or sound. It does not put a person down, limiting activity as migraine does. The pain of TTH is commonly located in the neck, jaw, or temple area and should have pericranial tenderness, or pain on muscle palpation noted on examination.

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This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.

Associated findings

Classification The International Classification of Headache Disorders v3 classifies TTH as:

Infrequent episodic with or without pericranial tenderness

Frequent episodic tension-type headache with or without pericranial tenderness

Chronic tension-type headache with or without pericranial tenderness

Probable frequent, infrequent, or chronic tension-type headache with or without pericranial tenderness

Previously used terms for tension-type headache:

tension headache

muscle contraction headache

psychomyogenic headache

stress headache

ordinary headache

essential headache

idiopathic headache

psychogenic headache.

Tension-type headache is common, with a lifetime prevalence in the general population ranging in different studies between 30% and 78%. It has a high socio-economic impact.

While it was previously considered to be primarily psychogenic, studies since ICHD-I strongly suggest a neurobiological basis to tension-type headache, especially for the more severe subtypes.

What does Tension-type headache feel like?

Descriptive terms:

tight

tense

pressure

squeezing

band-like

clamp-like

Is tension-type headache confused with other headache types?

Yes, confusion between tension-type headache and migraine is common and many persons have both tension-type headache and migraine. Also, it is difficult to differentiate between tension-type headache and medication-overuse headache. Both a diagnosis of migraine and medication-overuse headache should be added to tension-type diagnoses when appropriate.

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How is pericranial sensitivity perceived?

The examining physician palpates over areas of pain indicated by the patient, using two fingers to check for perceived patient tenderness at that spot.

Which type of tension-type headache is the worse?

Chronic tension-type headache is the worst type of TTH and is a significant medical problem which causes decreased quality of life and disability requiring headache specialist consultation and prescribed medication.

What is the treatment for tension-type headache?

Aerobic physical exercise should be performed by everyone but is especially recommended as treatment for tension-type headache.

Massage, rubbing the affected area, and heat from a pad or a shower are helpful.

Patients with tension-type headaches often do not sleep well and drugs in the class of tricyclic antidepressants such as amitriptyline, nortriptyline, or doxepin may be used for sleep and pain relief.

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Although this site provides information about various medical conditions, the reader is directed to his own treating physician for medical treatment.

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All the best.

Britt Talley Daniel MD