Causes
- Stress: Physical or emotional stress can lead to muscle contractions and tension in the head and neck.
- Poor Posture: Sitting or standing with poor posture can strain muscles.
- Eyestrain: Prolonged periods of reading, computer use, or other activities that require intense concentration.
- Fatigue: Lack of sleep or physical fatigue.
- Hunger: Skipping meals or not eating at regular intervals.
- Dehydration: Not drinking enough fluids.
- Mental Health Issues: Anxiety and depression can contribute to TTH.
Pathophysiology
- Muscle Contraction Theory: Prolonged contraction of muscles in the head and neck.
- Central Sensitization: Increased sensitivity of pain pathways in the central nervous system, especially in chronic TTH.
- Peripheral Mechanisms: Activation of nociceptors (pain receptors) in muscles and tissues around the head and neck.
- Neurotransmitter Imbalance: Dysregulation of serotonin and other neurotransmitters that modulate pain.
Diagnosis
- Clinical Evaluation: Based on patient history and symptoms, typically bilateral, non-pulsating headache with mild to moderate intensity.
- Exclusion of Other Conditions: Rule out migraines, cluster headaches, and other secondary headaches.
- Diagnostic Criteria (ICHD-3):
- At least 10 episodes occurring on fewer than 1 day per month on average (<12 days per year).
- Lasting from 30 minutes to 7 days.
- At least two of the following characteristics: bilateral location, pressing/tightening (non-pulsating) quality, mild or moderate intensity, not aggravated by routine physical activity.
- Both of the following: no nausea or vomiting, no more than one of photophobia or phonophobia.
- Physical Examination: Check for muscle tenderness in the head, neck, and shoulders.
Prevention
- Stress Management: Techniques such as relaxation exercises, biofeedback, and cognitive-behavioral therapy.
- Posture Improvement: Ergonomic adjustments and exercises to improve posture.
- Regular Sleep Patterns: Ensuring adequate and consistent sleep.
- Healthy Diet: Regular, balanced meals and proper hydration.
- Regular Physical Activity: Exercise to reduce muscle tension and improve overall well-being.
- Avoidance of Triggers: Identifying and avoiding personal headache triggers.
Management
- Medications:
- Acute Treatment: Over-the-counter analgesics like acetaminophen, ibuprofen, and aspirin.
- Preventive Medications: Antidepressants (e.g., amitriptyline), muscle relaxants, and anticonvulsants.
- Non-Pharmacological Treatments:
- Cognitive-Behavioral Therapy (CBT): Helps manage stress and behavioral factors contributing to TTH.
- Physical Therapy: Techniques to relieve muscle tension and improve posture.
- Biofeedback: Teaches control over physiological functions such as muscle tension.
- Massage Therapy: Relieves muscle tension and reduces stress.
- Acupuncture: May help reduce headache frequency and intensity.
- Lifestyle Modifications: Stress reduction techniques, regular exercise, and healthy sleep habits.
Summary
Tension type headache is the most common type of headache, often associated with stress and muscle tension. Understanding and managing the causes, pathophysiology, and effective treatment options can significantly improve the quality of life for individuals suffering from TTH.
