* Infrequent episodic tension-type headache: occur less than once per month.
* Frequent episodic tension-type headache: occur one to 14 days per month.

Both types of ETTH do not usually require medical attention

University of Michigan - Ann Arbor

Tension-type headaches are the most commonly experienced kind of headache, accounting for about 42% of all headaches worldwide. They are characterized by relatively mild, dull, bilateral pain. In the United States, over one-third of the population experiences tension headaches each year. The primary trigger is the tightening of facial and neck muscles, often due to environmental factors like stress.

Tension-type headache

Ashina, S., Mitsikostas, D. D., Lee, M. J., Yamani, N., Wang, S. J., Messina, R., Ashina, H., Buse, D. C., Pozo-Rosich, P., Jensen, R. H., Diener, H. C., & Lipton, R. B. (2021). Tension-type headache. Nature reviews. Disease primers, 7(1), 24. https://doi.org/10.1038/s41572-021-00257-2

Tension-type headache 

Twin studies have shown that genetic factors are more significant in more frequent episodic tension-type headache and chronic tension-type headache. The genes that contribute to TTH are not fully understood, but genes that have been implicated include 5-HTTLPR and Val158Met COMT, while APOE-e4 is said to protect against TTH.

Genetics of tension-type headache

The causes of tension-type headaches are multifaceted, involving both physiological and environmental factors. Sufferers often exhibit increased tenderness in pericranial muscles. A range of triggers can contribute, including sleep deprivation, skipping meals, eye strain, overexertion, and poor posture. Stress is a particularly significant factor, believed to contribute by increasing muscle contraction and heightening the body's sensitivity to pain. This mechanism is supported by findings that individuals with tension headaches have a lower pain threshold and greater pain sensitivity than non-sufferers. Therefore, stress may trigger or worsen these headaches by amplifying pain perception in already-sensitized neural pathways.

Causes of tension-type headache

Episodic tension-type headache

When a tension-type headache occurs for at least 15 days per month. CTTH can have debilitating effects on patients. 

The mechanism by which a tension-type headache becomes chronic is not fully understood. The current understanding is that abnormal input from muscles in the head and neck, and vascular structures, sensitize peripheral nociceptors (pain receptors). This results in the sensitization of second-order neurons in the spinal cord and A-Beta fibers become pro-nociceptive. The PAG reduces inhibition of pain, the RVM of medulla increases facilitation of pain. Ultimately, this causes increased pain signals to the thalamus and then the somatosensory cortex.

Chronic tension-type headache

* Therapy
* Analgesics
* Muscle relaxants
* Antidepressants

Treatments for tension-type headache

A client reports experiencing a headache after a particularly stressful week at work. They describe the sensation as a constant, dull ache with a feeling of pressure, like a tight band is wrapped around their head. The pain is felt on both sides of their forehead and is not severe enough to prevent them from continuing their daily activities. Based on the provided scenario, identify the most likely type of headache the client is experiencing and justify your answer by referencing at least two key characteristics from the description.

Headache Scenario Analysis

A patient describes experiencing a persistent, dull ache on both sides of their head, which they compare to 'a tight band being squeezed around the skull.' They mention that the pain is most frequent during stressful periods at work but is not severe enough to make them miss a day. Based on this description, what is the most likely underlying mechanism for their headache?

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