In the United States, it is estimated that 2–3% of the population suffers from chronic tension headaches, a condition where tension headaches occur on a frequent, near-daily basis.

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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

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Prevalence of Chronic Tension Headaches

Analyze the patient's new symptom of pain from light touch. Based on the neurophysiological changes that occur when tension-type headaches become chronic, what specific shift in the peripheral and central nervous system best explains this new experience?

Neurological Shift in Chronic Headaches

A patient has a history of occasional, mild tension-type headaches. Over the last year, the headaches have become a daily occurrence, described as a constant, dull, bilateral pain. The patient also reports that now, even a gentle massage of the neck and scalp, which used to be soothing, can sometimes feel intensely painful. Based on the described physiological mechanism of chronic tension-type headaches, explain the neurological changes that would account for this patient's transition from occasional headaches to persistent, daily pain with increased sensitivity.

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