Tension Headache

Tension type headache (TTH) is the most common form of headache in the general population, characterized by mild to moderate bilateral, non-throbbing pain. It is often associated with stress and mental tension. TTH is categorized into three subtypes: infrequent episodic, frequent episodic, and chronic. Chronic TTH may be linked to stress, anxiety, and depression. Understanding the nuances of TTH, including its diagnostic approach and treatment modalities, is crucial for effective management.

Overview of Tension Type Headache (TTH)

Tension type headache (TTH) is the most prevalent headache in the general population. The typical presentation of a TTH attack is mild to moderate intensity, bilateral, nonthrobbing headache without other associated features. Stress and mental tension are reported to be the most common precipitants for TTH.

Subtypes of TTH

There are three main subtypes of TTH which include infrequent episodic (headache episodes less than one day per month), frequent episodic (headache episodes 1- 14 days per month), and chronic TTH (headaches 15 or more days per month). Chronic TTH is often associated with stress, anxiety, and depression. Neuroimaging is not necessary in most patients with TTH.

Acute and Abortive Therapy

The acute and abortive therapy of TTH includes both non- pharmacological measures (heat, ice, massage, rest, and biofeedback) and analgesic medications. Pharmacological therapy includes NSAIDs, aspirin, and acetaminophen.

Limitations to Prevent Medication Overuse Headache

To avoid medication overuse headache (MOH), management of TTH requires limitation of acute therapy. The use of over-the-counter combination analgesics should be limited, as should NSAIDs. For emergency ward, or inpatient treatment of moderate to severe TTH, additional therapy options include parenteral chlorpromazine, intramuscular ketorolac, and the combination of metoclopramide-diphenhydramine.

Preventive Treatment for TTH

Preventive treatment is recommended for patients with frequent or long-duration headaches. This includes behavioral and cognitive interventions, and tricyclic antidepressants like amitriptyline, nortriptyline, or protriptyline.

References

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