Tension - Type Headache - Diagnosis and Treatment
Introduction
Tension-type headache is the most common headache disorder. The ratio of women to men with tension-type headache is approximately 5 to 4. In the past "tension headache" was a poorly defined term, usually associated with psychopathology and attributed to excess muscle contraction, usually in the muscles of the neck or scalp.
The International Headache Society (IHS) classification of 1988, redefined this entity to include episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH).
Episodic tension-type headache (ETTH) is defined as recurrent episodes of a headache meeting the following criteria.
Headache lasting from 30 minutes to seven days
At least two of the following pain characteristics:
- Pressing or tightening, non-pulsating quality
- Mild or moderate intensity
- Bilateral location
- Not aggravated by physical activity or walking stairs
No nausea or vomiting. Photophobia and phonophobia are usually absent, but one may be present.
The number of days with such headaches is less than 15 per month.
Chronic tension-type headaches (CTTH) have all the criteria and pain characteristics mentioned above for episodic tension-type headaches. In addition, the headaches usually occur for more than 15 days per month. Chronic tension-type headache is often associated with severe pain and often associated with medication over-usage.
Treatment
One of the most important elements in treating tension-type headaches, and headache patients in general, is to take their complaints seriously, and examine them thoroughly.
Treatment of Tension-Type Headaches
NONPHARMACOLOGIC - BEHAVIORAL
Reassurance and counseling on stress management.
Relaxation therapy.
Biofeedback.
Physical therapy including heat and cold packs, ultrasound, electrical stimulation.
PHARMACOLOGIC
Milder analgesics such as aspirin and acetaminophen, and nonsteroidal anti-inflammatories such as naproxen or ibuprofen.
Stronger analgesics such as Tylenol® with Codeine or Fiorinal® with Codeine.
The newer anti-inflammatory agents such as Celebrex®.
Stress reduction medications such as Tranxene®, Xanax®, and BuSpar®. When using these medications mentioned in #1 and #2 above, one has to be sure the patient is not converted from an episodic tension-type headache to a chronic tension-type headache or rebound headache.23