Tension-type headaches or TTHs are the most common type of headaches and are often self-treated, and are different from migraines . TTH occurs in roughly 68% of men and more than 88% of women in the United States. They are more likely to occur in a patient’s 30s, particularly in higher educated Caucasians.

Symptoms of Tension-Type headaches

Tension-type headaches are defined as pain in the head, scalp, neck or even shoulders. THH can last anywhere from 30min to up to 7 days. The pain has been described as a relentless tightening, occurring on both sides of the body, especially in the forehead, temples or back of the head. These pains are often dull and result in a sensitivity to touch the areas experiencing pain. This pain is typically mild to moderate and is unaffected by physical activity.
These headaches may be accompanied by discomfort related to light (photophobia) or sound (phonophobia).

Causes of Tension-Type headaches

Tension-type headaches are caused by tension or tightness of the muscles in their areas. TTH is associated with chronic muscle issues. It is believed that people that experience TTH may be more sensitive to pain in the muscles around the head. However, CTTH is thought to be due to dysfunction of pain regulation by the central nervous system.

TTH has also been found to result from stress, poor posture, smoking, fatigue, eye strain and alcohol use.

Types of TTH

1. Infrequent episodic, less than 12 headache days per year
2. Frequent episodic, occurring 12 to 180 days per year
3. Chronic, which occurs more than 180 days per year

Most headaches are infrequent and episodic . Those that become chronic headaches, typically become more painful over time. There are also tension migraines. These are very similar to tension headaches. The primary difference is that tension headaches do not also have auras, nausea or vomiting. Movement is also less likely to exacerbate tension headaches while they may for tension migraines. Nearly 3% of adults experience chronic tension-type headaches (CTTH) . CTTH is diagnosed in patients that experience headaches more than 15 times a month. Much like chronic migraines these can have significantly disabling effects on the patient and harm their quality of life.

Treatments of  Tension-Type headaches

The most commonly used and effective treatments for tension-type headaches are aspirin, acetaminophen, and NSAIDS. As with migraines, patients with a chronic form of tension-type headaches can have a resistance response to medication and thus should take pharmaceutical treatments with care. NSAIDs like ibuprofen and Advil have side effects such as gastroesophageal reflux disease and ulcers. Taking them with food can help reduce GI upset and risks. Tylenol can cause liver or kidney dysfunction over time. Triptans while effective for cluster headaches and migraines is not effective in treating TTH.

Prevention of  Tension-Type headaches

Non-pharmaceutical options
Because pharmacological treatments can lead to more tension-type headaches through overuse, it is imperative that headaches are prevented from developing in the first place. Non-pharmaceutical prevention mechanisms include relaxation training, exercise, regular sleep, stress management, acupuncture, cognitive behavioral activities, physical therapy and avoidance of headache triggers.

Pharmaceutical Options
Pharmacological options include low doses of antidepressants, specifically tricyclic antidepressants such as amitriptyline. These treatments not only improve a headache but sleep as well. The efficacy of antidepressants is still controversial, and they are also accompanied by several side effects that could limit its use. Alternative antidepressants that may also be effective include nortriptyline, clomipramine, and tetracyclic antidepressants like mirtazapine, maprotiline, and mianserin. Injectable nerve blocks including botulinum toxin type A injections have also been shown to block headache development in patients with CTTH. There is still limited data on their efficacy.,