Tension Type Headache (TTH) Overview, Causes, Prevention & Treatment

Overview:- Tension Type Headache

Tension Type Headache (TTH) is very common, with a lifetime prevalence in the general population ranging in between 30% and 78%. Tension-type headache (TTH) is known by multiple names like tension headache, muscle contraction headache, psychomyogenic headache, stress headache, ordinary headache, essential headache, idiopathic headache, and psychogenic headache.

Tension-type headache (TTH) is the most common type of headache experienced by mankind. Patient of tension headache experiences recurrent headaches. Which can be of mild to moderate intensity, occurs on both side of head, and feels like tight band around head to the patient.

It is seen in every continent, no specific race is affected by this stress headache. Patients can be easily diagnosed by the general physician based on history of onset and duration and also by ruling out other secondary causes.

Symptoms of TTH

• Mild or Moderate head pain in different sides of head i.e front, top or sides of head.
• Feeling tightness or continuous pressure around the head or sides of head. Feeling aching head pain.
• Headache start early in day or later evening.
• Feeling tenderness or muscle aches in other parts of body such as scalp, eyes, neck and shoulders etc.
• Tiredness, Unable to focus, sensation to light or noise.
• High Fever along with pain in forehead.
• loss of balance

Tension Type Headache Causes

The exact mechanism of tension type headache is still unclear. However, it seems that peripheral mechanisms are responsible for the origin of pain in Tension-type headache (TTH).

As per The Global Burden of Diseases Study 2010, global prevalence of TTH as 21%. Which is highest among all types of headache.

Tension-type headache and mild forms of Migraine without aura appears similar because patients with frequent headaches often suffer from both disorders. Both of these need to be differentiated because treatment of the two is far apart.

Although root cause of Tension type headache is still unknown but experts says they are commonly caused by muscle contraction in neck and head region.

These contractions develops in individual according to their lifestyle, food habits, work environment and stressors.

People who work for long hours over computer screen or who drive for long hours gets their muscles week and triggers the headache.

Triggers for Tension Type headache

Although there no single factor that results in tension type headache but individuals stress level, food habits, climate conditions develop the TTH. Below are some some trigger factors for headache.

• Stress:- Individuals dealing with high work stress, family stress, relationship and friend stress etc. which are experienced continuously and last longer results in Tension type headache. However episodic stress do not lead to Tension type headache but daily stress lead to TTH.
• Food Habits:- consumption of processed food, hunger, skipping a meal regularly, continuous calorie deficit dieting can cause tension headache.
• Alcohol and Smoking, Drug Abuse
• Anxiety, Fatigue
• Obesity
• Consumption of foods which are rich in caffeine
• cold or flue, sinus infection
• No sleep or lack of sleep, continuous working for long hours without taking break.
• Long hours of driving, Driving in hilly area or cold area.
• Eye straining, dry eyes, Lack of water
• Low iron level or vitamin deficiency
• Jaw or Dental problem

Diagnosis of Tension-type headache (TTH)

Episodic TTH is divided into 3 types:

1. Infrequent Episodic TTH, with headache episodes less than once per month
2. Frequent Episodic TTH (IHS 2013).
3. Chronic tension-type headache is a serious disease, causing greatly decreased quality of life and high disability.

Infrequent episodic TTH is diagnosed by the following parameters:

1. Lifetime history of at least 10 episodes occurring on fewer than one day per month (fewer than 12 days per year) and satisfying criteria 2 through to 4 below.
2. Headache lasting from 30 minutes to seven days.
3. Headache has at least two of the following characteristics:
   1. bilateral location;
   1. pressing or tightening (non‐pulsating) quality;
   1. mild or moderate intensity;
   1. not aggravated by routine physical activity such as walking or climbing stairs.
4. Both:
   1. no nausea or vomiting (anorexia may occur);
   1. no more than one of photophobia or phonophobia.
5. Not attributed to another disorder.

Frequent episodic TTH Diagnosis

Frequent episodic TTH is diagnosed when there is a lifetime history of least 10 episodes occurring on at least one day but fewer than 15 days per month for at least three months (at least 12 and fewer than 180 days per year), and when criteria 2 through to 5, above, are also met.

Treatment for Tension Type Headache

Pharmacological therapy is the mainstay of clinical management and can be divided into acute and preventive treatments.

Simple analgesics have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of TTH. Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and if simple analgesics are ineffective, poorly tolerated or contraindicated

Recommended preventive treatments include amitriptyline, venlafaxine and mirtazapine, as well as some selected non-pharmacological therapies.

Despite the widespread prevalence and associated disability of TTH, little progress has been made since the early 2000s owing to a lack of attention and resource allocation by scientists, funding bodies and the pharmaceutical industry

Risk Factors for Tension headache

Different studies have shown that up to 80% adults in U.S suffer from tension headache time to time. Women suffer twice from tension headache compare to men. In U.S 5% of people suffers from chronic headache episodes.

Chronic headache episodes lasts longer till 60 to 90 days

When to see doctor for Treating Tension headache

If headache episodes are disrupting your normal life and you have plan to get rid of them from your life. If you are experiencing the headache episodes more then once a week than you should consult the doctor.

Immediately call 911 if the headache episodes are very high and you are experiencing the continuous high pain, facing difficulty to see or hear.

Doctors will treat your headache on the basis of your headache symptoms and its frequency. They may ask you below questionaries’ for diagnosis and treatment

• What are your food habits?
• Do you skip meal or are you following any specific diet plan?
• What is water intake of your body throughout the day?
• What is your sleeping pattern or how long your sleep?
• Do you work for continuous or long hours over computers/laptops etc.?
• Have you got any head injury in past or recently?
• What is the severity of pain or how does pain feel like?
• What is the pattern of headache or When do you feel headache?
• Are you dealing with any stress like workload, family, friends or peer pressure?

Once the Doctor have answers to above or similar questionaries’ they may perform some tests to rule out other possibilities. You may need to take blood test, X-rays, CT-Scan, MRI test to get pictures of the inside of your head.

Researches have shown very promising results for complementary health approaches for tension headache or migraine. However evidence of effectiveness is limited or conflicting for other approaches

How to prevent future tension headaches?

To prevent future tension headache, you have to mitigate your trigger points. Once the headache trigger points are identified we can prevent the tension headache episodes by making some lifestyle changes to stop the triggers.

In order to determine the causes of headache, you should record your daily routine and observe your schedule. You can make one handbook and record your Daily Food intake, Working hours, Exercise, Sleeping pattern or any other situation which cause stress.

Once you have a sufficient data, then you can compare the data in between for the days when the headache was triggered and normal days. You can analyze and rule out the trigger point. For example if you had any specific meal on the day you experience headache and you noticed the same procedure on the other days of headache than that food may be you trigger.

Another example would be suppose you have worked for long hours and couldn’t get proper sleep or rest and experienced the headache over that day. You would be able to identify the trigger point. Next time you can take rest in between when working for long hours, have shorter span of working hours and take rest as required for body.

Must Read:- What causes Headache, Headache Types and Headache Prevention

Tension Type Headache Prevention

You can try below preventive measures for headache:-

a. Biofeedback Training Session:- In Biofeedback training session helps to determine certain body responses to reduce pain. In the biofeedback session you are connected to the devices which monitors your body functions such as heart rate, blood pressure, pulses and muscle tension. Once the values are noted then you learn how to control and slow down heart rate, deep breathing and reducing muscle tension.

b. Cognitive behavioral therapy:- This is talk therapy exercise, therapist teaches you how to actively manage your stress and helps you to lower down your stress level. These therapies results in reducing the episodes of headache and lower down the pain.

c. Acupuncture:- Acupuncture is ancient practice followed by Chinese people and now everywhere in world. Patients are injected with thin needles in the specific point of body primarily used to get relief from pain. In U.S more than 4 million peoples uses acupuncture to get rid of pain.

d. Massage Therapy:- Massage therapy is one of the oldest therapy originated from Ayurveda. Today, there are more than 100 types of massage therapy available. They differ from each other in terms of style, body part, pressure movement and technique. The process involves pressurizing the muscles by pressing, rubbing or other body parts with hand, finger toes. High pressure massage may involve elbow, forearms or feet. Wide variety of oils, gels are used while massaging the body.

e. Spinal Manipulation:- In spinal manipulation technique doctors apply apply a controlled force to a joint of the spine by a device or hands. This technique is frequently used to treat headache however there are no clear evidence that manipulation is helpful in treating headache because different studies have showcased contradictory results.

f. Deep Breathing Exercises:- Breathing exercises lower down anxiety and helps in reducing stress. There are various type of breathing exercises involved like Deep breathing, rhythmic breathing , visualized breathing. All these breathing exercise lower down your heart rate. You are able to concentrate more. You feel more energetic and stress free.

g. Yoga and Meditation:- Yoga exercises plays a key role in muscle relaxation and lower down the anxiety.

h. Dietary Supplements:- Butterbur helps to reduce migraine headache episodes in adults and children. Studies have shown following supplements have resulted in reducing headache episodes but not severity i.e Coenzyme Q10, Feverfew, Magnesium, Riboflavin, Omega-3 Fatty Acids,

Note:- Before taking any Dietary supplements and medicines kindly consult with your Doctor.

Lifestyle changes to reduce stress and prevent tension type headache:-

• Limiting Stress:- Try to limit your stress by planning and executing the things. Do the things which you love more and get relived from stress.
• Exercise:- Try to take out 1 hour for your body to train it. Do stuff like jogging, walking, swimming, weigh lifting etc. which makes you stronger.
• Yoga:- In order to get healthy and fit, join Yoga classes and learn the Yoga asanas. Once you master try to practice them at your home or garden.
• Sleep:- Give your body rest, try to sleep for adequate hours. Proper sleep reduces the stress level and keep you joyful.
• Stop Smoking:- Try to stop smoke asap it has adverse affect on your mental and physical health.
• Alcohol Abuse:- Don’t drink too much alcohol because exceeding alcohol limits leads to hangover and headaches. Try to stop drinking alcohol.
• Protein and Nutrition Diet:- Add more fruits, green vegetables in to your diet to get more proteins and required vitamins for your body. Always enjoy healthy and balanced diet.
• Record, Analyze and stop headache triggers:- Try to make one handbook to record your daily habits, food activities, working hours etc. Analyze and compare the data for the days when you experienced tension type headache vs normal days. Identify triggers point and avoid them.
• Increase water intake of your body:- Try to drink plenty of water. It keeps you hydrated and helps in smooth body functionality.

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Next we have most common and Frequently Asked Questions for tension type headache

How Tension type headache is different from Cluster Headache?

Cluster headache is very different from tension type headache. Cluster headache pains occurs in clusters and patient suffers from very severe pain.

Cluster headaches are of two types:- Chronic cluster headaches and Episodic cluster headaches. Chronic cluster headaches have long span where as Episodic cluster headache have shorter spans. To read more about cluster headache check our blog What is Cluster Headache? Types, Symptoms, Causes and Prevention

Must Read:- Types of Cluster Headaches, cluster headache prevention & cluster headache treatment