[Tension-type headaches]

Abstract

Tension-type headache is one of the most common and most significant primary headaches. Tension-type headache is a very heterogeneous disorder. It can be divided into episodic and chronic tension-type headache. The pain is a dull, pressing, tightening, typically band-like sensation. The pain is of non-pulsating quality, the location is bilateral, and there is no nausea, vomiting, phonophobia or photophobia. There are no prodromal symptoms or aura. The pain is mild to moderate and it does not aggravate with routine physical activities. Some patients have increased tenderness of pericranial muscles. Psychological factors are common in tension-type headache. Nitric oxide has an important role in the pathophysiology of chronic tension-type headache. Probably it promotes central sensitization and therefore increases nociception. In differential diagnosis of tension type-headache, all structural and metabolic diseases causing headache have to be ruled out, as well as all other primary headaches. All comorbid and coexistent states should also be considered. In the treatment of tension-type headache, pharmacological and non-pharmacological methods are employed. Analgesics, myorelaxants, anxiolytics and antidepressants are most commonly used, as well as physical therapy, massage, acupuncture, behavioral therapy and psychotherapy. Recently, the applications of botulinum toxin and acupuncture have been described in the treatment and prophylaxis of tension-type headache.