The Specialist Forum Volume 13 No 11 November 2013 | Page 21
PAIN
Combination therapy recommended
for tension-type headaches
A
ccording to the International Headache Society
(IHS), headache disorders remain underdiagnosed and undertreated. The IHS has developed a classification system that defines 12 major
categories of headache disorders. The categories
are divided into primary and secondary headache
disorders.
Primary headache disorders represent the vast
majority of headache types and are divided into
four major groups:
• Migraine.
• Tension-type headaches.
• Cluster headaches.
• Other.
Secondary headache disorders can be
caused by:
• Headache attributed to head and/or
neck trauma.
• Headache attributed to
cranial or cervical vascular disorder.
• Headache attributed
to non-vascular intracranial disorder.
• Headache attributed to a substance or its withdrawal.
• Headache attributed to infection.
• Headache attributed to disorder of homoeostasis.
• Headache or facial pain attributed to disorder of cranium, neck, eyes,
ears, nose, sinuses, teeth, mouth or other facial or cranial structures.
• Headache attributed to psychiatric disorder.
Prevalence of headache
Research has shown that the lifetime prevalence of headache of any
kind in men is 93%, of which tension-type headache account for 69%.
For women, lifetime prevalence is 99% for headache of any kind, of
which more than 88% are classified as tension-type headache. In
children headache prevalence increases from 39% at the age of six, to
70% at the age of 15 years. The one-year prevalence of tension-type
headache is 63% for men and 86% for women.
risk of developing chronic tension-type headache. This condition, although less common,
affects 2.6% of females and 1.6% of males.
Episodic tension-type headache occurs less
than once per month and is usually triggered
by temporary stress, anxiety, fatigue or anger.
It may disappear with the use of over-thecounter analgesics, withdrawal from the
source of stress or a relatively brief period
of relaxation.
Frequent
Occurring one to 15 days per month,
this type of headache often coexists with migraine.
Chronic
Chronic tension-type headache
occurs 15 or more days per
month and evolves over
time from episodic
headache. It is often
a daily or continuous
headache,
which
may have some variability in the intensity
of the pain during
a 24-hour cycle. Chronic daily tension-type headache is often associated with depression or other emotional problems. Changes in
sleep patterns or insomnia, early morning or late day occurrence of
headache, feelings or guilt, weight loss, dizziness, poor concentration, ongoing fatigue and nausea commonly occur. This type should
be treated preventively to avoid becoming dependent on pain relieving
drugs.
Cause of tension-type headache
Tension-type headache is the most common form of headache and is
nonspecific. It is classified as episodic, frequent or chronic and occurs
more frequently in women.
According to the IHS, the underlying cause of tension-type headache
is likely due to chemical and neuronal imbalances in the brain and may
be related to muscle tightening in the back of the neck and/or scalp.
The pain is pressing or tightening, of mild to moderate intensity, and
occurs on both sides of the head and is not aggravated by routine
physical activity.
A review by the Mayo Clinic suggests that the most common cause
of tension-type headache is a heightened sensitivity to pain in people
who have tension headaches and possibly a heightened sensitivity to
stress. Increased muscle tenderness, a common symptom of tension
headache, may result from a sensitised pain system.
Episodic
Warning features
Studies show that episodic tension-type headache is by far the most
common primary headache disorder, affecting 40% of the population.
Individuals with episodic tension-type headache may be at increase
• Headache that is new or unexpected in an individual patient.
• Thunderclap headache (intense headache with abrupt or ‘explosive’
onset).
Tension-type headaches
The Specialist Forum | November 2013
Page 21