Tension-Type Headaches


Stephen D. Silberstein, M.D., F.A.C.P., One Penn Blvd., Philadelphia, PA 19144


Tension-type headache is the term designated by the International Headache Society to describe what was previously called tension headache, muscle contraction headache, psychomyogenic headache, stress headache, ordinary headache, and psychogenic headache. The International Headache Society defines tension-type headache more precisely, distinguishes between the episodic and the chronic varieties, and divides them into two groups, those associated with a disorder of the pericranial muscles and those not associated with this type of disorder. Most clinic-based studies of tension-type headache suffer from selection bias, as they include patients with more severe headaches, patients with concomitant migraine, and patients with chronic daily headache. Traditionally, episodic tension-type headache and migraine have been considered distinct disorders, and the International Headache Society continues the separation, Some believe that both migraine and tension-type headache are recurring benign headaches. Chronic tension-type headache used to be called chronic daily headache, but they are not identical, Chronic tension-type headache must be distinguished from chronic daily headache even though the International Headache Society has not done this. Chronic daily headache is a syndrome consisting of a group of disorders and can be subclassified into primary and secondary types, The primary chronic daily headache disorders include transformed migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Secondary causes of chronic daily headache include post-traumatic headache, cervical spine disorders, and headache associated with vascular disorders and nonvascular intracranial disorders. Patients with frequent headaches are prone to overuse analgesics, ergotamine, or both. Most patients with chronic daily headache overuse symptomatic medication. Treatment is most difficult for patients with chronic daily headache. These patients often have physical and emotional dependency, low frustration tolerance, a sleep disturbance, and depression. Stopping overused medication is crucial. Detoxification is difficult and frequently requires hospitalization and aggressive headache management.