Muscle Contraction Tension Headache

Muscle Contraction Tension Headache

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Tension-type headache (TTH) represents one of the most costly diseases because of its very high prevalence. TTH is the most common type of headache, and it is classified as episodic (ETTH) or chronic (CTTH). It had various ill-defined names in the past including tension headache, stress headache, muscle contraction headache, psychomyogenic headache, ordinary headache, and psychogenic headache. See Medscape’s Headache Resource Center for more information.

The International Headache Society (IHS) defines TTH more precisely and differentiates between the episodic and the chronic types.

The following is a modified outline of the IHS diagnostic criteria:

At least 10 previous headaches fulfilling the following criteria; number of days with such headache fewer than 15 per month

Headaches lasting from 30 minutes to 7 days

At least 2 of the following pain characteristics:

Pressing/tightening (nonpulsating) quality

Mild or moderate intensity (may inhibit but does not prohibit activities)

Bilateral location

No aggravation from climbing stairs or similar routine physical activity

Both of the following:

No nausea or vomiting

Photophobia and phonophobia absent or only one present

Secondary headache types not suggested or confirmed

See the list below:

Average headache frequency of more than 15 days per month for more than 6 months fulfilling the following criteria

At least 2 of the following pain characteristics:

Pressing/tightening (nonpulsating) quality

Mild or moderate intensity (may inhibit but does not prohibit activities)

Bilateral location

No aggravation from climbing stairs or similar routine physical activity

Both of the following:

No vomiting

No more than one of the following: nausea, photophobia, or phonophobia

Secondary headache types not suggested or confirmed

Pathogenesis of TTH is complex and multifactorial, with contributions from both central and peripheral factors. In the past, various mechanisms including vascular, muscular (ie, constant overcontraction of scalp muscles), and psychogenic factors were suggested. The more likely cause of these headaches is believed now to be abnormal neuronal sensitivity and pain facilitation, not abnormal muscle contraction.

Various evidence suggests that, like migraine, TTH is associated with exteroceptive suppression (ES2), abnormal platelet serotonin, and decreased cerebrospinal fluid beta-endorphin. In one study, plasma levels of substance P, neuropeptide Y, and vasoactive intestinal peptide were found to be normal in patients with CTTH and unrelated to the headache state.

Several concurrent pathophysiologic mechanisms may be responsible for TTH; according to Jensen, extracranial myofascial nociception is one of them. Headache is not related directly to muscle contraction, and possible hypersensitivity of neurons in the trigeminal nucleus caudalis has been suggested.

Bendtsen described central sensitization at the level of the spinal dorsal horn/trigeminal nucleus due to prolonged nociceptive inputs from pericranial myofascial tissues. [1] The central neuroplastic changes may affect regulation of peripheral mechanisms and can lead to increased pericranial muscle activity or release of neurotransmitters in myofascial tissues. This central sensitization may be maintained even after the initial eliciting factors have been normalized, resulting in conversion of ETTH into CTTH.

Further research is necessary to understand and clarify the mechanisms of TTH. Research may lead to the development of more specific and effective management in the future.

United States

TTH is the most common primary headache syndrome.


Rasmussen et al reported a lifetime prevalence of TTH of 69% in men and 88% in women in the Danish population. [2] The patient may experience more than one primary headache syndrome. In one study by Ulrich et al, the 1-year prevalence of TTH was the same among individuals with and without migraine. [3]

Women are slightly more likely to be affected than men.

The female-to-male ratio for TTH is approximately 1.4:1.

In CTTH, female preponderance is 1.9:1.

TTH can occur at any age, but onset during adolescence or young adulthood is common. It can begin in childhood.

Bendtsen L. Central sensitization in tension-type headache–possible pathophysiological mechanisms. Cephalalgia. 2000 Jun. 20(5):486-508. [Medline].

Rasmussen BK, Olesen J. Epidemiology of migraine and tension-type headache. Curr Opin Neurol. 1994 Jun. 7(3):264-71. [Medline].

Ulrich V, Russell MB, Jensen R. A comparison of tension-type headache in migraineurs and in non- migraineurs: a population-based study. Pain. 1996 Oct. 67(2-3):501-6. [Medline].

Holroyd KA, O’Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001 May 2. 285(17):2208-15. [Medline].

Saper JR, Silberstein SD, Lake AE 3rd. Double-blind trial of fluoxetine: chronic daily headache and migraine. Headache. 1994 Oct. 34(9):497-502. [Medline].

Bendtsen L, Jensen R. Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia. 2000 Jul. 20(6):603-10. [Medline].

Saper JR, Winner PK, Lake AE. An open-label dose-titration study of the efficacy and tolerability of tizanidine hydrochloride tablets in the prophylaxis of chronic daily headache. Headache. 2001 Apr. 41(4):357-68. [Medline].

Biondi M, Portuesi G. Tension-type headache: psychosomatic clinical assessment and treatment. Psychother Psychosom. 1994. 61(1-2):41-64. [Medline].

Soderberg EI, Carlsson JY, Stener-Victorin E, Dahlof C. Subjective Well-being in Patients With Chronic Tension-type Headache: Effect of Acupuncture, Physical Training, and Relaxation Training. Clin J Pain. 2011 Jun. 27(5):448-56. [Medline].

Adelman LC, Adelman JU, Von Seggern R. Venlafaxine extended release (XR) for the prophylaxis of migraine and tension-type headache: A retrospective study in a clinical setting. Headache. 2000 Jul-Aug. 40(7):572-80. [Medline].

Altura BM, Altura BT. Tension headaches and muscle tension: is there a role for magnesium?. Med Hypotheses. 2001 Dec. 57(6):705-13. [Medline].

Arena JG, Hightower NE, Chong GC. Relaxation therapy for tension headache in the elderly: a prospective study. Psychol Aging. 1988 Mar. 3(1):96-8. [Medline].

Ashina M, Bendtsen L, Jensen R. Plasma levels of calcitonin gene-related peptide in chronic tension- type headache. Neurology. 2000 Nov 14. 55(9):1335-40. [Medline].

Ashina M, Bendtsen L, Jensen R. Plasma levels of substance P, neuropeptide Y and vasoactive intestinal polypeptide in patients with chronic tension-type headache. Pain. 1999 Dec. 83(3):541-7. [Medline].

Ashina M, Bendtsen L, Jensen R. Possible mechanisms of action of nitric oxide synthase inhibitors in chronic tension-type headache. Brain. 1999 Sep. 122 ( Pt 9):1629-35. [Medline].

Bendtsen L, Jensen R, Olesen J. A non-selective (amitriptyline), but not a selective (citalopram), serotonin reuptake inhibitor is effective in the prophylactic treatment of chronic tension-type headache. J Neurol Neurosurg Psychiatry. 1996 Sep. 61(3):285-90. [Medline].

Benoliel R, Sharav Y. Craniofacial pain of myofascial origin: temporomandibular pain & tension-type headache. Compend Contin Educ Dent. 1998 Jul. 19(7):701-4, 706, 708-10 passim; quiz 722. [Medline].

Borgeat F, Elie R, Larouche LM. Pain response to voluntary muscle tension increases and biofeedback efficacy in tension headache. Headache. 1985 Oct. 25(7):387-91. [Medline].

Cohen GL. Protriptyline, chronic tension-type headaches, and weight loss in women. Headache. 1997 Jul-Aug. 37(7):433-6. [Medline].

Diamond S, Balm TK, Freitag FG. Ibuprofen plus caffeine in the treatment of tension-type headache. Clin Pharmacol Ther. 2000 Sep. 68(3):312-9. [Medline].

Friedman AP. Assessment of Fiorinal with Codeine in the treatment of tension headache. Clin Ther. 1986. 8(6):703-21. [Medline].

Friedman AP. Characteristics of tension headache: a profile of 1,420 cases. Psychosomatics. 1979 Jul. 20(7):451-7, 461. [Medline].

Gerwin RD. Chronic daily headache. N Engl J Med. 2006 May 4. 354(18):1958; author reply 1958. [Medline].

Granella F, D’Alessandro R, Manzoni GC, Cerbo R, Colucci D’Amato C, Pini LA, et al. International Headache Society classification: interobserver reliability in the diagnosis of primary headaches. Cephalalgia. 1994 Feb. 14(1):16-20. [Medline].

Jensen R. Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia. 1999 Jul. 19(6):602-21. [Medline].

Jensen R. Tension-type Headache. Curr Treat Options Neurol. 2001 Mar. 3(2):169-180. [Medline].

Jensen R, Olesen J. Initiating mechanisms of experimentally induced tension-type headache. Cephalalgia. 1996 May. 16(3):175-82; discussion 138-9. [Medline].

Jensen R, Olesen J. Tension-type headache: an update on mechanisms and treatment. Curr Opin Neurol. 2000 Jun. 13(3):285-9. [Medline].

Kunkel RS. Muscle contraction (tension) headache. Clin J Pain. 1989. 5(1):39-44. [Medline].

Lance JW. Headache. Ann Neurol. 1981 Jul. 10(1):1-10. [Medline].

Lancet. Biofeedback and tension headache. Lancet. 1980 Oct 25. 2(8200):898-9. [Medline].

Langemark M, Olesen J. Pericranial tenderness in tension headache. A blind, controlled study. Cephalalgia. 1987 Dec. 7(4):249-55. [Medline].

Langemark M, Olesen J. Sulpiride and paroxetine in the treatment of chronic tension-type headache. An explanatory double-blind trial. Headache. 1994 Jan. 34(1):20-4. [Medline].

Leistad RB, Sand T, Westgaard RH. Stress-induced pain and muscle activity in patients with migraine and tension-type headache. Cephalalgia. 2006 Jan. 26(1):64-73. [Medline].

Lipchik GL, Holroyd KA, O’Donnell FJ, Cordingley GE, Waller S, Labus J, et al. Exteroceptive suppression periods and pericranial muscle tenderness in chronic tension-type headache: effects of psychopathology, chronicity and disability. Cephalalgia. 2000 Sep. 20(7):638-46. [Medline].

Marks DR, Rapoport AM. Practical evaluation and diagnosis of headache. Semin Neurol. 1997. 17(4):307-12. [Medline].

Murros K, Kataja M, Hedman C. Modified-release formulation of tizanidine in chronic tension-type headache. Headache. 2000 Sep. 40(8):633-7. [Medline].

Myers DE, Shaikh Z, Zullo TG. Hypoalgesic effect of caffeine in experimental ischemic muscle contraction pain. Headache. 1997 Nov-Dec. 37(10):654-8. [Medline].

Nakashima K, Tumura R, Wang Y. Effects of tizanidine administration on exteroceptive suppression of the temporalis muscle in patients with chronic tension-type headache. Headache. 1994 Sep. 34(8):455-7. [Medline].

Nuechterlein KH, Holroyd JC. Biofeedback in the treatment of tension headache. Current status. Arch Gen Psychiatry. 1980 Aug. 37(8):866-73. [Medline].

Olesen J. Clinical and pathophysiological observations in migraine and tension- type headache explained by integration of vascular, supraspinal and myofascial inputs. Pain. 1991 Aug. 46(2):125-32. [Medline].

Peterson AL, Talcott GW, Kelleher WJ. Site specificity of pain and tension in tension-type headaches. Headache. 1995 Feb. 35(2):89-92. [Medline].

Porta M. A comparative trial of botulinum toxin type a and methylprednisolone for the treatment of tension-type headache. Curr Rev Pain. 2000. 4(1):31-5. [Medline].

Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain. 1993 Apr. 53(1):65-72. [Medline].

Rasmussen BK, Jensen R, Schroll M. Epidemiology of headache in a general population–a prevalence study. J Clin Epidemiol. 1991. 44(11):1147-57. [Medline].

Redillas C, Solomon S. Prophylactic pharmacological treatment of chronic daily headache. Headache. 2000 Feb. 40(2):83-102. [Medline].

Rollnik JD, Karst M, Fink M. Coping strategies in episodic and chronic tension-type headache. Headache. 2001 Mar. 41(3):297-302. [Medline].

Rossi LN, Cortinovis I, Menegazzo L. Classification criteria and distinction between migraine and tension- type headache in children. Dev Med Child Neurol. 2001 Jan. 43(1):45-51. [Medline].

Schachtel BP, Furey SA, Thoden WR. Nonprescription ibuprofen and acetaminophen in the treatment of tension- type headache. J Clin Pharmacol. 1996 Dec. 36(12):1120-5. [Medline].

Silberstein SD. Advances in understanding the pathophysiology of headache. Neurology. 1992 Mar. 42(3 Suppl 2):6-10. [Medline].

Silberstein SD. Tension-type and chronic daily headache. Neurology. 1993 Sep. 43(9):1644-9. [Medline].

Silberstein SD. Tension-type headaches. Headache. 1994 Sep. 34(8):S2-7. [Medline].

Silberstein SD, Lipton RB. Chronic daily headache. Curr Opin Neurol. 2000 Jun. 13(3):277-83. [Medline].

Simons DG, Mense S. Understanding and measurement of muscle tone as related to clinical muscle pain. Pain. 1998 Mar. 75(1):1-17. [Medline].

Solomon S. Diagnosis of primary headache disorders. Validity of the International Headache Society criteria in clinical practice. Neurol Clin. 1997 Feb. 15(1):15-26. [Medline].

Solomon S, Elkind A, Freitag F. Safety and effectiveness of cranial electrotherapy in the treatment of tension headache. Headache. 1989 Jul. 29(7):445-50. [Medline].

Stewart WF, Shechter A, Rasmussen BK. Migraine prevalence. A review of population-based studies. Neurology. 1994 Jun. 44(6 Suppl 4):S17-23. [Medline].

Sutton EP, Belar CD. Tension headache patients versus controls: a study of EMG parameters. Headache. 1982 May. 22(3):133-6. [Medline].

Walker Z, Walker RW, Robertson MM, Stansfeld S. Antidepressant treatment of chronic tension-type headache: a comparison between fluoxetine and desipramine. Headache. 1998 Jul. 38(7):523-8. [Medline].

Wheeler AH. Botulinum toxin A, adjunctive therapy for refractory headaches associated with pericranial muscle tension. Headache. 1998 Jun. 38(6):468-71. [Medline].

White AR, Resch KL, Chan JC. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia. 2000 Sep. 20(7):632-7. [Medline].

Wittrock DA. The comparison of individuals with tension-type headache and headache- free controls on frontal EMG levels: a meta-analysis. Headache. 1997 Jul-Aug. 37(7):424-32. [Medline].

Wober-Bingol C, Wober C, Karwautz A. Tension-type headache in different age groups at two headache centers. Pain. 1996 Sep. 67(1):53-8. [Medline].

Zagami AS. Pathophysiology of migraine and tension-type headache. Curr Opin Neurol. 1994 Jun. 7(3):272-7. [Medline].

Ziegler DK. Tension headache. Med Clin North Am. 1978 May. 62(3):495-505. [Medline].

Zissis N, Harmoussi S, Vlaikidis N. A randomized, double-blind, placebo-controlled study of venlafaxine XR in out-patients with tension-type headache. Cephalalgia. 2007 Mar 7. [Medline].

Zwart JA, Bovim G, Sand T. Tension headache: botulinum toxin paralysis of temporal muscles. Headache. 1994 Sep. 34(8):458-62. [Medline].

Manish K Singh, MD Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience

Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Headache Society, American Association of Physicians of Indian Origin, American Medical Association, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American College of International Physicians, American Heart Association, American Stroke Association, American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, National Association of Managed Care Physicians, American College of Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Joseph Carcione, Jr, DO, MBA Consultant in Neurology and Medical Acupuncture, Medical Management and Organizational Consulting, Central Westchester Neuromuscular Care, PC; Medical Director, Oxford Health Plans

Joseph Carcione, Jr, DO, MBA is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Muscle Contraction Tension Headache

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