Tension-type headaches

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.

Silberstein SD

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