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Tension-Type Headache

Kaniecki, Robert, G.

CONTINUUM: Lifelong Learning in Neurology: August 2012 - Volume 18 - Issue 4, Headache - p 823–834
doi: 10.1212/01.CON.0000418645.32032.32
Review Articles

Purpose of Review: This article provides an update on the appropriate diagnosis and evaluation of patients with tension-type headache, with reviews of the latest concepts regarding pathogenesis and the evidence-based recommendations for management of this disorder.

Recent Findings: Pericranial myofascial mechanisms are probably of importance in episodic tension-type headache, whereas sensitization of central nociceptive pathways and inadequate endogenous antinociceptive circuitry seem to be more relevant in chronic tension-type headache. While acute treatment with simple analgesics is generally helpful, recent data attempting to document the efficacy of preventive therapies are unconvincing.

Summary: Tension-type headache is the most common form of headache in the general population. It is characterized by recurrent episodes of headache that are relatively featureless and mild to moderate in intensity. The diagnosis is based solely on the history and examination. Exclusion of secondary headaches or forms of migraine is important in the assessment process. Despite extensive investigation, the underlying pathophysiology remains a matter of speculation, with peripheral muscular and CNS components both likely involved. Acute management with simple analgesics, nonsteroidal anti-inflammatory drugs, and caffeine-containing compounds is typically effective. Preventive therapies include a number of nonpharmacologic recommendations as well as several antidepressant drugs. Prognosis is generally favorable.

Address correspondence to Dr Robert G. Kaniecki, University of Pittsburgh Headache Center, 120 Lytton Avenue, #250, Pittsburgh, PA 15213,

Relationship Disclosure: Dr Kaniecki has served as a consultant for NuPathe, Inc. and as a speaker for Zogenix, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Kaniecki discusses the unlabeled use of preventive options for tension-type headache. Most preventive options for tension-type headache are not US Food and Drug Administration approved.

© 2012 American Academy of Neurology
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