Tension-type headache

Tension-type headache (TTH) is the most common headache encountered, with most people experiencing TTH at some time in their lives. Diagnostic criteria are somewhat vague and nonspecific, with TTH mainly defined by the absence of associated migrainous features. Generally, TTH does not cause impairment, and sufferers can go about their daily lives. TTH can be divided into episodic and chronic, with the chronic variety being much more likely to come to medical attention. Pathophysiology is still largely unknown, and TTH is associated with a greater chance of comorbid anxiety disorders and depression. Treatment involves patient education and consideration of medication and nonmedication options. The mainstays of treatment are the intermittent use of simple analgesics and nonsteroidal anti-inflammatory medications. The most commonly used prophylactic options are the tricyclic antidepressants. Relaxation therapy and biofeedback are clearly beneficial as well. The practitioner is cautioned that apparent TTH may mimic secondary headache disorders hence one must be cautious with the diagnosis, especially in older individuals and new onset headache.