Neurology
Tension Headache
긴장형두통
Bilateral non-pulsating pressure-type headache
- How common
- Lifetime 78% (most common headache)
- Typical age
- Ages 20–50
What is it?
Increased peripheral myofascial nociception and central pain modulation dysfunction.
Commonly affected: Pericranial, cervical, shoulder muscles (bilateral)
How it develops
- Muscle tensionChronic tension in pericranial/neck/shoulder muscles
- Peripheral sensitizationMyofascial nociceptor activation
- Central sensitizationDorsal horn and trigeminal nucleus amplification
- Chronification≥15 days/month becomes chronic TTH
Symptoms
- Band-like pressureTight band around the head
- BilateralBoth sides simultaneously
- Mild-moderate intensityDoes not prevent activity
- Neck tightnessTender pericranial/neck muscles
How it is examined
- ICHD-3 criteriaBilateral + pressing + mild-mod + no aggravation
- Pericranial tendernessPalpate pericranial/neck muscles
- Neurological examShould be normal
Imaging
Clinical diagnosis; imaging not needed.
- Clinical diagnosis
Brain MRI if red flags to exclude secondary causes.
- Normal
Non-surgical care
- NSAIDsIbuprofen/naproxen (≤9 days/month)
- Amitriptyline (chronic)Low-dose for chronic TTH prevention
- Physical therapyCervical/shoulder massage, stretching
- CBTStress management, relaxation training
- Avoid medication overuseRisk of MOH if analgesics ≥15 days/month
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
None (conservative management)
Procedures that may be discussed
- Botulinum toxin (controversial)
- Nerve block
Outlook
Generally good; chronification reduces quality of life.