Head / Face
Tension-type Headache
긴장성 두통
Bilateral pressing/tightening headache from sustained cervicocranial muscle tension
- How common
- Very common (lifetime prevalence 40–78%)
- Typical age
- Ages 20–50
What is it?
Sustained pericranial muscle tension combined with peripheral and central nociceptive sensitization produces bilateral pressing headache.
Commonly affected: Suboccipitals, upper trapezius, temporalis, frontalis
How it develops
- Muscle Tension TriggerStress/poor posture drives sustained cervicocranial muscle contraction
- Peripheral SensitizationMyofascial nociceptor activation with trigger point formation
- Central SensitizationTrigeminocervical complex becomes hypersensitive
- ChronificationFrequency rises → chronic TTH if ≥15 days/month
Symptoms
- Bilateral pressing painBand-like tightening sensation
- Neck/shoulder tensionStiffness of trapezius and suboccipitals
- Pericranial tendernessPalpable tenderness over temporalis/occipitalis
- Mild-moderate intensityDoes not prohibit daily activity
- No nausea/photophobiaDistinguishing feature from migraine
How it is examined
- Total Tenderness ScoreManual palpation of temporalis, frontalis, occipitalis, SCM
- Reduced cervical ROMLimited flexion, extension, rotation
- Myofascial trigger pointsActive trigger points in trapezius and temporalis
- Normal neurologic examCranial nerves, strength, sensation all normal
Imaging
Imaging usually normal — performed only to exclude secondary causes (tumor, sinusitis, trauma).
- Normal cranial structures
- Possible straightened cervical lordosis
- Clear sinuses
Clinical diagnosis; MRI only for red-flag features to rule out intracranial pathology.
- Usually normal
- No mass/lesion
- No white matter abnormality — excludes secondary cause
Non-surgical care
- Ergonomic correctionMonitor height, seating, 20-20-20 rule
- NSAIDs/acetaminophenAcute episodes, short-term (≤2x/week to avoid MOH)
- Myofascial release/PTTrigger point therapy, cervical mobilization, stretching
- Amitriptyline (chronic)First-line prophylaxis for chronic TTH
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
No surgical indication
Procedures that may be discussed
- Conservative care only
Outlook
Most improve with lifestyle and PT; chronic form requires long-term management.