Tension Type Headache

What is Tension-Type Headache?

Tension-Type Headache is the world’s most prevalent headache, according to the International Headache society, and research suggests it can be prevalent in 60-86% of the population ^{[1, 2]}. WHO reports suggest that Tension-Type Headaches affect a large proportion of the population episodically, however 20-30% of sufferers experience more chronic episodes ^[1].

Characterised by a sensation of tightening, squeezing or pressing around the head, Tension-Type Headaches affect both sides of the head at the same time. This sensation has led to the misconception that Tension-Type Headache is caused by the tightening of the muscles around the head and face. These headaches are often mild-moderate in severity, and can vary in both the length of attacks, as well as their frequency.

As opposed to migraines, nausea and vomiting are not a feature of Tension-Type Headaches, but it is possible for patients to experience sensitivity to light or sound.

What are the different types of Tension-Type Headache?

Episodic Tension-Type Headache

Episodic Tension-Type Headaches are defined by the frequency of attacks a person experiences, per month. Typically, a person who has attacks on fewer than 15 days per month, is experiencing Episodic Tension-Type Headaches ^[3]. These headaches tend to peak in the fourth decade of life (30-39 years) in both males and females, with a prevalence of 42% for men and 46% for women of this age. Women, on average, are most likely to experience these types of headache ^[3].

Chronic Tension-Type Headache

Chronic Tension-Type Headaches are when attacks are experienced more frequently. A patient is suffering from Chronic Tension-Type Headaches if they experience attacks on more than 15 days per month, for longer than a three-month period ^{[1, 3]}. As these headaches are more persistent, they can be very disabling to a person’s life. Sometimes these people can have these headaches for between 10-30 years, and they can become resistant to pain killers.

How are these different from migraines?

People who suffer from Tension-Type Headaches are often wrongly diagnosed as suffering from migraines. The key difference between the two is that Tension-Type headaches are described as a bilateral, tightening or pressing sensation around the head, whereas migraines are described as a unilateral, pulsating pain in the head or face. Tension-Type Headaches are often mild-moderate in terms of intensity, and migraines are often more severe.

Also, Tension-Type headaches will generally not get worse with normal activities and exercise, whereas these will aggravate a migraine.

So, what causes Tension-Type Headaches?

With more modern research, we now know that Tension-Type Headaches are not actually caused by a tightening of muscles around the head. In fact, EMG studies have shown that there is no increase in muscle activity in the head or face in these people at all. More recent studies are starting to identify that people who experience Tension-Type Headaches have some increased sensitisation of pain pathways in the central nervous system and brain stem ^[2].

Modern headache research suggests that Tension-Type Headaches arise from problems in the upper cervical spine (C1-3). These patients have been shown to have an ‘up-regulated’ Trigemino-cervical Nucleus (TCN) as part of a sensitised brain stem ^[3]. This sensitised brainstem then interprets information coming from nerves in the neck incorrectly, sending symptoms around the head. This pain, referred from a sensitised brainstem, is what sufferers of Tension-Type Headache patients are experiencing.

I’ve done it all, is there anything else that can help me?

It isn’t uncommon for Tension-Type Headache sufferers to have tried most treatments or therapies available, often with very limited success. A big reason why this is the case, is because most practitioners don’t attempt to identify the cause of your headaches. At The Headache & Migraine Clinic, we use the experience that we have gathered from seeing countless similar patients with Tension-Type Headache, and we utilize the most current and up-to-date research to assess, treat and correctly diagnose your headaches. By assessing the joints in your upper cervical spine and the using techniques to determine the level of sensitivity in your brainstem, we can determine if this is the cause of your Tension-Type Headache.

If this is the case, then we can start treatment right then and there. Our treatment technique doesn’t involve any medication or surgery and is completely non-invasive. We expect that 90% of the time, improvement will occur in the first 5 sessions, and our clinic’s results speak for themselves.