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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute tension-type headache is a very common condition that rarely is a problem in treatment. Chronic tension-type headache, however, is often a difficult therapeutic problem. The pathogenesis is not well understood, but both peripheral muscle contraction and central pain-modulating systems are probably involved. Therapy usually works best when multiple techniques are used, including pharmacologic, psychological, and physiologic modalities.
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PMID:Diagnosis and treatment of muscle contraction (tension-type) headaches. 202 Feb 15

The nociceptive thresholds to mechanical and thermal stimuli in patients with chronic tension-type headache were compared. Palpation of pericranial tenderness was performed in 50 patients and a total tenderness score (TTS) was calculated. Palpation was repeated, and pressure pain thresholds (PPTs) were determined with a pressure algometer in the temporal and occipital regions. In 32 of the patients, pain thresholds for heat and cold and limens for detection of non-painful temperature changes were determined in the hands and the temporal regions. Twenty-four healthy volunteers served as controls. Scores obtained by manual palpation (TTS) at the first and second visit were positively correlated. A negative correlation between headache severity and PPT was found in the temporal region. A positive correlation between PPT in the temporal and occipital region was found, and PPT and TTS were negatively correlated. Thermal pain thresholds were consistently less extreme in patients compared to controls, and patients reporting severe headache on the examination day were those most sensitive to thermal pain. No difference was found between patients and controls with respect to detection of temperature changes. A correlation was found between PPT and the corresponding cold pain thresholds, but no correlation could be demonstrated between TTS and thermal pain thresholds. In conclusion, headache patients had decreased pain perception thresholds. Chronic tension-type headache might be a result of dysmodulation of nociceptive impulses, but it is likely that sensitized nociceptors also play a role.
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PMID:Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache. 278 74

Tension-type headache is the term designated by the International Headache Society to describe what was previously called tension headache, muscle contraction headache, psychomyogenic headache, stress headache, ordinary headache, and psychogenic headache. The International Headache Society defines tension-type headache more precisely, distinguishes between the episodic and the chronic varieties, and divides them into two groups, those associated with a disorder of the pericranial muscles and those not associated with this type of disorder. Most clinic-based studies of tension-type headache suffer from selection bias, as they include patients with more severe headaches, patients with concomitant migraine, and patients with chronic daily headache. Traditionally, episodic tension-type headache and migraine have been considered distinct disorders, and the International Headache Society continues the separation. Some believe that both migraine and tension-type headache are recurring benign headaches. Chronic tension-type headache used to be called chronic daily headache, but they are not identical. Chronic tension-type headache must be distinguished from chronic daily headache even though the International Headache Society has not done this. Chronic daily headache is a syndrome consisting of a group of disorders and can be subclassified into primary and secondary types. The primary chronic daily headache disorders include transformed migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Secondary causes of chronic daily headache include post-traumatic headache, cervical spine disorders, and headache associated with vascular disorders and nonvascular intracranial disorders. Patients with frequent headaches are prone to overuse analgesics, ergotamine, or both. Most patients with chronic daily headache overuse symptomatic medication.(ABSTRACT TRUNCATED AT 250 WORDS)
Headache 1994 Sep
PMID:Tension-type headaches. 796 Jul 25

Leukocyte subsets, serum cortisol and immunoglobulin production were investigated in a group of 12 migraine without aura patients, 12 chronic tension-type headache patients and compared with findings in 12 healthy controls. Chronic tension-type headache patients had statistically significant increased levels of B-lymphocytes (CD19+ cells) (p < 0.05), while migraine sufferers had a similarly significant decrease in CD8+ T-lymphocytes (p < 0.05). Migraine patients also had an increased percentage of B-lymphocytes although this failed to reach statistical significance. Immunoglobulin production and cortisol serum levels did not differ in the two headache groups. We conclude that the observed abnormalities in tension-type headache and migraine are unlikely to be a consequence of pain or of hypothalamic-pituitary-adrenal axis dysfunction.
Cephalalgia 1994 Apr
PMID:Leukocyte subsets and cortisol serum levels in patients with migraine without aura and chronic tension-type headache. 806 52

Chronic tension-type headache, which is included in the International Headache Classification, is present in only a minority of patients who present with chronic daily headache. The majority have what is termed transformed migraine, with a history of distinct episodes of migraine in the initial years which progresses into chronic daily headache. These patients with transformed migraine exhibit mixed features of migraine and chronic tension-type headache. Two distinct types of transformed migraine are identifiable, namely those related to excessive intake of medications (drug-induced transformed migraine) and those unrelated to excessive use of medications. The clinical features of transformed migraine and the drug-induced variety are described. The need for revision of the International Classification to include chronic daily headache and the subtypes of transformed migraine is pointed out.
Cephalalgia 1993 Apr
PMID:Transformed migraine. 850 Jan 55

Chronic tension-type headache occurs in 3% of the Danish population. the aetiology remains an enigma, even though it is one of the most frequent illnesses with chronic pain. A family study indicates the importance of genetic factors. Compared with the general population, first degree relatives (parents, siblings and children) of probands with chronic tension-type headache have a three-fold significantly increased risk of chronic tension-type headache, while spouses had no increased risk. Complex segregation analysis indicates multifactorial inheritance. Thus, a combination of genetic and environmental factors causes chronic tension-type headache.
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PMID:[Familial occurrence of chronic tension headache]. 998 90

Although headache is the most common pain complaint seen by primary care physicians, the measurement of quality of life in patients with headache is in its earliest stages. Most of the research has been published within the past 2 years, much of it only in abstract form. Quality-of-life data derived from the Medical Outcomes Study instrument (SF-20) demonstrate that chronic headache disorders are associated with significant limitations in all 6 health categories of patient well-being and functioning. The outcomes profile for each of the common benign headache disorders appear to be unique for the specific headache diagnosis. Migraine is primarily associated with an impairment in role (work) functioning. Chronic tension-type headache is associated with a marked impairment in mental health and a generalised impairment in functioning. Cluster headache is associated with the greatest amount of pain, but with little impairment in physical functioning. The economic toll of recurrent headache is considerable. Lost productivity in the US due to migraine is estimated at $US6.5 to 17.2 billion per year. Chronic headache disorders cause significantly more morbidity, impairment of function, and economic loss than has previously been recognised.
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PMID:Quality-of-life assessment in patients with headache. 1014 52

Chronic tension-type headache (CTTH) assessed by proband report was evaluated in a family study of CTTH. A clinical interview of first-degree relatives by a physician was used as index of validity. Familial occurrence of CTTH in first-degree relatives was also investigated. Patterns of familial aggregation of CTTH were assessed by calculating the population relative risk. A neurological resident carried out all the interviews of probands and their first-degree relatives. The operational diagnostic criteria of the International Headache Society were used. The 122 probands had 377 first-degree relatives. Sensitivity, specificity, predictive values, and chance-corrected agreement rate for the diagnosis CTTH were 68%, 86%, 53% (PVpos), 92% (PVneg), and 0.48, respectively. The low sensitivity of CTTH assessed by proband report indicates that a clinical interview by a physician is necessary in family studies of CTTH. Clinically interviewed parents, siblings, and children had a 2.1 to 3.9-fold significantly increased risk of CTTH compared with the general population. The gender of the probands did not influence the risk of CTTH among first-degree relatives. The significantly increased familial risk of CTTH and no increased risk of CTTH in spouses suggest that a genetic factor is involved in CTTH.
Cephalalgia 1999 May
PMID:Familial occurrence of chronic tension-type headache. 1037 64

Chronic tension-type headache may be caused by prolonged painful input from pericranial myofacial tissues, for example tender points, resulting in central sensitisation (increased excitability of neurons in the central nervous system). Animal studies have shown that sensitisation of pain pathways may be caused by or associated with the activation of neuronal nitric oxide synthase and the generation of nitric oxide. Furthermore, it has been shown that nitric oxide synthase inhibitors reduce central sensitisation in animal models of persistent pain. On the basis of this information, the analgesic effect of the nitric oxide synthase inhibitor L-N(G) methyl arginine hydrochloride was investigated. This drug significantly reduced headache and myofacial factors in patients with chronic tension-type headache. These studies show that nitric oxide plays a crucial role in the pathophysiology of tension-type headache. The analgesic effect of nitric oxide synthase inhibition in patients with chronic tension-type headache is probably due to a reduction in central sensitisation at the level of the spinal dorsal horn, trigeminal nucleus or both. Furthermore, inhibition of nitric oxide synthase may become a novel principle in the future treatment of chronic headache.
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PMID:Nitric oxide synthase inhibitors for the treatment of chronic tension-type headache. 1193 42

Although tension-type headache is the most prevalent headache and affects 78% of the general population, the substantial societal and individual burden associated with this primary headache has been overlooked. In contrast to migraine headache, there has been limited focus on tension-type headache. Most patients with the chronic form of tension-type headache, which affects 3% of the population, are left virtually without any specific treatment. Chronic tension-type headache differs from the episodic form in frequency, lack of effect to most treatment strategies, more medication overuse, and more loss of quality of life. Daily or near daily headaches also constitute a major diagnostic and therapeutic problem and distinguishing chronic tension-type headache from migraine headache and from medication-induced headache is a substantial diagnostic challenge because management strategies are completely different. Considerable benefits for the society can be gained by specific strategies leading to reductions in the amount of sickness absence and impaired working abilities. The burden on the affected patients' and their families' quality of life also may be improved by a general acceptance of the disorder and by the development of a specific treatment strategy.
Curr Pain Headache Rep 2003 Dec
PMID:Diagnosis, epidemiology, and impact of tension-type headache. 1460 4


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