Tension-Type-Headache (TTH) represents one of the most costly diseases because of its high frequency in the general population.  TTH is the most common in the headache category. In the past it has been called:

  • tension headache
  • stress headache
  • muscle contraction headache
  • psychomyogenic headache
  • ordinary headache

Classification of tension-type-headaches

International Headache Society defines TTH as either:

A. Episodic tension-type-headaches (ETTH) is defined as:

At least 10 previous headaches meet the following criteria

1. Fewer than 15 episodes per month

2. At Least 2 of the following characteristics

  • Pressing/tighening (not pulsating)
  • Mild or moderate intensity (does not prohibit activity)
  • Bilateral location
  • No aggivation from climbing steps or routine activity

3. Both of the following:

  • No nausea or vomiting
  • Absence of both photophobia and phonophobia OR only one present

B. Chronic tension-type headache (CTTH)

1. Frequency more than 15 days per month for more than 6 month

2. Has at least 2 of following characteristics

  • Pressing/tightening quality
  • Mild or moderate intensity
  • Bilateral location
  • No intensity of pain with stair climbing or routine activities

3. Both of the following:

  • No vomiting
  • No more than one of following: nausea, photophobia, or phonophobia

TTH Causes

50% of TTH patients identify stress or hunger as a precipitating factor for their headache. Common precipitating factors arwe as follows:

  • Stress- usually in late afternoon or evening
  • Sleep deprivation
  • Uncomfortable stresssful position or bad posture
  • irregular meals
  • Eyestrain

CCTH and ETTH treatment options

ETTH usually responds well to over-the-counter analgesics such as:

  • Acetaminophen
  • Ibuprofen
  • Asperin
  • Naproxen
  • Caffeine

CTTH usually reguires

  • pharmacotherapy
  • Psychological therapy
  • Physical Therapy

Preventive medications usually consists of antidepressents such as:

  • Elavil
  • Pamelor
  • Prozac
  • Paxil
  • Zoloft
  • Doxepin
  • Despramine
  • protripyline
  • Buspirone

Psychophysiologic therapy consists of:

  • Reassurance
  • Counseling
  • Relaxation therapy
  • Stress management
  • Biofeedback

Physical Therapy

  • Heat
  • massage
  • stretching
  • Light strengthening exercise
  • Cranial Electrotherapy (This is not the same as TENS. It is a specific EMS that has achieved good results in clinical trials.)

Minimal invasive treatment

When the above options do not achieve optimum results, one of the following may be considered by your physician:

  • Trigger point injections
  • Greater or lesser occipital nerve blocks
  • Auriculotemporal nerve block
  • Supraorbital nerve block
  • Botox injections in pericranial muscle


At this stage of your journey, I hope you are beginning to see tension-type-headache is similar to other symptoms that add to the confusion of diagnosing fibromyalgia. We have discussed a number of symptoms that include stress, posture, and lifestyle habits in common as a precipitating factor. 

The other common denominator is the tretatment options. Other than different medications, some form of stress management, relaxation, lifestyle changes, and some alternative treatments have been discussed.

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