Current perspectives on sex differences in tension-type headache

ABSTRACT

Introduction

Clinical and experimental evidence supports the presence of several gender differences in the pain experience.

Areas covered

The current paper discusses biological, psychological, emotional, and social differences according to gender and their relevance to TTH. Gender differences have also been observed in men and women with tension-type headache and they should be considered by clinicians managing this condition. It appears that multimodal treatment approaches lead to better outcomes in people with tension-type headache; however, management of tension-type headache should consider these potential gender differences. Different studies have observed the presence of complex interactions between tension-type headache, emotional stress, sleep, and burden and that these interactions are different between men and women.

Expert opinion

Based on current results, the authors hypothesize that treatment of men with tension-type headache should focus on the improvement of sleep quality and the level of depression whereas treatment of women with TTH should focus on nociceptive mechanisms and emotional/stressful factors. Future trials should investigate the proposed hypotheses.

KEYWORDS:

• Gender
• tension-type headache
• sleep quality
• pain
• depression
• treatment

Article highlights

• Evidence supports the presence of biological, psychological, emotional, and social differences between men and women which could affect the pain experience.

• The relationships between headache, sleep, mood disorders, and related-burden are highly complex in patients with tension-type headache.

• The interactions between headache, sleep, mood disorders, and burden are slightly different between men and women with tension-type headache.

• The presence of musculoskeletal disorders is more prevalent in women than in men with tension-type headache and are associated with anxiety and hyperalgesia.

• A hypothesis that the management of men with tension-type headache should focus on the improvement of the sleep quality (coping strategies or physical activity) and depressive levels (psychological management) is provided.

• A hypothesis that treatment of women with TTH should focus on nociceptive pain mechanisms (non-pharmacological physical therapy) and emotional or stressful (coping strategies or cognitive behavior interventions) factors is also provided.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.