Recent advancements in tension-type headache: a narrative review

ABSTRACT

Introduction

Tension-type headache (TTH) is the most common primary headache disorder with a prevalence of up to 78% in general population and huge expenses in terms of health service. Despite its high incidence and impact on life’s quality the knowledge on the pathophysiology and efficacious treatment of TTH was still limited.

Areas covered

In recent years, a series of studies highlighted the heterogeneous nature of this pathology that seems to be determined by a complex interaction between genetic, environmental, and neuromuscular factors, which result in nociceptive system activation. In this setting, alongside the simple analgesic therapies used during the acute attack, a series of therapeutic options based on newly acquired experiences have taken hold.

Expert Review

Not having a single substrate or a typical site of pathophysiology, TTH must be analyzed in a global and multidisciplinary way. Herein, we perform a narrative review of the most recent advancement stimulating the concept of this disease as the tip of the iceberg of a more complex individual malaise secondary to different alterations. Strategies based solely on symptomatic drugs should therefore be avoided by experienced personnel and treatment should aim at taking charge of the patient considering the processes behind this complex pathology.

KEYWORDS:

• Tension-type headache
• treatment
• pathogenesis
• comorbidities
• psychopathology
• alternative medicine

Article highlights

• Tension-type headache is the most common primary headache disorder causing substantial individual and societal burdens.

• The pathogenesis is complex and is the product of a still unclear interaction between genetic, hormonal, environmental and neuro-muscular factors.

• Acute treatment is mainly based on paracetamol or other analgesics but should be managed with caution because of the risk of medication-overuse headache.

• Chronic treatment is based on pharmacological and non-pharmacological approaches, the latter have taken hold in the last period and range from preferring a healthy lifestyle to alternative medicines

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.