ChiroACCESS Clinical Review

Episodic Tension-type Headache: Prevention

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Lead Author(s): 

Dwain M. Daniel, D.C.


How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)

Published on

December 1, 2009

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Headache may be the most common physical complaint of mankind.  Of the headache types, the bulk of research has addressed migraine headache. Far less attention has been paid to episodic tension-type headache (ETTH) although its one year prevalence in the United States has been estimated at 38% (1) compared to approximately 12% for migraine (2).  

ETTHs have been classified as a primary headache which, by definition, “have no apparent organic disease” (3).  Etiology is unknown.  As a result the evidence is limited to primarily observational studies or expert opinion.  Many potential triggers have been identified.  Knowledge of those triggers may be utilized to prevent onset.   

Interestingly the traditional cited cause for tension headaches, muscle tension, has been significantly weakened on the basis of electromyographic studies (4)

Chronic tension headache (5) and migraine headache (6) have both been associated with onset of more frequent ETTH.  Possibly the most important aspect of prevention of ETTH is to reduce the chance of ETTH developing into these more debilitating and quality of life altering forms of headache.

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Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA 1998 Feb 4;279(5):381-3.

 [ Medline ID 9459472 ]


Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001 Jul;41(7):646-57.

 [ Medline ID 11554952 ]


Millea PJ, Brodie JJ. Tension-type headache. Am Fam Physician 2002 Sep 1;66(5):797-804.

 [ Medline ID 12322770 ]


Clark GT, Sakai S, Merrill R, Flack VF, McCreary C. Cross-correlation between stress, pain, physical activity, and temporalis muscle EMG in tension-type headache. Cephalalgia 1995 Dec;15(6):511-8, discussion.

 [ Medline ID 8706116 ]


Loder E, Rizzoli P. Tension-type headache. BMJ 2008 Jan 12;336(7635):88-92.

 [ Medline ID 18187725 ]


Leviton A. Even tension-type headaches doesn't sound right. Acta Paediatr 2008 Oct;97(10):1344-5.

 [ Medline ID 18782358 ]


Zivadinov R, Willheim K, Sepic-Grahovac D, Jurjevic A, Bucuk M, Brnabic-Razmilic O, et al. Migraine and tension-type headache in Croatia: a population-based survey of precipitating factors. Cephalalgia 2003 Jun;23(5):336-43.

 [ Medline ID 12780762 ]


Fragoso YD, Carvalho R, Ferrero F, Lourenco DM, Paulino ER. Crying as a precipitating factor for migraine and tension-type headache. Sao Paulo Med J 2003 Jan 2;121(1):31-3.

 [ Medline ID 19330208 ]


Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain 1993 Apr;53(1):65-72.

 [ Medline ID 8316392 ]


Rasmussen BK. Migraine and tension-type headache in a general population: psychosocial factors. Int J Epidemiol 1992 Dec;21(6):1138-43.

 [ Medline ID 7758098 ]


Armstrong JF, Wittrock DA, Robinson MD. Implicit associations in tension-type headaches: a cognitive analysis based on stress reactivity processes. Headache 2006 Sep;46(8):1281-90.

 [ Medline ID 16942473 ]


Davis PA, Holm JE, Myers TC, Suda KT. Stress, headache, and physiological disregulation: a time-series analysis of stress in the laboratory. Headache 1998 Feb;38(2):116-21.

 [ Medline ID 9529767 ]


Wober C, Holzhammer J, Zeitlhofer J, Wessely P, Wober-Bingol C. Trigger factors of migraine and tension-type headache: experience and knowledge of the patients. J Headache Pain 2006 Sep;7(4):188-95.

 [ Medline ID 16897622 ]


Spierings EL, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine versus tension-type headache. Headache 2001 Jun;41(6):554-8.

 [ Medline ID 11437890 ]


Arjona A, Rubi-Callejon J, Guardado-Santervas P, Serrano-Castro P, Olivares J. Menstrual tension-type headache: evidence for its existence. Headache 2007 Jan;47(1):100-3.

 [ Medline ID 17355502 ]


Blau JN, Kell CA, Sperling JM. Water-deprivation headache: a new headache with two variants. Headache 2004 Jan;44(1):79-83.

 [ Medline ID 14979888 ]


Svensson P. Muscle pain in the head: overlap between temporomandibular disorders and tension-type headaches. Curr Opin Neurol 2007 Jun;20(3):320-5.

 [ Medline ID 17495627 ]


Ballegaard V, Thede-Schmidt-Hansen P, Svensson P, Jensen R. Are headache and temporomandibular disorders related? A blinded study. Cephalalgia 2008 Aug;28(8):832-41.

 [ Medline ID 18498400 ]


Davidoff RA. Trigger points and myofascial pain: toward understanding how they affect headaches. Cephalalgia 1998 Sep;18(7):436-48.

 [ Medline ID 9793695 ]