Tension-Type Headache

  • Lars BendtsenEmail author
  • Sait Ashina
Part of the Headache book series (HEAD)


A 59-year-old woman referred by a neurologist to the Danish Headache Center, a tertiary headache centre, for the treatment of refractory migraine presents for the initial consultation. The patient has suffered from frequent headaches since childhood and in the last couple of years from daily headaches. She told me that she was so tired of the headaches that have ruined her life and of all the various treatments she has received during her life. None of the treatments has had any effect, several have been costly and several had bothersome side effects. She had almost given up hope. The patient did not fill out the 4-week headache diary that has been mailed to her from the headache centre prior to the initial consultation, and it was difficult for her to give a detailed headache history. She reported that her headaches could be unilateral or bilateral, of moderate to severe intensity, throbbing and at times pressing in character and could be aggravated by waking stairs. She also reports frequent nausea and sometimes sensitivity to sounds and light. The headaches are clearly provoked by psychological stress and to a lesser extent by physical activity. Sometimes headaches are preceded by visual disturbances. She had been on sick leave due to the headaches in the past 3 months. She reports being often anxious but she denies depressed mood. She works as a teacher and had some stress at work. Otherwise, she is healthy. Her mother had suffered from life-long migraines. Her paternal uncle had brain aneurysm. At the first consultation, it was obvious that the patient suffered from migraine, tension-type headache (TTH) and anxiety on the most severe headache days. General and neurological examination demonstrates increased pericranial myofascial tenderness. Her blood pressure and pulse are within normal limits. Electrocardiogram and routine blood tests are unremarkable. What to do for this severely incapacitated woman?


Migraine Attack Migraine With Aura Medication Overuse Migraine Without Aura Secondary Headache 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. 1.
    Ashina M (2004) Neurobiology of chronic tension-type headache. Cephalalgia 24:161–172PubMedCrossRefGoogle Scholar
  2. 2.
    Ashina S, Bendtsen L, Ashina M, Magerl W, Jensen R (2006) Generalized hyperalgesia in patients with chronic tension-type headache. Cephalalgia 26:940–948PubMedCrossRefGoogle Scholar
  3. 3.
    Bendtsen L (2000) Central sensitization in tension-type headache – possible pathophysiological mechanisms. Cephalalgia 20:486–508PubMedCrossRefGoogle Scholar
  4. 4.
    Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J (2010) EFNS guideline on the treatment of tension-type headache – report of an EFNS task force. Eur J Neurol 17:1318–1325PubMedGoogle Scholar
  5. 5.
    Bendtsen L, Jensen R (2011) Treating tension-type headache – an expert opinion. Expert Opin Pharmacother 12(7):1099–1109PubMedCrossRefGoogle Scholar
  6. 6.
    Cathcart S, Petkov J, Winefield AH, Lushington K, Rolan P (2010) Central mechanisms of stress-induced headache. Cephalalgia 30:285–295PubMedCrossRefGoogle Scholar
  7. 7.
    Fernandez-de-Las-Penas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA (2007) Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia 27:383–393PubMedCrossRefGoogle Scholar
  8. 8.
    Holroyd KA, O’Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW (2001) Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA 285:2208–2215PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Jensen R, Zeeberg P, Dehlendorff C, Olesen J (2010) Predictors of outcome of the treatment programme in a multidisciplinary headache centre. Cephalalgia 30:1214–1224PubMedCrossRefGoogle Scholar
  10. 10.
    Leistad R, Sand T, Westgaard R, Nilsen K, Stovner L (2006) Stress-induced pain and muscle activity in patients with migraine and tension-type headache. Cephalalgia 26:64–73PubMedCrossRefGoogle Scholar
  11. 11.
    Nestoriuc Y, Rief W, Martin A (2008) Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol 76:379–396PubMedCrossRefGoogle Scholar
  12. 12.
    Sandrini G, Rossi P, Milanov I, Serrao M, Cecchini AP, Nappi G (2006) Abnormal modulatory influence of diffuse noxious inhibitory controls in migraine and chronic tension-type headache patients. Cephalalgia 26:782–789PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Neurology, Faculty of Health and Medical SciencesDanish Headache Center, Glostrup Hospital, University of CopenhagenGlostrupDenmark
  2. 2.Department of Pain Medicine and Palliative CareIcahn School of Medicine at Mount Sinai, Beth Israel Medical CenterNew YorkUSA
  3. 3.Department of Neurology, Headache ProgramIcahn School of Medicine at Mount Sinai, Beth Israel Medical CenterNew YorkUSA

Personalised recommendations