TENSION-TYPE HEADACHE

1. Definition

Tension-type headache (TTH) is the most common form of headache. It can be categorized into
three subtypes according to the International Classification of Headache Disorders based on
headache frequency: (1) infrequent episodic TTH (<12 headache days/year), (2) frequent episodic
TTH (12-180 days/year), and (3) chronic TTH (>180 days/year).

2. Classification

a. Infrequent episodic tension-type headache

There are at least 10 episodes of attack in <1 day / month (or <12 days / year), headache ends
within 30 minutes - 7 bilateral days, suppresses binding, no pulsation, mild or moderate, no
nausea / vomiting, may be present phonophobia / photophobia, has absolutely nothing to do with
other headache diseases.

b. Frequent episodic tension-type headache

There are at least 10 episodes of attack in 1-15 days / month in a period of at least 3 months (or
12-180 days per year), headache ends within 30 minutes-7 days, bilateral, pressing, binding,
non-throbbing, mild or moderate , no nausea / vomiting, there may be phonopobia / photopobia,
absolutely nothing to do with other headaches.
c. Chronic tension-type headache
Headache from ETTH that occurs> 15 days / month within> 3 months (or> 180 days / year).
d. Probable tension-type headache

It was found to meet the TTH criteria but less one criterion for TTH was mixed with one of the
probable migrane criteria. Headache lasts> 15 days / month for> 3 months (or> 180 days / year),
headache lasts for several hours or continuously, bilateral, feeling of pressure / binding, mild or
moderate intensity, no severe nausea or vomiting , there may be photopobia / phonopobia, no
relation to other head diseases, at least the last 2 months.

3. Etiology
a. Tension and stress.
b. Tiredness
c. Anxiety
d. Length of reading, typing or concentration (eye strain)
e. Poor posture
f. Neck and spine lesions
g. High blood pressure
h. Physical dan stress emotional

4. Clinical Features
 TTH comprises headache attacks with mild to moderate pain intensity and is often described as
having a pressing or tightening (nonpulsating) quality that is not aggravated by routine physical
activity, such as walking or climbing stairs. The pain lasts for at least several hours to days and is
predominantly felt bilaterally.

5. Pathophysiology

TTH is often associated with psychopathological psychological stress disorder, especially anxiety
and depression. Depression is a situation characterized by an unpleasant mood that feels all the
dislike and inability to get pleasure. In sufferers of depression, stress, and disorders (anxiety) in
place there is a lack of serotonin, and noradrenaline levels in the brain. Serotonin and nor-
adrenaline are neurotransmitters that play a role in the healing process and depression, which
regulates mood. Serotonin deficits occur, so vasoconstriction occurs in blood vessels and
transferred to the threshold of headache. Serotonin is degraded by the enzymatic action of
monoamine oxidase and is released through 5-hydroxyindoleacetic acid 5-hydroxyindoleacetic
acid (Mumenthaler and Mattle, 2004).

TTH can be caused by stress, alcohol, and hormonal which will stimulate the sympathetic nervous
system resulting in an increase in nor-epinephrine which is spread to the muscle spindles and
causes vasoconstriction. Nor-epinephrine is also associated with blood vessels so that it is
stimulated by cervical sympathetic ganglia and comfortable neck pain (Wesley, 2001).

6. Therapy

Treatment consists of acute pharmacological, preventive pharmacological, and

nonpharmacological interventions, used alone or in combination depending on headache
frequency and individual preferences. Simple analgesics and nonsteroidal anti-inflammatory drugs
(NSAIDs) are effective in treating acute headache. Tricyclic antidepressants (especially
amitryptiline) should be the primary choice in preventive medication for patients with frequent
or chronic TTH. Nonpharmacological interventions such as muscle relaxation training and
electromyographic biofeedback have solid clinical support in treating TTH and have a success rate
comparable to medical preventive treatment. Treatment strategies should be adapted
accordingly, based on patient self-report and a headache diary.