The most recent definitions of frequent and infrequent episodic tensiontype headaches, as defined by the international classification of headache disorders ichd 3 criteria, are presented in table 41. Keywords tension type headache, clinical trials, acute treatment, prophylactic treatment date received. There was a negative correlation between the total sf36 and hit6 scores spearmans correlation. Chronic tensiontype headache sufferers were 3 to 15 times more likely than matched controls to receive a diagnosis of an anxiety or mood disorder with almost half of the patients exhibiting. Its also helpful to know that the two arent mutually exclusive. Keywords tensiontype headache, clinical trials, acute treatment, prophylactic treatment date received. However, despite being a major health problem, it does not receive appropriate attention from the medical community or lay public. As many as 90% of adults have had tension type headache these headaches are typically a steady ache rather than a throbbing one, and affect both sides of the head distracting but usually not debilitating. Tensiontype headache tth is the most common primary headache disorder 1,2.
In the us population, the estimated annual prevalence for episodic tensiontype headache is 38. To examine the relationship of recalled adverse childhood experiences aces with migraine and episodic tension type headache etth. Tension type headache danish headache centertype headache nonpharmacological and pharmacological treatment lars bendtsen associate professor, md, phd, dr med sci danish headache center, department of neurology glostrup hospital, univers ity of copenhagen, denmark european headache school, belgrade, may, 2012 treatment 1200 bc drawing by p. Headache attributed to cranial or cervical vascular disorder. Headache attributed to trauma or injury to the head andor neck. These guidelines are intended to assist in the design of wellcontrolled clinical trials in tensiontype headache. Cephalalgia guidelines for controlled trials of drugs in. We modeled headache type using logistic regression adjusting for sociodemographic. Tensiontype headaches are common in athletes and the general population.
Intensity is mild or moderate, the pain occurs bilaterally, and is not aggravated by routine physical activity like walking or climbing stairs. It may feel like a constant ache that affects both sides of the head. Disturbed sleep patterns can trigger an episodic tensiontype headache. Tension type headache is not as well studied as migraine and was once thought to be primarily psychogenic. The typical presentation of a tth attack is that of a mild to moderate intensity, bilateral, nonthrobbing headache without other associated features. Tensiontype headaches account for nearly 90% of all headaches. Tensiontype headache tth is the most prevalent headache in the general population, and the secondmost prevalent disorder in the world. In international headache society classification ichd ii, tension type headaches have been divided into two forms, episodic etth and chronic ctth first digit classification table 1.
Headache classification committee of the international. Frontal headache, with pain in one of the following. You can have a mix of both headache types in the same person. Episodic tensiontype headache episodic tensiontype headache is defined as lasting from 30 min to 7 days and is of pressingtightening, nonpulsating quality. The average frequency of attacks is two per month, and the duration of each episode is about 2 h. In ichd ii, the episodic type was further divided into an infrequent type, with headache episodes less than once per month, and a frequent type. Central pain mechanisms play more important role in chronic tensiontype headache.
Ichdii diagnostic criteria for tensiontype headache tth. Headache attributed to aeroplane travela distinct severe headache that usually occurs at descent and disappears quickly after landinghas been recognised for the first time. As infrequent episodic tensiontype headache except. These guidelines are intended to assist in the design of wellcontrolled clinical trials in tension type headache. The international classification of headache disorders ichd is a detailed hierarchical classification of all headacherelated disorders published by the international headache society. Mar 16, 2016 pathophysiology peripheral pain mechanisms are most likely to play a role in infrequent episodic tension type headache and frequent episodic tensiontype headache.
Experts opinion about the primary headache diagnostic. Tensiontype headache tth american migraine foundation. Ichd 3 guide to use and key definitions ashs ucns board. The international classification of headache disorders3 beta diagnostic criteria for tensiontype headache include the absence of several associated symptoms that are present in migraine and distinguish the two conditions. Headache attributed to cranial andor cervical vascular disorder 73 7. Disturbed sleep patterns can trigger an episodic tension type headache. Psychological stress is the most common trigger for tension type headache. Nov 23, 2017 in clinical studies, chronic tension type headache was found in 5% to 20. A tensiontype headache is the most common type of headache and the one we think of as a normal everyday headache. This has happened and, as of today, translations have been published in more than 15 languages, with more to come.
Tensiontype headache into episodic and chronic types, introduced in ichd. Episodic tension type headache episodic tension type headache is defined as lasting from 30 min to 7 days and is of pressingtightening, nonpulsating quality. Headache attributed to trauma or injury to the head andor neck 64 6. Tension type like headache missing one of the features required to fulfil all criteria for a type or subtype of tension type headache coded above, and not fulfilling criteria for another headache disorder. Tensiontype headache is not as well studied as migraine and was once thought to be primarily psychogenic. Tensiontype headache algorithm diagnosis and treatment of headache eleventh editionjanuary 20 the patient would enter this algorithm from box 17 of the diagnosis algorithm. Tensiontype headache is usually characterised by a mild pain intensity, normal or slightly reduced activities and no accompanying symptoms, while migraine is a more severe pain. Please note that many guidelines are in pdf format which require acrobat reader in order to view. Headache attributed to cranial or cervical vascular disorder 694 7.
No more than one of photophobia, phonophobia or mild nausea. The international classification of headache disorders. In clinical studies, chronic tensiontype headache was found in 5% to 20. Ichd3 the international classification of headache. The prevalence of tth is estimated to be between 30 and 70% of the general population according to different studies 2. Patients meeting one of the sets of criteria below may also meet the criteria for 1. In children, tensiontype headache may be triggered by psychosocial stress. Cervicogenic headache and headache attributed to temporomandibular disorder remain controversial because the borderland between them and tensiontype headache is not. Guidelines for all healthcare professionals in the diagnosis. Tension headache is the most common type of headache, with a reported lifetime prevalence as high as 78%. Advances in basic pain and clinical research have improved our understanding of pathophysiologic mechanisms of tensiontype headache. Extended periods of mental tension or psychological stress may play a role in central sensitization and the development of chronic tension type headache. Mean age at onset of episodic tensiontype headache is 7 years.
This first version was based primarily upon the opinions of experts, but proved nevertheless to be largely valid. The episodic tension type headache has been divided into two groups, namely infrequent and. They can range from the occasional mild headache to daily disabling headaches in some cases. The members of the classification committee have all worked hard for three years in order to accomplish this beta version. Psychological stress is the most common trigger for tensiontype headache. Jan 02, 2020 to really help identify your headache type, it helps to understand how tensiontype headache and migraine are the same and how they are different. Headache is a common complaint of children and adolescents. Pathophysiology peripheral pain mechanisms are most likely to play a role in infrequent episodic tension type headache and frequent episodic tensiontype headache.
Tension type headache tth is the most prevalent headache in the general population, and the secondmost prevalent disorder in the world. The most common types of chronic daily headache are chronic migraines and chronic tension type headaches. It can be categorized into three subtypes according to the international classification of headache disorders based on headache frequency. Tensiontype headache, but so far with no evidence that such a change would be beneficial. In clinical practice you do not need the classification for the obvious case of migraine or tension type headache, but it is useful when the diagnosis is uncertain.
When the international classification of headache disorders, second edition ichd 2 was published in january 2004, we knew that it would be an immediate success and would be put to generally use throughout the world. Diagnosis and management of headache patrick jm lavin the vanderbilt headache clinic. While it was previously considered to be primarily psychogenic, a number of studies since ichd i strongly suggest a neurobiological basis to 2. When a child presents with headache, it is important to determine whether the cause is due to primary disorder, as in migraine or tension type headache tth versus secondary, due to a brain lesion or infection. Text in blue in this algorithm indicates a linked corresponding annotation. Tension type headache definition tension type headache tth is the most common form of headache. Tension type headache danish headache center type headache nonpharmacological and pharmacological treatment lars bendtsen associate professor, md, phd, dr med sci danish headache center, department of neurology glostrup hospital, univers ity of copenhagen, denmark european headache school, belgrade, may, 2012 treatment 1200 bc drawing by p.
Tension type headaches have been called by various names over the years, including tension headache, muscle contraction headache. Mean age at onset of episodic tension type headache is 7 years. Tensiontype headache were proposed in the appendix of ichd ii, as a2. Extended periods of mental tension or psychological stress may play a role in central sensitization and the development of chronic tensiontype headache. International classification of headache disorders, second. Headache attributed to trauma or injury to the head andor neck 686 6. We modeled headache type using logistic regression adjusting for. Tensiontype headache cluster headache medicationoveruse headache 3rd edition 1st revision 2010 these guidelines are available at uk guidelines for all healthcare professionals in the diagnosis and management of. Tensiontype headache definition tensiontype headache tth is the most common form of headache. If a single headache type fulfills 2 different sets of explicit criteria, use other data to decide. Characterization of frequently recurring headache generally requires a headache diary to record information on pain and associated symptoms daybyday for at least one month. Headache occurring on 15 daysmonth on average for 3 months 180 daysyear and fulfilling criteria bd. Because tension type like headache is within the diagnostic criteria for 1.
There are limited data regarding the epidemiology of tensiontype headaches in athletes seifert et al. British association for the study of headache 2 british association for the study of headache guidelines for all. Tension headache, also known as tensiontype headache tth or stress headache, is the most common type of primary headache. As many as 90% of adults have had tensiontype headache these headaches are typically a steady ache rather than a throbbing one, and affect both sides of the head distracting but usually not debilitating. In children, tension type headache may be triggered by psychosocial stress. Guidelines published by national society members and submitted for publication on this site are also accessible. To examine the relationship of recalled adverse childhood experiences aces with migraine and episodic tensiontype headache etth. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. These stricter diagnostic criteria remain in the appendix, for research purposes only. Ichd3 beta the international classification of headache. The episodic tension type headache has been divided into two groups, namely infrequent and frequent second digit classification. Ichd3 beta translations ichd3 beta the international. Increased excitability of the central nervous system generated by repetitive and sustained pericranial myofascial input may be responsible for the transformation of. Types of headaches while headaches can be caused by medical conditions, injuries, or infections, they are sometimes not due to a specific disease or other identified medical condition.
Increased pericranial tenderness may be recorded by manual palpation. Eight and two were diagnosed with tension type and probable tension type headache, respectively. Eight and two were diagnosed with tensiontype and probable tensiontype headache, respectively. It is considered the official classification of headaches by the world health organization, and, in 1992, was incorporated into the 10th edition of their. The criteria for the diagnosis of tensiontype headaches according to international classification of headache disorders, 3rd edition ichd 3 are. Initiate patient education and lifestyle management 15 18 migraine see migraine treatment algorithm 16 tension type see tension type headache algorithm 17 chronic daily headache 19 other headache 20 no return to table of contents. If a red flag for a secondary cause of headache is present, magnetic resonance imaging of. Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension type, cluster and medicationoveruse headache writing committee. Probable tensiontype headache the clinical picture is inconclusive and no other cause for headache was found. As infrequent episodic tension type headache except. The most common types of chronic daily headache are chronic migraines and chronic tensiontype headaches.
Ichd3 the international classification of headache disorders. It is considered the official classification of headaches by the world health organization, and, in 1992, was incorporated into the 10th edition of their international classification of diseases. Tensiontype headache patient meets criteria for tensiontype headache. Tensiontype headache an overview sciencedirect topics. Tensiontype headache most prevalent, still unknown. All guidelines, reports and recommendations published by ihs are accessible below. Pathophysiology of tensiontype headache springerlink. Tensiontype headache, at least for its more severe subtypes. Headache attributed to nonvascular intracranial disorder. Scribd is the worlds largest social reading and publishing site. Tension type headaches are the most common form of headache, occurring in about threequarters of the general population. We conducted a crosssectional analysis of aces among 2007 american migraine prevalence and prevention study survey respondents with etth and migraine.
Pdf the international classification of headache disorders. In clinical practice you do not need the classification for the obvious case of migraine or tensiontype headache, but it is useful when the diagnosis is uncertain. The three most common of those types of primary headaches are tension, cluster, and migraine headaches. Ichd 3 is published as the first issue of cephalalgia in 2018, exactly 30 years after the first edition of the international classification of headache disorders, ichd i as we now call it. The international classification of headache disorders ichd. Guidelines for all healthcare professionals in the. Ea macgregor, tj steiner, ptg davies 3rd edition 1st revision. A patient suffering from tensiontype headaches indicating location of pain. Cooccurrence of tensiontype headache and migraine tensiontype headache and migraine are clinically distinct headache syndromes and defined so by the ichd 1,2.
Tensiontype headache and migraine are both very common. Tension headache, also known as tension type headache tth or stress headache, is the most common type of primary headache. Tension type headaches are the most common, affecting upwards of 75% of all headache sufferers. The international classification of headache disorders 3rd edition beta version after two very successful editions of the international classification of headache disorders ichd, a third is now close to being final. Chronic tension type headache sufferers were 3 to 15 times more likely than matched controls to receive a diagnosis of an anxiety or mood disorder with almost half of the patients exhibiting. International classification of headache disorder, 1st edition ichd 1 in 1988 ichd 2 in 2004 ichd 3 beta in 20 ichd 3 in 2018 based on 4 years of input including field testing and research aimed at. Recalled maltreatment, migraine, and tensiontype headache. In the us population, the estimated annual prevalence for episodic tension type headache is 38. When a child presents with headache, it is important to determine whether the cause is due to primary disorder, as in migraine or tensiontype headache tth versus secondary, due to a brain lesion or infection. Tensiontype headache is one of the most common primary headache disorders.