Tension type headaches are the most common type of headaches in adults. It is estimated that around 40% of population suffers infrequent TTH.

Symptoms and classification

TTH could be episodic (< 15 days month) or chronic (>15days a month). Episodic TTH can be infrequent (< 1 or 2 times a month) or frequent (> 2 times a month).

TTH is usually mild to moderate and often described as band like, heaviness, tightness, pressure sensation. These are in the occipital or frontal region bilaterally and over the entire head. Unlike migraine headaches, tension-type headaches are not accompanied by nausea and vomiting and are not made worse by physical activity, light, sounds, or smells. The headache worsens as the day progresses.

Causes

The tightening in the scalp muscles could be due to poor posture, stress, poor sleep. Poor adjustment strategies to day-to-day botherations may lead to muscular contraction and TTH. Work related stress, deadlines at work, family problems are common sources of stress. Moreover, stress could be covert (unknown, subconscious stress).

Diagnosis

TTH is a primary headache disorder meaning neurologic examination and imaging is normal.

Treatment

Infrequent TTH does not require anything more than simple analgesics like paracetamol, naproxen or ibuprofen. Chronic TTH or frequent TTH may necessitate prophylaxis with amitriptyline, tizanidine, topiramate or gabapentin.

Non pharmacologic interventions like stress management/relaxation training, counseling, biofeedback, yoga, pranayama and self-care combined with medications is beneficial. Lifestyle and home remedies like assuming a proper posture, managing stress levels, massage, hot or cold fomentation are useful.