Treating tension-type headache – an expert opinion

  title={Treating tension-type headache – an expert opinion},
  author={Lars Bendtsen and Rigmor H{\o}jland Jensen},
  journal={Expert Opinion on Pharmacotherapy},
  pages={1099 - 1109}
Introduction: Tension-type headache (TTH) is a highly prevalent disorder with enormous costs for the individual and the society. Areas covered: Nonpharmacological and pharmacological treatments are reviewed. Electromyographic (EMG) biofeedback has a documented effect in TTH, while cognitive-behavioral therapy and relaxation training are most likely to be effective. Physical therapy and acupuncture may be valuable options for patients with frequent TTH. Simple analgesics and nonsteroidal anti… 

Tension type headache

  • L. Bendtsen
  • Psychology, Medicine
    The Journal of Headache and Pain
  • 2013
Tension-type headache is a common primary headache with high socioeconomic impact and treatment of chronic TTH may be difficult and multidisciplinary treatment strategies are recommended.

Tension-Type Headache

An update on the appropriate diagnosis and evaluation of patients with tension-type headache is provided, with reviews of the latest concepts regarding pathogenesis and the evidence-based recommendations for management of this disorder.

Laboratory tests of headache disorders – dawn of a new era?

  • H. SchytzJ. Olesen
  • Medicine, Psychology
    Cephalalgia : an international journal of headache
  • 2016
The palpometer test, quantitative sensory testing, nociceptive blink reflex and autonomic tests may be valuable to phenotype and/or diagnose subforms of migraine, tension-type headache, cluster headache, trigeminal neuralgia and medication-overuse headache.

Tension-Type Headache: A Life-Course Review

Further longitudinal epidemiological research is needed to help distinguish tension-type headache from migraine, particularly in young people, as well as developing effective prevention and treatment strategies.

Contribution of verbal suggestion to the therapeutic efficacy of an analgesic agent for acute primary headache

Simple verbal suggestions did not alter the efficacy of an analgesic agent for headache in an emergency setting and the contributions of suggestibility, desire and expectation in acute primary headache patients should be further investigated.

Pathophysiology of TTH: Current Status and Future Directions

Nitric oxide may play a key role in the pathophysiology of tension-type headache, and nitric oxide synthase inhibitors may become a future treatment option for chronic tension- type headache.

Chronic tension-type headache. Treatment with acupuncture, physical training and relaxation training

In patients with CTTH, headache symptoms increase during the day and stress, poor ergonomic factors and workload are the strongest triggering factors.

Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020

The Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark.

Chronic Tension-Type Headache

A 42-year-old woman was admitted to the emergency room (ER) for the worsening of a continuous headache and received a diagnosis of headache secondary to hypertension and was treated accordingly.



Tension-type headache: current research and clinical management

Pharmacotherapy of tension-type headaches

  • M. Stillman
  • Medicine
    Current pain and headache reports
  • 2002
Tension-type headaches remain the most nonspecific of all the commonly observed primary headaches, and new research is emerging that points to the potential use of botulinum toxin and nitric synthase inhibitors.

Headache (chronic tension-type).

  • N. Silver
  • Medicine, Psychology
    BMJ clinical evidence
  • 2007
This systematic review presents information relating to the effectiveness and safety of the following interventions: acupuncture, amitriptyline, benzodiazepines, botulinum toxin, cognitive behavioural therapy, Indian head massage, mirtazapine, regular acute pain relief medication, relaxation and electromyographic biofeedback, serotonin reuptake inhibitor antidepressants, and tricyclic antidepressants.

Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache

Mirtazapine reduced area-under-the-headache curve (AUC) by 34% more than placebo in difficult-to-treat patients, and may stimulate the development of prophylactic treatments with increased efficacy and fewer side effects for tension-type headache and other types of chronic pain.

Tension-type headache: the most common, but also the most neglected, headache disorder

New data on the prevalence, incidence and prognosis of tension-type headache are valuable for health care planning and in daily clinical practice and hold promise for much-needed improvements in the understanding of pathophysiological mechanisms and treatment.


If the headache occurs daily, is present when the patient awakens, remains for most of the day and has been occurring for months or even years, the patient becomes an important therapeutic problem.

Treatment of Chronic Tension-Type Headache with Botulinum Toxin: a Double-Blind, Placebo-Controlled Clinical Trial

  • G. Boudreau
  • Medicine, Psychology
    Cephalalgia : an international journal of headache
  • 2005
The results suggest that the effectiveness of botulinum toxin type A in the treatment of migraine may be due in part to its ability to repress calcitonin gene-related peptide release from activated sensory neurones.

Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial

This randomised, controlled, multicentre, patient-and observer-blinded trial was carried out in 122 outpatient practices in Germany on 409 patients with TTH, defined as ≥0 headache days per month of which ≤1 included migraine symptoms.

Aspirin in Episodic Tension-Type Headache: Placebo-Controlled Dose-Ranging Comparison with Paracetamol

Aspirin 1000 mg were statistically more effective than placebo despite a high placebo-response rate, and secondary end-points including functional recovery were consistent with these findings, although a minority of subjects recorded long-duration functional impairment.