Tension-type headache, otherwise known as a stress headache, is a very common type of head pain with a 30-78% portion of the general population experiencing this condition at some point in their life (lifetime prevalence).1
The International Headache Society has established a process to identify chronic tension-type headache with the following 5 points:1
- Headache occurring on ≥15 days per month on average for >3 months (≥180 days per year), fulfilling criteria 2-5.
- Lasting hours to days, or unremitting
- At least two of the following four characteristics:
i. Bilateral location (presents both sides of the head)
ii. Pressing or tightening (non-pulsating) quality
iii. Mild or moderate intensity
iv. Not aggravated by routine physical activity such as walking or climbing stairs
- Both of the following:
i. No more than one of photophobia, phonophobia or mild nausea
ii. Either moderate or severe nausea nor vomiting
- Not better accounted for by another ICHD-3 diagnosis.
An investigation published in the Journal of Pain (1996) reported that sufferers of tension-type headache have an increased tenderness of pericranial muscles, which increases during attacks.2 Pericranial muscles are muscles that cover the surface of the skull and neck. The main pericranial muscles include muscles of the head (frontalis, temporal masseter, medial and lateral pterygoid muscles), and neck (sternocleidomastoid, splenius, and trapezius muscles).
“The primary sources of pain in tension-type headache may be a local and reversible sensitisation of nociceptors (pain receptors) in the pericranial muscles. In addition, a segmental central sensitisation may contribute to the pain in frequent sufferers of tension-type headache.”2
That is, an individual suffering from tension-type headache becomes more pain-sensitive with less provocation to the pericranial muscles compared to non-tension-type headache individuals.
Since ‘weak’ pericranial muscles are the source of pain of tension-type headache, sufferers of this form of headache may benefit from manual therapy (e.g. chiropractic, or physiotherapy, etc.) by addressing any postural imbalances, in particular, the cervical (neck) region. Postural exercise techniques and adopting proper workstation ergonomics will further strengthen and stabilise the head and neck muscles.
1.Headache Classification Committee of the International Headache Society (IHS). (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia;33(9):629-808.
2.Jensen, R (1996). Mechanisms of spontaneous tension-type headaches: an analysis of tenderness, pain thresholds and EMG. Pain,64(2):251–256.