Headaches: Tension-Type

Description

Risk Factors

Tension-type headaches are the most common headaches. International studies suggest that the prevalence and risk factors are high in any country, in both the East and the West, and in developed and less-developed nations. Evidence suggests that the prevalence of chronic tension-type headache is as high as 3% in the US, Europe, and Asia. According to another study, nearly 40% of Americans had at least one episode of tension headaches during the year. And some reports estimate that over 85% of women and about 63% of men will experience a tension-type headache at some point during a year. Virtually everyone, then, has at least one tension-type headache during the course of their lives.

Individuals at highest risk for chronic headaches are middle-aged women, Caucasians, and people who are well educated. Surveys indicate that about 3% and 5% of the general population has chronic tension-type headache, with the prevalence possibly being higher in women.

Age

About 40% of people with tension-type headaches first have them before they are age 20 and another 40% first experience them between ages 20 and 40. Most of the remaining headache sufferers first have tension-type headaches in the decade between ages 40 and 50. Chronic tension-type headache tends to occur in older adults.

Headaches in Children. Headaches are rare before age four but increase in prevalence throughout childhood, reaching a peak around age 13. In one large 2001 British study, about 8% of seven year olds and 15% of 11 year olds had headaches, and 10% of these childhood headaches were recurrent. In many of these patients chronic headaches persist into adulthood. In addition, as adults they have a tendency to develop multiple physical or psychiatric complaints, such as back pain, muscle aches, digestive complaints, and depression.

Studies have found that only a minority of chronic childhood headaches is due to physical conditions, such as head injuries or medical problems. In one study, over 62% of children with tension-type headache episodes suffered some form of emotional disorder. In the study, every child reported the presence of stress factor. Psychologic factors that have been associated with childhood headaches include the following:

• Moderate or severe depression.
• Emotional rigidity in a child and more repressed anger than their peers.
• Family stress. This includes separation from the mother for more than a week, chronic illness in the mother, family bereavement issues, relationship problems, mental illness in a family member, and other stressful family events.
• Problems at school.

Some Specific Risk Factors for Tension-Type Headaches

The following conditions can make people susceptible to tension-type headaches.

• Chronic poor posture.
• Chronic overwork.
• Upper respiratory tract infections, such as colds and flu, can produce tension-type headache. In fact, according to one 1999 study, tension-type headaches in children are most often associated with such infections.
• Sleep disorders. Sleep problems, such as insomnia, sleep apnea, or habitual snoring, are common in all primary headaches. Headache of course can disturb sleep, but sleep disorders may also contribute directly to tension headache, particularly those that occur at night or early morning. (In one study, for example, treating people who had chronic headaches for sleep apnea cured the headaches in many cases.)
• Hypothyroidism, or decreased thyroid function.
• Dental problems.
• Allergies.
• Substance or alcohol abuse.
• Temporomandibular joint dysfunction (TMJ, also called TMD). This is a condition in which there are abnormalities in the jaw joints. TMJ itself can cause headache and it also often coexists with chronic tension headache.

Triggers for Tension-Type Headache Episodes

Certain triggers, including the following, may cause headache episodes in people with chronic tension-type headaches:

• Specific stressful events.
• Not eating on time.
• Fatigue or lack of sleep.
• Crying. In one study, only stress, anxiety, and menstruation were more important headache triggers in women.
• Withdrawal from over-used substances (caffeine, nicotine, alcohol, pain relievers).
• Eyestrain.
• Intense physical exertion, including sexual activity. Athletes are at higher risk for headaches. Patients with tension-type headaches should not avoid exercise, however. Ordinary levels of physical activity do not usually precipitate these headaches. Furthermore, a sedentary lifestyle may increase the risks for stress and thereby for tension headaches in susceptible people.
• Certain foods, such as chocolate, cheese, and the flavor enhancer monosodium glutamate (MSG), are commonly cited as triggers for tension headaches as they are for migraines. Of interest, however, was a study in which chronic headache sufferers were given chocolate and a similar substitute. There was no difference in the effect on headache from either substance. The researchers suggested that people may believe chocolate triggers headache because a craving for sweets often precedes a headache.
• Medications (overuse of headache medications, nitrates, certain anti-depressants, some drugs used to treat high blood pressure, and many others.)
• Hormonal changes, such as specific menstrual phases, in women.

Of note, stress, crying, not eating on time, fatigue and lack of sleep are also migraine triggers. Weather conditions, certain smells, smoke, and light, which can set off migraines, are not common triggers for tension-type headaches.