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Year : 2021  |  Volume : 69  |  Issue : 7  |  Page : 116--123

Advances in the Understanding of Pathophysiology of TTH and its Management

1 Associate Professsor, Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Director Professor and Head, Department of Neurology, G. B. Pant Hospital, New Delhi, India

Correspondence Address:
Dr. Sanjeev Kumar Bhoi
Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751 019
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.315986

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Background: Tension-type headache (TTH) is the most common form of primary headache. Objective: The aim of this study was to document and summarize the advances in the understanding of TTH in terms of pathogenesis and management. Material and Methods: We reviewed the available literature on the pathogenesis and management of TTH by searches of PubMed between 1969 and October 2020, and references from relevant articles. The search terms “tension-type headache”, “episodic tension-type headache”, chronic tension-type headache, “pathophysiology”, and “treatment” were used. Results: TTH occurs in two forms: episodic TTH (ETTH) and chronic TTH (CTTH). Unlike chronic migraine, CTTH has been less thoroughly studied and is a more difficult headache to treat. Frequent ETTH and CTTH are associated with significant disability. The pathogenesis of TTH is multifactorial and varies between the subtypes. Peripheral mechanism (myofascial nociception) and environmental factors are possibly more important in ETTH, whereas genetic and central factors (sensitization and inadequate endogenous pain control) may play a significant role in the chronic variety. The treatment of TTH consists of pharmacologic and non-pharmacologic approaches. Simple analgesics like NSAIDs are the mainstays for acute management of ETTH. CTTH requires a multimodal approach. Preventive drugs like amitriptyline or mirtazapine and non-pharmacologic measures like relaxation and stress management techniques and physical therapies are often combined. Despite these measures, the outcome remains unsatisfactory in many patients. Conclusion: There is clearly an urgent need to understand the pathophysiology and improve the management of TTH patients, especially the chronic form.


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