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Tension type headache

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.

Many patients have difficulty falling asleep and staying asleep, chronic fatigue, irritability, disturbed concentration, mild sensitivity to light or noise and general muscle aching, fibromyalgia and anxiety symptoms.

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).

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 amitryptiline, tizanidine, topiramate or gabapentine.

Non pharmacologic interventions like stress management/relaxation training, counseling, biofeedback, yoga, pranayaam 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.