Tension headache pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]

Overview

The pathophysiology for tension type headache is multifactorial and generally includes increased sensitivity of central and peripheral nociceptive pathways, environmental and genetic factors. It includes hypersensitivity of central and peripheral nociceptive pathways: lack of habituation, Nitric oxide and combination of genetic and envirommental factors.

Pathophysiology

The pathophysiology for tension type headache is multifactorial and generally includes increased sensitivity of central and peripheral nociceptive pathways, environmental and genetic factors.[1][2][3][4][5]

Hypersensitivity of central and peripheral nociceptive pathways:

  • Increased sensitivity of central and peripheral nociceptive pathways has a central role in the pathogenesis of tension type headache.[2]
  • Hypersensitivity of central nociceptive pathways and central nervous system is more commonly involved with chronic type tension headache.[6]
  • Hypersensitivity of peripheral nociceptive pathways and peripheral nervous system is more commonly involved with episodic type tension headache.[7] [8]
    • Peripheral factors:[9][10]
      • Active and latent trigger points (Increased muscle tenderness)[11]
      • Forward head posture[12]
      • Decreased neck mobility[13][14]
      • Increased levels of interleukin-1 beta (inflammatory mediator)

Lack of Habituation:

  • Lack of habituation is also observed to be an important pathogenetic factor in a subset population of tension type headache
  • Low pain, electrical and thermal thresholds in patients with chronic tension type headache may suggest abnormal limbic-controlled descending pain pathways secondary to underlying deficient descending inhibition.[15]

Nitric oxide:

  • NO is one of the most importanr chemical mediator involved in the pathogenesis of tension type headache[16]
  • Nitric oxide synthase inhibitors have a potent antinociceotive effect[17]

Genetic factors:

  • Genetic factors have a strong association in the pathogenesis of chronic tension headaches compared to episodic.[3]
  • First degree relatives of chronic TTH have 3 times higher risk of developing chronic TTH compared to the general population[4]
  • Chronic TTH has a complex multifactorial inheritance[5]

Environmental factors:

  • Several studies have shown that episodic TTH may be caused by a variety of genes in combination with environmental factors.

References

  1. "Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition". Cephalalgia. 38 (1): 1–211. January 2018. doi:10.1177/0333102417738202. PMID 29368949.
  2. 2.0 2.1 Jensen R (2003). "Peripheral and central mechanisms in tension-type headache: an update". Cephalalgia. 23 Suppl 1: 49–52. doi:10.1046/j.1468-2982.2003.00574.x. PMID 12699459.
  3. 3.0 3.1 Ulrich V, Gervil M, Olesen J (June 2004). "The relative influence of environment and genes in episodic tension-type headache". Neurology. 62 (11): 2065–9. doi:10.1212/01.wnl.0000129498.50793.8a. PMID 15184615.
  4. 4.0 4.1 Russell MB, Ostergaard S, Bendtsen L, Olesen J (May 1999). "Familial occurrence of chronic tension-type headache". Cephalalgia. 19 (4): 207–10. doi:10.1046/j.1468-2982.1999.019004207.x. PMID 10376164.
  5. 5.0 5.1 Russell MB, Iselius L, Ostergaard S, Olesen J (February 1998). "Inheritance of chronic tension-type headache investigated by complex segregation analysis". Hum. Genet. 102 (2): 138–40. doi:10.1007/s004390050666. PMID 9521579.
  6. Bezov D, Ashina S, Jensen R, Bendtsen L (February 2011). "Pain perception studies in tension-type headache". Headache. 51 (2): 262–71. doi:10.1111/j.1526-4610.2010.01768.x. PMID 21029081.
  7. Bendtsen L, Fumal A, Schoenen J (2010). "Tension-type headache: mechanisms". Handb Clin Neurol. 97: 359–66. doi:10.1016/S0072-9752(10)97029-2. PMID 20816435.
  8. Schmidt-Wilcke T, Leinisch E, Straube A, Kämpfe N, Draganski B, Diener HC, Bogdahn U, May A (November 2005). "Gray matter decrease in patients with chronic tension type headache". Neurology. 65 (9): 1483–6. doi:10.1212/01.wnl.0000183067.94400.80. PMID 16275843.
  9. Bendtsen L (June 2000). "Central sensitization in tension-type headache--possible pathophysiological mechanisms". Cephalalgia. 20 (5): 486–508. doi:10.1046/j.1468-2982.2000.00070.x. PMID 11037746.
  10. Ashina S, Bendtsen L, Ashina M (December 2005). "Pathophysiology of tension-type headache". Curr Pain Headache Rep. 9 (6): 415–22. doi:10.1007/s11916-005-0021-8. PMID 16282042.
  11. Bendtsen L, Fernández-de-la-Peñas C (December 2011). "The role of muscles in tension-type headache". Curr Pain Headache Rep. 15 (6): 451–8. doi:10.1007/s11916-011-0216-0. PMID 21735049.
  12. Fernández-de-Las-Peñas C, Cuadrado ML, Pareja JA (May 2007). "Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache". Headache. 47 (5): 662–72. doi:10.1111/j.1526-4610.2006.00632.x. PMID 17501847.
  13. Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA (September 2006). "Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache". Headache. 46 (8): 1264–72. doi:10.1111/j.1526-4610.2006.00440.x. PMID 16942471.
  14. Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA (March 2006). "Trigger points in the suboccipital muscles and forward head posture in tension-type headache". Headache. 46 (3): 454–60. doi:10.1111/j.1526-4610.2006.00288.x. PMID 16618263.
  15. Bendtsen L (December 2003). "Central and peripheral sensitization in tension-type headache". Curr Pain Headache Rep. 7 (6): 460–5. doi:10.1007/s11916-003-0062-9. PMID 14604505.
  16. de Tommaso M, Ceci E, Pica C, Trojano M, Delussi M, Franco G, Livrea P, Ruggieri M (July 2012). "Serum levels of N-acetyl-aspartate in migraine and tension-type headache". J Headache Pain. 13 (5): 389–94. doi:10.1007/s10194-012-0448-3. PMC 3381063. PMID 22527035.
  17. Fischer M, Wille G, Klien S, Shanib H, Holle D, Gaul C, Broessner G (August 2012). "Brain-derived neurotrophic factor in primary headaches". J Headache Pain. 13 (6): 469–75. doi:10.1007/s10194-012-0454-5. PMC 3464472. PMID 22584531.


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