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]

Pathophysiology

The pathophysiology for tension type headache is multifactorial and generally includes increased sensitivity of central and peripheral nociceptive pathways, environmental and genetic factors.

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.
• Hypersensitivity of central nociceptive pathways and central nervous system is more commonly involved with chronic type tension headache.
• Hypersensitivity of peripheral nociceptive pathways and peripheral nervous system is more commonly involved with episodic type tension headache.
  • Peripheral factors:
    • Active and latent trigger points (Increased muscle tenderness)
    • Forward head posture
    • Decreased neck mobility
    • 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

Nitric oxide:

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

Genetic factors:

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

Environmental factors:

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

References

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