Time to take tension-type headache seriously.

Abstract

Over 80% of the global population experience tension-type headache (TTH) at some point in their lives, with one in 10 suffering every week 1, 2. Just 10% of those with primary headaches will consult a neurologist, making TTH one of the most prevalent conditions managed in primary care 3. Despite its ubiquity, primary care physicians are often more primed to consider the treatment options for ‘red flag’ headaches than TTH. This is hardly surprising: just 20% of patients consult a primary care physician for their headache, with 50% opting for self-care 1, 3. For many patients, pharmacy therefore plays a critical role in optimising TTH treatment 4. Diagnostically, TTH is simple. A bilateral, mild-to-moderate pain, unaccompanied by other symptoms, distinguishes TTH from other types of headache 5. Familiarity with the condition, and patients' perceived confidence in managing TTH, can mean that healthcare intervention is broadly limited to identifying signs and symptoms indicative of a sinister aetiology. As the world's most prevalent headache type 6, it is necessary for healthcare professionals to continually improve their understanding of TTH, so that they are best prepared to advise patients on appropriate management. To achieve this, a greater awareness of the pathophysiology of TTH is essential. While the pathophysiology of TTH is still not entirely understood, it is now thought that it is a referred pain, stemming from the peripheral muscles in the head and neck 7, 8. Current guidelines recommend simple analgesics as first-line therapy, and treatments that directly target the source of the pain are likely to be most effective in the management of TTH 9. Data suggest that non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are more effective than paracetamol in relieving TTH 1, 9-11. This may be because of their differing modes of action. While it is unclear exactly how paracetamol relieves pain, it is thought to act via central nociceptive pathways; in contrast, NSAIDs act on both peripheral and central nociceptive pathways 12, 13. For patients, an awareness of the origins of TTH could help reduce future episodes of headaches, by making lifestyle changes and selecting more appropriate treatments. Some patients describe their TTH as ‘starting at the back of the neck’; however, further education is needed. Building on an inherent belief that the muscles are important, and that different muscles could possibly produce different headaches, can help facilitate a dialogue on the role of referred muscle pain, which is the source of TTH. Helping patients make the connection that early treatment can help prevent the condition persisting long term also allows healthcare professionals to encourage early analgesic intervention. Data show that around half of headache sufferers will delay treatment until the pain is intolerable 14. However, initiating early treatment ensures patients return to ‘normal’ as soon as possible and may also help prevent the chronic sensitisation that results in chronic TTH 15. A recent meeting considered the need for improved education on TTH and its management for primary healthcare professionals. The following articles summarise the proceedings of this meeting and provide a valuable resource for use in practice. Dr. Jarvis received lecture fees from, or consulted for, various health conditions and medical-related behaviours, from a number of pharmaceutical companies (including Reckitt Benckiser) as well as media outlets on subjects related to health. The author does not hold any shares, stocks or options or any other financial instruments in any pharmaceutical company.