Muscle Contraction Tension Headache Clinical Presentation

Updated: May 21, 2019
  • Author: Syed M S Ahmed, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Presentation

History

Tension-type headaches (TTHs) are characterized by pain that is usually mild or moderate in severity and bilateral in distribution. Unilateral pain may be experienced by 10-20% of patients. Headache is a constant, tight, pressing, or bandlike sensation in the frontal, temporal, occipital, or parietal area (with frontal and temporal regions most common).

  • Ulrich et al reported that 82% of TTHs last less than 24 hours. [3]

  • The deep steady ache differs from the typical throbbing quality of migraine headache.

    • Prodrome and aura are absent.

    • Occasionally, the headache may be throbbing or unilateral, but most patients do not report photophobia, sonophobia, or nausea, which commonly are associated with migraine.

  • Some patients may have neck, jaw, or temporomandibular joint discomfort.

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Physical

Patients with TTH have normal findings on general and neurologic examinations.

Some patients may have tender spots or taut bands in the pericranial or cervical muscles (trigger points).

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Causes

Various precipitating factors may cause TTH in susceptible individuals. One half of patients with TTH identify stress or hunger as a precipitating factor.

  • Stress - Usually occurs in the afternoon after long stressful work hours

  • Sleep deprivation

  • Uncomfortable stressful position and/or bad posture

  • Irregular meal time (hunger)

  • Eyestrain

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