From the Guidelines
Tension-type headache is the most common primary headache disorder, but migraine is typically more disabling unless it becomes chronic. When considering the impact of primary headache disorders on patients, it's essential to differentiate between prevalence and disability. Tension-type headaches are indeed the most prevalent, affecting approximately 26% of the global population 1. However, migraines, despite being less common, are often more disabling due to their severe symptoms, including moderate to severe throbbing pain, nausea, vomiting, and sensitivity to light and sound.
- Migraines are characterized by their significant functional impairment during attacks, which can last from 4 to 72 hours.
- The pathophysiology of migraines involves neuronal hyperexcitability, cortical spreading depression, and activation of the trigeminovascular system, explaining their complex and disabling symptomatology.
- Treatment options for migraines include acute medications like triptans, NSAIDs, or combination analgesics, and preventive treatments such as beta-blockers, anticonvulsants, or CGRP antagonists for frequent episodes.
- Patients with migraines benefit from identifying and avoiding triggers, maintaining regular sleep patterns, and stress management techniques, highlighting the need for a comprehensive approach to managing this condition. Given the potential for significant disability and the availability of various treatment options, migraine stands out as a primary headache disorder that may not be adequately addressed in primary care settings unless it becomes chronic, emphasizing the need for clinicians to prioritize its management to improve patient outcomes and quality of life 1.
From the Research
Primary Headache Disorders
- The most common type of primary headache disorder is Tension-type headache (TTH) 2, 3
- TTH has a worldwide lifetime prevalence of 46% to 78% 2
- TTH is typically disabling unless it becomes chronic 2, 3
Comparison with Other Headache Disorders
- Migraine is the second leading cause of years lived with disability worldwide, but it is less common than TTH 4
- Cluster headache is a type of trigeminal autonomic cephalalgia, but it is less prevalent than TTH and migraine 5
- Posttraumatic headache is a type of secondary headache disorder, which is not directly comparable to TTH 4, 6
Clinical Characteristics of TTH
- TTH is characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity 3
- The diagnosis of TTH is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition 3