What is the patient education for tension-type headache?

From the Guidelines

Tension headache patients should be educated on a multimodal approach to therapy, including lifestyle modifications, stress reduction techniques, and medication management, to improve their quality of life. When managing tension headaches, it is essential to consider the following key points:

• Educate patients on the importance of maintaining a headache diary to track their symptoms and identify potential triggers 1
• Encourage patients to practice stress management techniques, such as relaxation training, meditative therapy, or cognitive-behavioral therapy (CBT), which have been shown to provide relief for tension headache patients 1
• Recommend regular exercise, such as 40 minutes of moderate-intensity exercise three times a week, which has been shown to be effective in preventing migraines and may also be beneficial for tension headaches 1
• Emphasize the importance of establishing realistic expectations for symptom resolution and the potential need for a long-term management plan 1
• Consider referring patients to specialist care if their symptoms persist or worsen despite initial management 1 Some additional considerations for tension headache management include:
• Encouraging patients to stay hydrated by drinking 8-10 glasses of water daily
• Practicing good posture and taking regular breaks to stretch the neck and shoulders
• Identifying and avoiding personal triggers, such as certain foods or environmental factors
• Ensuring adequate sleep quality and duration, aiming for 7-9 hours per night By prioritizing a comprehensive and multimodal approach to therapy, tension headache patients can experience improved symptom management and enhanced quality of life.

From the Research

Tension Headache Patient Education

• Tension-type headache (TTH) is the most common primary headache disorder, with a worldwide lifetime prevalence of 46% to 78% 2
• The etiology of TTH is thought to be multifactorial, involving genetic and environmental factors, and it causes greater disability and accounts for more missed work days than migraine 2
• Patients typically describe headache pain as pressing, dull, and with the sensation of a tight band around the head 2

Diagnosis and Treatment

• Diagnosis is based on clinical presentation, while the focus of evaluation is to rule out possible secondary causes of headache 3
• Treatment options include nonprescription analgesics for management of episodic TTH, and prophylaxis should be considered for patients with chronic TTH, with very frequent episodic TTH, at risk of medication overuse headache, and who are unable to tolerate effective doses of first-line drugs 2
• Amitriptyline is recommended as a first-line drug for prophylaxis, and physical and integrative therapies for TTH management include electromyography biofeedback, cognitive behavioral therapy, exercise, massage, and trigger point injection 2
• Yoga has been found to have a statistically significant overall effect in favor of reducing headache frequency, headache duration, and pain intensity in patients suffering from tension-type headaches 4

Management and Prevention

• Assessment of the headaches includes assessment for other headache disorders that may overlap it, such as a chronic migraine, and coexisting diseases that may contribute to the process, such as mood disorders and mechanical disorders of the spine and neck, require investigation 5
• Treatment is optimized by appropriate use of acute medications and preventive treatments that may include drugs in the antidepressant classes along with nonpharmacologic modalities and other alternative treatments ranging from biofeedback to manual therapy to the use of botulinum toxin type A injections 5
• A structured approach to the patient and a better comprehension of the very frequent coexistence of migraine and medication overuse headache in the clinical population are emphasized 6