Tension Headache (TTH)

Overview of Tension Headache

A useful clinical approach is to diagnose TTH in patients whose headaches are completely without accompanying features such as nausea, vomiting, photophobia, phonophobia, osmophobia, throbbing, and aggravation with movement.

Such an approach neatly separates migraine, which has one or more of these features and is the main differential diagnosis, from TTH.

The International Headache Society’s main definition of TTH allows an admixture of nausea, photophobia, or phonophobia in various combinations, although the appendix definition does not; this illustrates the difficulty in distinguishing these two clinical entities.

In clinical practice, dichotomizing patients on the basis of the presence of associated features (migraine) and the absence of associated features (in other words, TTH) is highly recommended.

In deed patients whose headaches fit the TTH phenotype and who have migraine at other times, along with a family history of migraine, migrainous illnesses of childhood, or typical migraine triggers to their migraine attacks, may be biologically different from those who have TTH headache with none of the features.

TTH May be infrequent (episodic) Or occur on 15 days or more a month (chronic).[2]

Nature of Headache:

The pain typically builds slowly, fluctuates in severity, and may persist more or less continuously for many days. The headache may be episodic or chronic (present >15 days per month). [2]

Indian epidemiology then other

Causes of Tension Headache (TTH):

Primary headaches are not normally due to an underlying medical condition.

Headaches are a physiological disorder and are not a psychological condition.

Research is ongoing to find the causes of tension-type headaches.

According to the National Health Service ( in other words, NHS), possible reasons for a tension-type headache may include i.e.:

• Stress
• Anxiety
• Lack of exercise
• Eyestrain or squinting
• Tiredness
• Missing meals
• Dehydration
• Regular exposure to loud noise
• Bright sunlight
• Poor posture
• Certain smells, such as perfumed products

Stress, anxiety, and depression may trigger jaw clenching, lack of sleep, or lack of exercise which could worsen the problem.[6]

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Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology of Tension Headache (TTH)

• The pathophysiology of TTH incompletely understood.
• It seems likely that TTH is due to a primary disorder of central Nervous system pain modulation alone, unlike migraine, which involves a more generalized disturbance of sensory modulation.
• Data suggest a genetic contribution to TTH, but this may not be a valid finding: given the current diagnostic criteria, the studies undoubtedly included many migraine patients.
• The name tension-type headache implies that pain is a product of nervous tension, but there is no clear evidence for tension as an etiology.
• Muscle Contraction has considered to be a feature that distinguishes TTH from migraine, but there appear to be no differences in contraction between the two headache types.[2]

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Sign & Symptoms of Tension Headache (TTH):

• The pain of tension headache is usually characterized as ‘dull’, ‘tight’ or like a ‘pressure’, and there may be a sensation of a band round the head or pressure at the vertex.
• It is of constant character and generalized, but often radiates forwards from the occipital region.
• In contrast to migraine, the pain can remain unabated for weeks or months without interruption, although the severity may vary, and there is no associated vomiting or photophobia.
• Activities are usually continued throughout, and the pain may be less noticeable when the patient is occupied.
• The pain is usually less severe in the early part of the day, becoming more troublesome as the day goes on.
• Tenderness may be present over the skull vault or in the occiput but is easily distinguished from the triggered pains of trigeminal neuralgia and the exquisite tenderness of temporal arteritis.
• Analgesics may be taken with chronic regularity despite little effect, and may serve to perpetuate the symptoms.[1]

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Diagnosis of Tension Headache (TTH):

You have chronic or recurrent headaches, your doctor may conduct physical and neurological exams, then try to pinpoint the type and causes of your headaches using these approaches i.e.:

Your doctor can learn a lot about your headaches from a description of your pain. Be sure to include these details:

• Pain characteristics- Does your pain pulsate? Or is it constant also dull or sharp or stabbing?
• Pain intensity- A good indicator of the severity of your headache is how much you’re able to function while you have it. Are you able to work? Do your headaches wake you or prevent you from sleeping?
• Pain location- Do you feel pain all over your head, on only one side of your head, or just on your forehead or behind your eyes?

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Tension Headache (TTH):

If you have unusual or complicated headaches, your doctor may order tests to rule out serious causes of head pain, such as a tumor. Two common tests that can be used to image your brain include:

• Magnetic resonance imaging (MRI)-An MRI scan combines a magnetic field, radio waves and computer technology to produce clear images.
• Computerized tomography (CT)- A CT scan is a diagnostic imaging procedure that uses a series of computer-directed X-rays to provide a comprehensive view of your brain.

Treatment of Tension Headache (TTH):

• The pain of TTH can generally be managed with simple analgesics such as acetaminophen, aspirin, or NSAIDs.
• Behavioral approaches including relaxation can also be effective.
• Clinical studies have demonstrated that triptans in pure TTH are not helpful, although triptans are effective in TTH when the patient also has migraine.
• For chronic TTH, amitriptyline is the only proven treatment; other tricyclics, selective serotonin reuptake inhibitors, and the benzodiazepines have not been shown to be effective.
• There is no evidence for the efficacy of acupuncture.
• Placebo-controlled trials of on a botulinum toxin type A in chronic TTH were negative.[2]

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Homeopathic Treatment of Tension Headache

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Tension Headache:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Kali Phos – Top Homeopathic Medicine for Tension Headache

• Kali Phos top grade medicine for tension headache triggered by stress, anxiety also emotional disturbances.
• It also works well in case a tension headache link to depression.
• Symptoms like sadness, excessive weeping, weakness, exhaustion, a sensation of a heavyweight in the back of the head also sensitivity to noise indicate the need for Kali Phos.

Cimicifuga Racemosa – For Tension Headache with Contracted Neck Muscles

• Cimicifuga Racemosa a medicine prepare from the roots of a plant named ‘black cohosh’ of natural order Ranunculaceae.
• It a well indicate homeopathic medicine for a tension headache with contracted neck muscles.
• The pain is present in the entire head also radiates to back of the neck and the shoulders.
• This is attended with soreness of the neck also shoulders.[5]

Gelsemium Sempervirens – For Tension Headache with a Band Sensation around the Head

• Gelsemium Sempervirens a natural medicine prepare especially from the plant yellow jasmine.
• This plant belongs to family Loganiaceae, also bark of its root is used to make the medicine.
• This medicine use for tension headaches where the person feels as if a band tie tightly across the forehead.
• Along with this, there is a dull pain in the head.
• A sensation of weight, pressure, also heaviness in the head is also present.
• In most cases, pain begins in neck muscles that extend over the entire head.
• Applying pressure also sleeping tends to relieve the headache.

Epiphegus – For Tension Headache Triggered by Overexertion and Fatigue

• Generally, Epiphegus a medicine prepare from the fresh plant named ‘beech drop’ of the order Orobanchaceae.
• It is a prominent medicine to treat a tension headache triggered by overexertion and fatigue.
• A headache appears in the temples of the head.
• Hunger may precede a headache.
• A peculiar feature increase salivation with constant spitting.
• Good sleep may bring relief especially, from the headache.

Glonoinum – For Tension Headache Triggered by Sun

• Glonoinum is a beneficial medicine for tension headache triggered by sunlight.
• A headache in the front, back of the head and also behind the ears appears.
• In some cases, there is a pain in the nape of the neck that extends to the top of the head.
• Congestion, heat, and soreness are felt in the head. Lastly, The headache may get better after sleep.

Nux Vomica – For Tension Headache Triggered by Alcohol

• Nux Vomica is a highly recommended medicine for tension headache triggered by alcohol intake.
• The pain appears on the forehead, vertex (top of head) and occiput.
• Mental irritability, scalp sensitivity on touch, also mental strain triggering a tension headache are the main symptoms indicating the need for Nux Vomica.
• This medicine is also suitable for treating tension headache that gets triggered by the intake of coffee.

 Ignatia Amara – For Tension Headache Triggered by Smoking

• Ignatia Amara a suitable medicine for a tension headache trigger by smoking.
• Sometimes smelling tobacco may also trigger a tension headache.
• The pain from the head may extend down the neck.
• This may attend with a tender scalp.
• Stooping may worsen a headache.
• Sleeplessness may also present.
• Ignatia Amara is also recommended for tension headaches associated with depression.

Belladonna – For Tension Headache from Cold and Sinus Infection

• Belladonna is a natural medicine prepared from a plant named ‘deadly nightshade.’
• The natural order of this plant is Solanaceae.
• It is a very useful medicine for tension headache that develops from cold and Sinusitis. 
• Fullness in the head, pain in forehead, back and side of the head, fluent coryza and sneezing are the characteristic symptoms.
• Light and noise may worsen the headache, while pressure tends to relieve the headache.[5]

Lycopodium Clavatum – For Tension Headache Triggered by Skipping Meals

• Lycopodium Clavatum is a medicine prepared from the plant ‘club moss’ belonging to the family Lycopodiaceae.
• It works well for tension headaches triggered especially by skipping or missing meals.
• Symptoms include a headache in the back of the head also over the eyes.
• Pain from the head may extend down the neck with weakness. Additionally, This is attended with soreness of the scalp.
• It may get better specifically by lying down.

Ruta Graveolens – For Tension Headache due to Eye Strain

• Ruta Graveolens a medicine recommended for tension headaches triggered specifically by eye strain.
• It plant-based medicine prepare from the plant ‘garden rue’ belonging to the family Rutaceae.
• Pressure in the forehead, pain in the forehead that extends to the temples, aching eyes, a pressure in the eye orbits, heat in the head, anxiety, also restlessness are the characteristic symptoms that indicate towards this medicine.

Coffea Cruda – For Tension Headache Triggered by Noise

• Coffea Cruda a well-indicate medicine for tension headache triggered by noise.
• The head feels tight, and there is a heaviness in the forehead above eyes.
• Motion and light tend to worsen the headache.
• A tension headache that trigger by certain smells also treat with Coffea Cruda.

Carbolic Acid – For Tension Headache with Scalp Tenderness

• Carbolic Acid is a prominent medicine for tension headache attended with scalp tenderness.
• There is a headache with a sensation as if a tight band stretch over the forehead from temple to temple.
• There is fullness in the head with dull aching.
• The scalp is tender to touch, and there may a pain in the neck.[5]

Diet & Regimen of Tension Headache (TTH)

• Rhythmic breathing: If your breathing is short and hurried, slow it down by taking long, slow breaths. Inhale slowly then exhale slowly. [3]
• Deep breathing
• Relax to music: Combine relaxation exercises with your favourite music in the background. In detail, Select the type of music that lifts your mood or that you find soothing or calming. Some people find it easier to relax while listening to specially designed relaxation audio tapes, which provide music and relaxation instructions.
• Mental imagery relaxation: It is important to identify negative self-talk and develop healthy, positive self-talk. By making affirmations, you can counteract negative thoughts also emotions. Meditation.
• Yoga
• Cognitive Behavior Therapy (in other words, CBT) [3]
• Do manage your stress
• Don’t skip your sleep
• Don’t smoke
• Avoid alcohol
• Prevent Dehydration [4]

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References use for Tension Headache (TTH):

[1] https://www.researchgate.net/publication/5754613_Tension-type_headache_Current_research_and_clinical_management

[2] Harrison-s_Principles_of_Internal_Medicine-_19th_Edition-_2_Volume_Set

[3] https://www.webmd.com/migraines-headaches/relaxation

[4] https://www.chiropracticsolutionsspringfield.com/tension-headaches-

[5] https://www.drhomeo.com/tension-headache/tension-headaches-homeopathic-treatment/

[6] https://www.medicalnewstoday.com/articles/313020#causes

Frequently Asked Questions

What is Tension Headache?

The term tension-type headache (TTH) is commonly used to describe a chronic head-pain syndrome characterized by bilateral tight, band-like discomfort.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Tension Headache?

• Kali Phos
• Cimicifuga Racemosa
• Gelsemium
• Glonoinum
• Nux Vomica
• Ignatia Amara
• Belladonna

What are the causes of Tension Headache?

• Stress
• Anxiety
• Lack of exercise
• Eyestrain or squinting
• Tiredness
• Missing meals
• Dehydration
• Regular exposure to loud noise

What are the symptoms of Tension Headache?

• Pain- ‘dull’, ‘tight’ or like a ‘pressure’
• Constant character and generalized
• Pain can remain unabated for weeks or months without interruption