Tension-Type Headache (TTH) affects up to 60% of the population, or approximately 13 million Australians. Many of these will be infrequent episodes. The percentage reflecting people who would consider themselves sufferers (frequent episodic) is estimated between 20-30% or approximately 7 million Australians. It affects women 1.5 times more than men(1).
TTH has traditionally been thought of as "Muscle Contraction Headache" due to the feeling of pressure, pressing or tightening that often accompanies head pain. In 1977 (2) researchers showed that scalp muscle EMG did not change significantly in TTH, yet the muscles in the top of the neck showed increased activity.
Like migraine, menstrual migraine, cluster headache and cervicogenic headache, studies show that the underlying problem in TTH is an overactive part of the brainstem called the trigeminocervical nucleus.
The feeling of tightness does not come from actual muscle contraction in the scalp. When the brainstem is overactive signals are sent to the brain indicating the muscles are contracting, when in fact the muscles are relaxed. The result is you "feel" the tightness in the absence of changes in the muscle.
The traditional model of headache has regarded the neck as having a minor role in headache. However the changes in understanding of the underlying problem put the neck front and centre in the headache story due to its having direct input into the "headache centre" in the brainstem (3).
TTH along with the other headache forms, has at the core of its pathology the upper part of the neck as a major influence.
What is required is an expert examination of the upper cervical spine to eliminate the spine as a cause.
This is supported by Dr Rothbart of the Pain Centre in Ontario, Canada (6): "Approximately 800 new headache patients per year are examined at our clinic. An estimated 80% of these patients are diagnosed with cervicogenic headache. Of these patients, almost none are referred with this diagnosis. Physicians are not taught to consider or explore neck structures when investigation headaches. This results in a rarely diagnosed but common condition”.
(1) Prevalence and cost of Headache. Headache Australia. www.http://headacheaustralia.org.au/what-is-headache/11-prevalence-and-cost-of-headache. Accessed 23/2/13. (2) Bakal D. A. and Kaganov, J. A. (1977) Muscle Contraction and Migraine Headache: Psychophysiologic Comparison. Headache: The Journal of Head and Face Pain. 17 (5) pp 208-215. (3)Andrew Charles – Professor of Neurology at UCLA interviewed on "Health Report" on ABC. Available on podcast via http://www.abc.net.au/radionational/programs/healthreport/migraine-research/4039834 (4) Classification of tension-type headache
