Tension-Type Headaches (TTH)
Tension-type headaches (TTH) are among the most common headache disorders worldwide. They affect approximately 26–35% of adults each year, while up to 70–90% of people experience episodic TTH at some point in their lifetime. In other words, if you’re reading this, you’ve likely had a TTH before.
TTH is typically characterised by a mild to moderate, diffuse, pressing or tightening pain around the head. Patients often describe it as a “tight band” or “headband” sensation. TTH can be classified into three categories:
Clinical Presentation
Frequent episodic TTH is the most common form. Chronic TTH is less common (approximately 2–3%) but can be significantly more disabling.
- Infrequent episodic: ≤1 day per month
- Frequent episodic: 1–14 days per month
- Chronic: ≥15 days per month
Common contributing factors include:
- Stress and psychological factors
- Musculoskeletal tension
- Sleep disturbances
- Work-related factors (e.g. posture, prolonged sitting)
- Caffeine overuse or withdrawal
- Hormonal influences (slightly higher prevalence in females)
These factors often interact with one another, which is why a thorough assessment is essential to identify the key contributors in each individual case.
Risk Factors
Prolonged contraction of muscles in the head and neck can lead to reduced local blood flow, the release of inflammatory mediators, and referred pain — meaning pain is perceived in an area distant from its actual source.
In more chronic cases, central sensitisation may occur. This involves increased sensitivity of the nervous system and a lowered pain threshold due to persistent nociceptive input.
Prognosis and Treatment
The prognosis for episodic TTH is generally excellent, particularly when treated with manual therapy approaches such as osteopathy. Chronic TTH can be more challenging but often improves significantly with consistent and targeted treatment.
Osteopathic Approach
The aim of osteopathic treatment is to identify and address the underlying source of the headache. Importantly, symptoms may be referred from structures outside the head, such as the cervical spine or surrounding musculature. Treatment may include:
- Manual therapy techniques
- Postural correction
- Exercise therapy
- Lifestyle modifications
With a comprehensive and individualised approach, TTH can be managed very effectively.