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Tension-type headache (TTH)
The mechanism of TTH is poorly understood, although it has long been regarded as a headache with muscular origins. It may be stress-related or associated with musculoskeletal problems in the neck. TTH has distinct sub-types. As experienced by very large numbers of people, episodic TTH occurs, like migraine, in attack-like episodes. These usually last no more than a few hours, but can persist for several days.
Chronic TTH, one of the chronic daily headache syndromes, is less common than episodic TTH but present most of the time: it can be unremitting over long periods. This variant of TTH is much more disabling. Headache in either case is usually mild or moderate and generalized, though it can be one-sided. It is described as pressure or tightness, like a band around the head, sometimes spreading into or from the neck. It lacks the specific features and associated symptoms of migraine.
TTH often begins during the teenage years, affecting three women to every two men, and reaches peak levels in the 30s. Episodic TTH is the most common headache disorder, reported by over 70% of some populations. Its prevalence varies greatly. African community-based studies, for example, have found only 1.7% of the population affected, but cultural attitudes to reporting a relatively minor complaint may largely explain this finding. Chronic TTH affects 1-3% of adults.
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