Tension type headaches: Whether they are primary or secondary headaches?

Tension-type headache is the most common type of headache affecting the population. Due to unclear etiology TTH is categorized as primary. However, it is quentionable if this categorisation is correct. Existing studies on TTH lack evidence that would connect it to primary headaches. Research shows that TTH has close connections with other conditions, meanwhile other primary headaches do not. Moreover, when comparing TTH to other primary headaches, phenotypical differences can be identified. TTH truly can impair a person's social, physical and occupational activity. Due to the uncertainty about the origin and pathophysiology of this obscure disease there are diminished possibilities in treatment. For this reason, many people are still suffering from it. The name Tension Type Headache has not been changed since the release of ICHD-I in 1988, in hopes for more comprehensive studies about its pathogenesis and etiology in the future. Though, it is evident that TTH is the least studied type of headache. The only unanimous opinion stands for the broad classification and diagnostic criteria. Criteria are based on moderate, bilateral, blunt pain, absence of typical migraine symptoms and lack of clear explanation. It is possible to group the provoking factors which include muscle related (muscle tension theory), environmental (stress, sleep disorders, depression and anxiety), genetic (this predisposition is not fully confirmed) and nutritional (correlation between vitamin D deficiency and TTH was found). TTH pathogenesis is most likely multifactorial, but no concrete mechanisms are clarified. Based on the history, etiology, and pathophysiology of TTH, as well as clinically applied treatment aimed at eliminating causal factors and alleviating pain as a symptom, it can be said that TTH is more likely to be of secondary origin, manifesting as an expression of other somatic, psychological, and affective disorders. For these reasons, TTH should be regarded as one of the symptoms or a component of a syndrome. The hypothesis: Tension-type headache is a headache of secondary rather than primary origin. Objective: To demonstrate that tension-type headache is not idiopathic primary headache.

Automated summary

Tension-type headache is the most common type of headache, but its classification as a primary headache is questionable. Existing studies lack evidence connecting it to other primary headaches, and there are phenotypical differences compared to other primary headaches. Due to the uncertainty of its origin and pathophysiology, treatment options for tension-type headache are limited.