Chronic Tension Headaches (CTH)

Tension headaches are the most common type of headaches. Chronic Tension Headaches (CTH) mean constant tension headaches more than 15 days per month for at least 3 months. The CTH last hours to days and are constant. They can be episodic or chronic. They involve both sides of the head and they are pressing or tightening kind of pain that change in intensity from mild to severe. Unlike migraines, they are not accompanied by other symptoms such as nausea and light sensitivity. CTH mostly affect working people with jobs in front of a computer and students who carry heavy backpacks.

The cause of CTH is unknown but both peripheral and central pain mechanisms play a role. The peripheral sensitization causes local tissue damage, producing pain and causing substances to be released. Prolonged peripheral sensitization leads to central sensitization which means that the pain radiates all around the original tissue. The main symptoms of CTH are tenderness and dull pain over frontal, neck muscles and chewing muscles. It hurts when a patient moves the neck up and down or sideways. It causes stiff neck muscles and postural abnormalities.

​The diagnosis includes eliminating other neck and brain causes contributing to pain syndrome first. Treatment is muscle relaxors, anti-inflammatory medications like Advil or Motrin and physical therapy. Physical therapist can evaluate the muscles, pain and pressure over the neck muscles. She can give isometric manual exercises, massage trigger points and mobilize joints. The best treatment is combination of physical therapy and massage. Botox is another option if all modalities fail.