Hallmarks of primary headache: part 2– Tension-type headache
Abstract Background and aim Tension-type headache is the most prevalent primary headache disorder. While the episodic subtype is more common, chronic tension-type headache significantly impacts health-related quality of life and contribute to increased healthcare utilization and disability. Despite...
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2025-07-01
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| Series: | The Journal of Headache and Pain |
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| Online Access: | https://doi.org/10.1186/s10194-025-02098-w |
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| author | Li-Ling Hope Pan Yu-Hsiang Ling Shuu-Jiun Wang Linda Al-Hassany Wei-Ta Chen Chia-Chun Chiang Soo-Jin Cho Min Kyung Chu Gianluca Coppola Adriana Della Pietra Zhao Dong Esme Ekizoglu Charl Els Fatemeh Farham David Garcia-Azorin Woo-Seok Ha Fu-Jung Hsiao Ryotaro Ishii Byung-Kun Kim Najib Kissani Alejandro Labastida-Ramirez Kristin Sophie Lange Ellina Lytvyak Dilara Onan Aynur Ozge Laura Papetti Lanfranco Pellesi Bianca Raffaelli Alberto Raggi Sebastian Straube Tsubasa Takizawa Surat Tanprawate Derya Uğurlu Uludüz Kiratikorn Vongvaivanich Marta Waliszewska-Prosół Yonggang Wang Tissa Wijeratne Jr-Wei Wu Sophie Merve Yener Paolo Martelletti |
| author_facet | Li-Ling Hope Pan Yu-Hsiang Ling Shuu-Jiun Wang Linda Al-Hassany Wei-Ta Chen Chia-Chun Chiang Soo-Jin Cho Min Kyung Chu Gianluca Coppola Adriana Della Pietra Zhao Dong Esme Ekizoglu Charl Els Fatemeh Farham David Garcia-Azorin Woo-Seok Ha Fu-Jung Hsiao Ryotaro Ishii Byung-Kun Kim Najib Kissani Alejandro Labastida-Ramirez Kristin Sophie Lange Ellina Lytvyak Dilara Onan Aynur Ozge Laura Papetti Lanfranco Pellesi Bianca Raffaelli Alberto Raggi Sebastian Straube Tsubasa Takizawa Surat Tanprawate Derya Uğurlu Uludüz Kiratikorn Vongvaivanich Marta Waliszewska-Prosół Yonggang Wang Tissa Wijeratne Jr-Wei Wu Sophie Merve Yener Paolo Martelletti |
| author_sort | Li-Ling Hope Pan |
| collection | DOAJ |
| description | Abstract Background and aim Tension-type headache is the most prevalent primary headache disorder. While the episodic subtype is more common, chronic tension-type headache significantly impacts health-related quality of life and contribute to increased healthcare utilization and disability. Despite considerable advances in the understanding of tension-type headache, critical gaps persist. This paper aims to provide a comprehensive review of the hallmarks of tension-type headache, from its pathophysiology, comorbidities, treatment options, to psychosocial impact. Main results Multiple factors are associated with tension-type headache, including peripheral mechanisms (increased muscle tenderness and myofascial trigger points), central sensitization, genetic predisposition, and psychological comorbidities such as anxiety and depression. Neuroimaging and neurophysiological studies demonstrated altered pain processing in cortical and subcortical regions in patients with tension-type headache. Regarding treatment strategy, in addition to pharmacological treatment, novel insights into non-pharmacological interventions such as cognitive behavioral therapy, neuromodulation techniques, physical therapy, mindfulness, lifestyle management, and patient education were highlighted as valuable components of comprehensive management strategies. Conclusions A complex interplay between peripheral and central mechanisms and psychosocial stressors underpins tension-type headache. Integrated multidisciplinary approaches combining pharmacological and non-pharmacological interventions are critical for optimal patient outcomes. Further research should continue to refine the understanding of these mechanisms to improve targeted therapeutic strategies and reduce the global burden of tension-type headache. |
| format | Article |
| id | doaj-art-b92e2f640bae446785769d1d24b79f8d |
| institution | Kabale University |
| issn | 1129-2377 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | The Journal of Headache and Pain |
| spelling | doaj-art-b92e2f640bae446785769d1d24b79f8d2025-08-20T03:42:52ZengBMCThe Journal of Headache and Pain1129-23772025-07-0126114410.1186/s10194-025-02098-wHallmarks of primary headache: part 2– Tension-type headacheLi-Ling Hope Pan0Yu-Hsiang Ling1Shuu-Jiun Wang2Linda Al-Hassany3Wei-Ta Chen4Chia-Chun Chiang5Soo-Jin Cho6Min Kyung Chu7Gianluca Coppola8Adriana Della Pietra9Zhao Dong10Esme Ekizoglu11Charl Els12Fatemeh Farham13David Garcia-Azorin14Woo-Seok Ha15Fu-Jung Hsiao16Ryotaro Ishii17Byung-Kun Kim18Najib Kissani19Alejandro Labastida-Ramirez20Kristin Sophie Lange21Ellina Lytvyak22Dilara Onan23Aynur Ozge24Laura Papetti25Lanfranco Pellesi26Bianca Raffaelli27Alberto Raggi28Sebastian Straube29Tsubasa Takizawa30Surat Tanprawate31Derya Uğurlu Uludüz32Kiratikorn Vongvaivanich33Marta Waliszewska-Prosół34Yonggang Wang35Tissa Wijeratne36Jr-Wei Wu37Sophie Merve Yener38Paolo Martelletti39Brain Research Center, National Yang Ming Chiao Tung UniversityDepartment of Neurology, Neurological Institute, Taipei Veterans General HospitalBrain Research Center, National Yang Ming Chiao Tung UniversityDepartment of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC, University Medical Center RotterdamDepartment of Neurology, Neurological Institute, Taipei Veterans General HospitalDepartment of Neurology, Mayo ClinicDepartment of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of MedicineDepartment of Neurology, Yonsei University College of MedicineDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOTDepartment of Molecular Physiology and Biophysics, Carver College of Medicine, University of IowaDepartment of Neurology, The First Medical Center of Chinese PLA General HospitalDepartment of Neurology, Istanbul Faculty of Medicine, Istanbul UniversityDepartment of Medicine, Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, University of AlbertaHeadache department, Iranian center of Neurological researchs, Neuroscience Institute, Tehran university of Medical SciencesDepartment of Neurology, Hospital Universitario Rio HortegaDepartment of Neurology, Yonsei University College of MedicineBrain Research Center, National Yang Ming Chiao Tung UniversityDepartment of Neurology, Kyoto Prefectural University of MedicineDepartment of Neurology, Nowon Eulji Medical Center, Eulji University School of MedicineNeurology Department, Mohammed VI University Hospital Center of MarrakechDivision of Neuroscience, Faculty of Biology, Medicine, and Health, University of ManchesterDepartment of Neurology, Charité– Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu BerlinDepartment of Medicine, Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, University of AlbertaDepartment of Physiotherapy and Rehabilitation, Faculty of Heath Sciences, Yozgat Bozok UniversityProfessor of Neurology, Headache ClinicDevelopmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCSDepartment of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern DenmarkDepartment of Neurology, Charité– Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu BerlinNeurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo BestaDepartment of Medicine, Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, University of AlbertaDepartment of Neurology, Keio University School of MedicineChiang Mai UniversityDepartment of Neurology, Istanbul Cerrahpasa University Medical FacultyNeuroscience center, Bangkok International Hospital, BDMSNeurology, Wroclaw Medical UniversityDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical UniversityDepartment of Neurology, Sunshine HospitalDepartment of Neurology, Neurological Institute, Taipei Veterans General HospitalMigraine Foundation AustraliaSchool of Health, Unitelma Sapienza University of RomeAbstract Background and aim Tension-type headache is the most prevalent primary headache disorder. While the episodic subtype is more common, chronic tension-type headache significantly impacts health-related quality of life and contribute to increased healthcare utilization and disability. Despite considerable advances in the understanding of tension-type headache, critical gaps persist. This paper aims to provide a comprehensive review of the hallmarks of tension-type headache, from its pathophysiology, comorbidities, treatment options, to psychosocial impact. Main results Multiple factors are associated with tension-type headache, including peripheral mechanisms (increased muscle tenderness and myofascial trigger points), central sensitization, genetic predisposition, and psychological comorbidities such as anxiety and depression. Neuroimaging and neurophysiological studies demonstrated altered pain processing in cortical and subcortical regions in patients with tension-type headache. Regarding treatment strategy, in addition to pharmacological treatment, novel insights into non-pharmacological interventions such as cognitive behavioral therapy, neuromodulation techniques, physical therapy, mindfulness, lifestyle management, and patient education were highlighted as valuable components of comprehensive management strategies. Conclusions A complex interplay between peripheral and central mechanisms and psychosocial stressors underpins tension-type headache. Integrated multidisciplinary approaches combining pharmacological and non-pharmacological interventions are critical for optimal patient outcomes. Further research should continue to refine the understanding of these mechanisms to improve targeted therapeutic strategies and reduce the global burden of tension-type headache.https://doi.org/10.1186/s10194-025-02098-wTension-type headacheDisease burdenPrimary headacheNon-pharmacological treatments |
| spellingShingle | Li-Ling Hope Pan Yu-Hsiang Ling Shuu-Jiun Wang Linda Al-Hassany Wei-Ta Chen Chia-Chun Chiang Soo-Jin Cho Min Kyung Chu Gianluca Coppola Adriana Della Pietra Zhao Dong Esme Ekizoglu Charl Els Fatemeh Farham David Garcia-Azorin Woo-Seok Ha Fu-Jung Hsiao Ryotaro Ishii Byung-Kun Kim Najib Kissani Alejandro Labastida-Ramirez Kristin Sophie Lange Ellina Lytvyak Dilara Onan Aynur Ozge Laura Papetti Lanfranco Pellesi Bianca Raffaelli Alberto Raggi Sebastian Straube Tsubasa Takizawa Surat Tanprawate Derya Uğurlu Uludüz Kiratikorn Vongvaivanich Marta Waliszewska-Prosół Yonggang Wang Tissa Wijeratne Jr-Wei Wu Sophie Merve Yener Paolo Martelletti Hallmarks of primary headache: part 2– Tension-type headache The Journal of Headache and Pain Tension-type headache Disease burden Primary headache Non-pharmacological treatments |
| title | Hallmarks of primary headache: part 2– Tension-type headache |
| title_full | Hallmarks of primary headache: part 2– Tension-type headache |
| title_fullStr | Hallmarks of primary headache: part 2– Tension-type headache |
| title_full_unstemmed | Hallmarks of primary headache: part 2– Tension-type headache |
| title_short | Hallmarks of primary headache: part 2– Tension-type headache |
| title_sort | hallmarks of primary headache part 2 tension type headache |
| topic | Tension-type headache Disease burden Primary headache Non-pharmacological treatments |
| url | https://doi.org/10.1186/s10194-025-02098-w |
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