UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Tension-type headache in children

Author
Hope O'Brien, MD, FAHS
Section Editors
Marc C Patterson, MD, FRACP
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

Headache is a common complaint of children and adolescents. When a child presents with headache, it is important to determine whether the cause is due to primary disorder, as in migraine or tension-type headache (TTH) versus secondary, due to a brain lesion or infection (table 1).

This topic will review TTH in children. Other aspects of pediatric headache are reviewed elsewhere. (See "Headache in children: Approach to evaluation and general management strategies" and "Classification of migraine in children" and "Pathophysiology, clinical features, and diagnosis of migraine in children".)

DEFINITION

Based upon criteria from the International Classification of Headache Disorders, 3rd edition (ICHD-3), TTH is characterized by a bilateral, non-throbbing head pain of mild to moderate intensity, lasting 30 minutes to seven days [1]. TTH is not accompanied by nausea or vomiting. Either photophobia or photophobia may be present (but not both). The headache is not aggravated by routine physical activity. The term "tension-type headache" replaces the previous terms "muscle contraction headache" and "tension headache".

The overlap of some of these symptoms with those of migraine can make differentiation between the two headache types difficult [2]. (See 'Evaluation and diagnosis' below and 'Differential diagnosis' below.)

The current classification distinguishes three subforms of TTH [1]:

                    

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Jun 01 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  2. Zebenholzer K, Wöber C, Kienbacher C, Wöber-Bingöl C. Migrainous disorder and headache of the tension-type not fulfilling the criteria: a follow-up study in children and adolescents. Cephalalgia 2000; 20:611.
  3. Bendtsen L, Jensen R. Tension-type headache: the most common, but also the most neglected, headache disorder. Curr Opin Neurol 2006; 19:305.
  4. Ashina S, Bendtsen L, Ashina M, et al. Generalized hyperalgesia in patients with chronic tension-type headache. Cephalalgia 2006; 26:940.
  5. Jensen R. Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia 1999; 19:602.
  6. Ashina S, Bendtsen L, Ashina M. Pathophysiology of tension-type headache. Curr Pain Headache Rep 2005; 9:415.
  7. Bendtsen L. Central sensitization in tension-type headache--possible pathophysiological mechanisms. Cephalalgia 2000; 20:486.
  8. Vandenheede M, Schoenen J. Central mechanisms in tension-type headaches. Curr Pain Headache Rep 2002; 6:392.
  9. Fernández-de-Las-Peñas C, Fernández-Mayoralas DM, Ortega-Santiago R, et al. Bilateral, wide-spread, mechanical pain sensitivity in children with frequent episodic tension-type headache suggesting impairment in central nociceptive processing. Cephalalgia 2010; 30:1049.
  10. Fernández-Mayoralas DM, Fernández-de-las-Peñas C, Ortega-Santiago R, et al. Generalized mechanical nerve pain hypersensitivity in children with episodic tension-type headache. Pediatrics 2010; 126:e187.
  11. Balottin U, Termine C, Nicoli F, et al. Idiopathic headache in children under six years of age: a follow-up study. Headache 2005; 45:705.
  12. Balottin U, Nicoli F, Pitillo G, et al. Migraine and tension headache in children under 6 years of age. Eur J Pain 2004; 8:307.
  13. Stovner Lj, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27:193.
  14. Barea LM, Tannhauser M, Rotta NT. An epidemiologic study of headache among children and adolescents of southern Brazil. Cephalalgia 1996; 16:545.
  15. Ozge A, Bŭgdayci R, Saşmaz T, et al. The sensitivity and specificity of the case definition criteria in diagnosis of headache: a school-based epidemiological study of 5562 children in Mersin. Cephalalgia 2003; 23:138.
  16. Anttila P, Metsähonkala L, Aromaa M, et al. Determinants of tension-type headache in children. Cephalalgia 2002; 22:401.
  17. Ayatollahi SM, Moradi F, Ayatollahi SA. Prevalences of migraine and tension-type headache in adolescent girls of Shiraz (southern Iran). Headache 2002; 42:287.
  18. Laurell K, Larsson B, Eeg-Olofsson O. Prevalence of headache in Swedish schoolchildren, with a focus on tension-type headache. Cephalalgia 2004; 24:380.
  19. Abu-Arefeh I, Russell G. Prevalence of headache and migraine in schoolchildren. BMJ 1994; 309:765.
  20. Linet MS, Stewart WF, Celentano DD, et al. An epidemiologic study of headache among adolescents and young adults. JAMA 1989; 261:2211.
  21. van der Wouden JC, van der Pas P, Baaij D, van Suijlekom-Smit LW. Headache in adolescents in Dutch general practice. Funct Neurol 2000; 15 Suppl 3:130.
  22. Ozge A, Sasmaz T, Cakmak SE, et al. Epidemiological-based childhood headache natural history study: after an interval of six years. Cephalalgia 2010; 30:703.
  23. Sillanpää M, Piekkala P. Prevalence of migraine and other headaches in early puberty. Scand J Prim Health Care 1984; 2:27.
  24. Krogh AB, Larsson B, Linde M. Prevalence and disability of headache among Norwegian adolescents: A cross-sectional school-based study. Cephalalgia 2015; 35:1181.
  25. Mathew PG, Garza I. Headache. Semin Neurol 2011; 31:5.
  26. Collin C, Hockaday JM, Waters WE. Headache and school absence. Arch Dis Child 1985; 60:245.
  27. Rothner AD, Linder SL, Wasiewski WW, O'Neill KM. Chronic nonprogressive headaches in children and adolescents. Semin Pediatr Neurol 2001; 8:34.
  28. Gallai V, Sarchielli P, Carboni F, et al. Applicability of the 1988 IHS criteria to headache patients under the age of 18 years attending 21 Italian headache clinics. Juvenile Headache Collaborative Study Group. Headache 1995; 35:146.
  29. Aromaa M, Sillanpää M, Rautava P, Helenius H. Pain experience of children with headache and their families: A controlled study. Pediatrics 2000; 106:270.
  30. Zuckerman B, Stevenson J, Bailey V. Stomachaches and headaches in a community sample of preschool children. Pediatrics 1987; 79:677.
  31. Rossi LN, Cortinovis I, Menegazzo L, et al. Classification criteria and distinction between migraine and tension-type headache in children. Dev Med Child Neurol 2001; 43:45.
  32. Monteith TS, Sprenger T. Tension type headache in adolescence and childhood: where are we now? Curr Pain Headache Rep 2010; 14:424.
  33. Rossi LN, Vajani S, Cortinovis I, et al. Analysis of the International Classification of Headache Disorders for diagnosis of migraine and tension-type headache in children. Dev Med Child Neurol 2008; 50:305.
  34. Rothner AD. The evaluation of headaches in children and adolescents. Semin Pediatr Neurol 1995; 2:109.
  35. Richardson GM, McGrath PJ, Cunningham SJ, Humphreys P. Validity of the headache diary for children. Headache 1983; 23:184.
  36. Gladstein J. Headaches: the pediatrician's perspective. Semin Pediatr Neurol 1995; 2:119.
  37. Askmark H, Lundberg PO, Olsson S. Drug-related headache. Headache 1989; 29:441.
  38. Mathew NT, Kurman R, Perez F. Drug induced refractory headache--clinical features and management. Headache 1990; 30:634.
  39. Fernández-de-las-Peñas C, Fernández-Mayoralas DM, Ortega-Santiago R, et al. Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache. J Headache Pain 2011; 12:35.
  40. Fernández-Mayoralas DM, Fernández-de-las-Peñas C, Palacios-Ceña D, et al. Restricted neck mobility in children with chronic tension type headache: a blinded, controlled study. J Headache Pain 2010; 11:399.
  41. Lewis DW, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002; 59:490.
  42. Prince JS, Gunderman R, Coley BD, et al. Expert Panel on Pediatric Imaging. ACR Appropriateness Criteria. Headache -- child. American College of Radiology, Reston, VA, 2008. www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonPediatricImaging/HeadacheChildDoc3.aspx (Accessed on March 17, 2011).
  43. Sempere AP, Porta-Etessam J, Medrano V, et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia 2005; 25:30.
  44. Graf WD, Kayyali HR, Abdelmoity AT, et al. Incidental neuroimaging findings in nonacute headache. J Child Neurol 2010; 25:1182.
  45. Schwedt TJ, Guo Y, Rothner AD. "Benign" imaging abnormalities in children and adolescents with headache. Headache 2006; 46:387.
  46. US Headache Consortium. Evidence-based guidelines in the primary care setting: Neuroimaging in patients with nonacute headache, 2000. www.aan.com/professionals/practice/pdfs/gl0088.pdf (Accessed on March 23, 2011).
  47. Medina LS, Pinter JD, Zurakowski D, et al. Children with headache: clinical predictors of surgical space-occupying lesions and the role of neuroimaging. Radiology 1997; 202:819.
  48. Seshia SS, Abu-Arafeh I, Hershey AD. Tension-type headache in children: the Cinderella of headache disorders! Can J Neurol Sci 2009; 36:687.
  49. Dowson AJ. Assessing the impact of migraine. Curr Med Res Opin 2001; 17:298.
  50. Smetana GW. The diagnostic value of historical features in primary headache syndromes: a comprehensive review. Arch Intern Med 2000; 160:2729.
  51. Manzano S, Doyon-Trottier E, Bailey B. Myth: Ibuprofen is superior to acetaminophen for the treatment of benign headaches in children and adults. CJEM 2010; 12:220.
  52. Packman B, Packman E, Doyle G, et al. Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache. Headache 2000; 40:561.
  53. Lewis DW, Winner P, Wasiewski W. The placebo responder rate in children and adolescents. Headache 2005; 45:232.
  54. Holroyd KA, O'Donnell FJ, Stensland M, et al. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA 2001; 285:2208.
  55. Tomkins GE, Jackson JL, O'Malley PG, et al. Treatment of chronic headache with antidepressants: a meta-analysis. Am J Med 2001; 111:54.
  56. Grazzi L, Andrasik F, Usai S, Bussone G. Magnesium as a treatment for paediatric tension-type headache: a clinical replication series. Neurol Sci 2005; 25:338.
  57. Miano S, Parisi P, Pelliccia A, et al. Melatonin to prevent migraine or tension-type headache in children. Neurol Sci 2008; 29:285.
  58. Verhagen AP, Damen L, Berger MY, et al. Conservative treatments of children with episodic tension-type headache. A systematic review. J Neurol 2005; 252:1147.
  59. Arndorfer RE, Allen KD. Extending the efficacy of a thermal biofeedback treatment package to the management of tension-type headaches in children. Headache 2001; 41:183.
  60. Bussone G, Grazzi L, D'Amico D, et al. Biofeedback-assisted relaxation training for young adolescents with tension-type headache: a controlled study. Cephalalgia 1998; 18:463.
  61. Trautmann E, Lackschewitz H, Kröner-Herwig B. Psychological treatment of recurrent headache in children and adolescents--a meta-analysis. Cephalalgia 2006; 26:1411.
  62. Eccleston C, Palermo TM, de C Williams AC, et al. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2012; 12:CD003968.
  63. Powers SW, Kashikar-Zuck SM, Allen JR, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA 2013; 310:2622.
  64. Grazzi L, D'Amico D, Usai S, et al. Disability in young patients suffering from primary headaches. Neurol Sci 2004; 25 Suppl 3:S111.
  65. Ernst MM, O'Brien HL, Powers SW. Cognitive-Behavioral Therapy: How Medical Providers Can Increase Patient and Family Openness and Access to Evidence-Based Multimodal Therapy for Pediatric Migraine. Headache 2015; 55:1382.
  66. Kovacs M. The Children's Depression, Inventory (CDI). Psychopharmacol Bull 1985; 21:995.
  67. BECK AT, WARD CH, MENDELSON M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561.
  68. Lachar D, Gruber CP.. Personality Inventory for Children, Second Edition (PIC-2), Western Psychological Services, Los Angeles 2001.
  69. Kline RB, Lachar D, Sprague DJ. The personality inventory for children (PIC): an unbiased predictor of cognitive and academic status. J Pediatr Psychol 1985; 10:461.
  70. De Benedittis G, Lorenzetti A. Minor stressful life events (daily hassles) in chronic primary headache: relationship with MMPI personality patterns. Headache 1992; 32:330.
  71. Drayton M. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Occup Med (Lond) 2009; 59:135.
  72. O'Brien HL, Kabbouche MA, Kacperski J, Hershey AD. Treatment of pediatric migraine. Curr Treat Options Neurol 2015; 17:326.
  73. Linder SL. Treatment of childhood headache with dihydroergotamine mesylate. Headache 1994; 34:578.
  74. Winner P. Classification of pediatric headache. Curr Pain Headache Rep 2008; 12:357.
  75. Parisi P, Papetti L, Spalice A, et al. Tension-type headache in paediatric age. Acta Paediatr 2011; 100:491.
  76. Guidetti V, Galli F. Evolution of headache in childhood and adolescence: an 8-year follow-up. Cephalalgia 1998; 18:449.
  77. Guidetti V, Galli F, Fabrizi P, et al. Headache and psychiatric comorbidity: clinical aspects and outcome in an 8-year follow-up study. Cephalalgia 1998; 18:455.