Tension Type Headache Clinical and Epidemiological Study

Abstract

Background: Headaches are a major cause of morbidity. Tension-type headache (TTH) is a significant cause of sickness absence and impaired ability at work. TTH is classified as a primary headache according to the International Classification of Headache Disorders. It is a very common form of headache and can be: Episodic TTH (affects 78% of the population), this occurs on fewer than 15 days each month. It can evolve into the chronic variety. Chronic TTH (affects 3% of the population), this occurs on more than 15 days each month and has all the features of the episodic TTH

Objective: To explain the age and sex predominance, clinical presentation, the underlying causes, associated migraine and the 1-year prevalence of (TTH)

Methods: A prospective clinical and epidemiological survey of a sample of 380 patients in Mosul city seen in private neurologic clinic between 1st Jan 2011 and 31st Dec 2012 diagnosed as having tension type headache (TTH) according to a structured interview and a neurological examination using the criteria of the ICHD-II Diagnostic Criteria for Tensiontype headache (TTH). Patients were assessed regarding age, sex, clinical presentation, treatment given, the 1-year prevalence. Associated migraine (diagnosed according to ICHD-II Diagnostic Criteria for Migraine) in such patients was also assessed but those with migraine per se were excluded. All patients were given Naproxen 250 mg bd, Orphenadrine 35 mg + Paracetamol 450 mg bd, trifluoperazine 1 mg bd for 1 month and Amitriptyline for 3 months as prophylactic and the recurrence of headache thereafter were assessed.

Results: The study revealed 1-year prevalence of TTH was 21%, most common age between 15 and 29 year old (42%) and its incidence decreases with increasing age, females were affected more than males (78%); 95% of patients had history of recent or old psychological trauma; 75% of patients had Episodic Tension Type Headache (ETTH) and 25% had Chronic Tension Type Headache (CTTH). 14.5% had associated migraine headache. The response to treatment in 90% was within two weeks and 19% had recurrence of headache after 3 months treatment. Study concluded that TTH is common in this city and the most common presenting neurological disorder which cause limitation activities and affect patient’s lifestyle.

Conclusion: TTH is a common primary headache disorder in this community, it mostly affects females in young age and it is decreasing in older ages, most common cause is big recent or old trauma because of the unstable security environment in Mosul city, although the prevalence 21%, we think that the 1-year prevalence is much more probably because of small sample study so we recommend wider population study. TTH in most patients cause activity and work limitation and change in the patient’s lifestyle.