is the most common type of primary headache and accounted for nearly 90% of all headaches as a result of muscle tightening in the back of the neck or other muscle groups in the body. Some researchers suggested that active trigger points TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with chronic and episodic tension-type headache forms(1)
Causes and Risk factors
A. Causes
There are no single cause of the headache, but some researchers agreed that tension type of headache are caused by muscle tightening in the back of the neck or other muscle groups in the body but some others suggested that headaches are caused by changes in brain chemicals called neurotransmitters as we mentioned in a migraine headaches. But in the study, conducted by Dr. and team found that children with frequent episodic tension-type headache (FETTH), at first instance, do not present deficits in the secretion of these cortisol and melatonin(5). Also Dr. Fernández-de-Las-Peñas C and team in the study of immunoglobulin A (IgA) (immune system) concentrations and α-amylase (sympathetic nervous system [SNS]) activity between children with chronic tension-type headache (CTTH) and healthy children, discovered that children with CTTH present with deficits in the immune system, but not dysfunction in the salivary cortisol (hypothalamic-pituitary-adrenocortical [HPA] axis) or sympathetic nervous system (SNS)(6)
B. Risk factors
1. Gender
Women tend to have more headaches than men
2. Changes in estrogen levels during a woman' s period or at menopause
Falling estrogen levels or estrogen withdrawal after periods of sustained higher levels can trigger migraine, and hormonally associated migraine is a specific clinical entity. It is important to diagnose the type of migraine, considering the fact that a decline in estrogen level at the end of menstrual cycle triggers migraine, so it can be treated by low levels of estrogen.(13).
3. Premenstrual syndrome
In the study of 50 women with headache in perimenstrual period in at least two out of three menstrual cycles, during the last year or longer. Two questionnaires, a questionnaire for headache and a questionnaire for PMS, showed that headache, occurring in perimenstrual period, is not always migraine, but could fulfill criteria for tension-type headache, as well. Specific characteristics of perimenstrual headache, which could distinguish it as a symptom of PMS(15)
4. Stress
Stress can have an impact on one’s mental and physical well-being, including migraine headache. Stress describes a negative concept, life events, and concomitant psychosomatic illnesses should be considered important when evaluating individuals with migraine, and gender aspects need to be taken into account(14)
5. Etc.
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