Tension-type headache and migraine causes
What are they?
Tension-type headache (TTH) is the most common type of headache, and is a head pain that occurs in frequent or infrequent shorter episodes (episodic)*, or occurs regularly or is constantly present (chronic)†2. TTH are usually mild or moderate in intensity and may present with a “pressing” or “tightening” quality. It is usually not aggravated by physical activity (e.g., climbing stairs).2
Migraines can be severe and disabling and can reoccur over time and are often felt on one side of the head.3 It has a “pulsating” quality and is often associated with symptoms of light, sound, and odor sensitivity. 3 A migraine is usually accompanied by nausea and neck stiffness, and during an attack patients will experience visual disturbances such as seeing spots or stars, and then feel fatigued or dizzy afterwards.3,4
* Less than 15 days per month. † Greater than 15 days per month.
Pathophysiology, causes, and triggers of tension-type headaches
Pathophysiology of tension-type headaches
Unlike migraines, the mechanism of TTH is not well understood.
The pathogenesis of TTH is probably multifactorial, but the precise mechanisms are uncertain.5,6 Given the wide variation in frequency and intensity in TTH, not only between individuals but within individuals over time, it is likely that the underlying pain mechanisms in TTH are dynamic and vary from one individual to another, and potentially from one attack to another in the same individual.5,6
TTH = tension-type headache.
The triggers for TTH are similar to migraines. The main triggers of TTH are related to stress or mental tension.7 Other triggers associated with TTH are sleep problems, fatigue, weather changes, menstruation, and the inability to relax after work.7
TTH = tension-type headache.
Pathophysiology, causes and triggers of migraines
Pathophysiology of migraines
Migraines are caused when the nerves and blood vessels around the trigeminal nerve (trigeminovascular system) located in the head are triggered to fire abnormally.8 When this happens, the trigeminal nerves produce, and release substances called vasoactive neuropeptides, such as substance P, neurokinin A, CGRP, and nitric oxide.8,9
On release, these substances cause inflammation of the surrounding blood vessels, which in turn activates the pain receptors nearby (nociceptors). 8,9 When nociceptors are activated, these sensory nerves send signals to parts of the brain responsible for producing sensation of pain such as the thalamus and cerebral cortex. 8,9
CGRP = calcitonin gene-related peptide.
Migraines are thought to have a genetic basis, with environmental factors playing a significant role in how it affects migraine sufferers.10
In fact, if 1 parent has migraines, there is a 50% chance of a child developing it.4 If both parents suffer from migraines, then the risk of their child developing migraines increases to 75%.4
Migraine triggers can be classified into different categories of factors such as:3,11
Factors Triggers Emotional Stress and anxiety Physical Poor sleep, menstruation, hormonal changes, lack of exercise, dehydration Dietary Red wine, fasting, or skipping meals, artificial sweeteners, monosodium glutamate Environmental Changes in weather, flickering light Medicines Drugs that cause vasodilatation (nitrates), oral contraceptives
Understanding headaches and migraine
How do they present?
Find out the signs and symptoms of tension-type headache and migraines. Discover how to differentiate them and learn about “red flag” symptoms that indicate when a referral to a doctor is necessary.
What can you recommend to your patients for pain relief from their headaches?
Find out more about the pharmacological and non-pharmacological treatments for tension-type headache and migraines.