The Mystery of chronic tension headache

This is the most common form of chronic headache (about 4 % of the world’s population), with, often, a negative impact on health and work.
Unlike migraine, this headache affects equally women and men. It consists of (according to the neurological definition) a headache that has a frequency ≥ 15 days a month, for at least 3 months, typically bilateral, with the quality of pressure (often the patient compares it to a helmet or to a headband that squeezes), with mild or moderate intensity (differently than migraine), the duration of hours or days or continuous. Sometimes it associates with nausea and photophobia.
The distinction with chronic migraine and drug overuse headache can be difficult, also because, often, the 3 conditions coexist.
The causes of chronic tension headache are mysterious and they are probably multiple. Probably, nervous and muscle peripheral mechanisms play a primary role with further sensitization of the brain centers of pain. The muscles of these patients become more rigid, which is the physical sign predominant for the clinical examination. The association with anxiety and depression is constant and stress is the most important trigger factor.
Although it is probably the most common headache in the world, tension headache remains a mystery, for the specialist too.
The complexity of mechanisms and causes explains the difficulty of treatment.
The effect of preventive pharmacological treatments (Amitryptiline or Mirtazapine) is often insufficient. The relaxation of cervical muscle and scalp is the primary objective and non-pharmacological treatments (massages, relaxation training, tens, cognitive-behavioral therapy for stress) can be indicated.
I propose mesotherapy.

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