Advances in the Pathophysiology of Tension-type Headache: From Stress to Central Sensitization

Current Pain and Headache Reports 2009, 13:484-494 Current Medicine Group  LLC ISSN 1531-3433 Copyright © 2010 by Current Medicine Group LLC

Yaniv Chen, MDCM

Corresponding author:
Yaniv Chen, MDCM
Department of Neurology, NYU Medical Center, New York University, 550 First Avenue, New York, NY, 10016.
Email: yaniv.chen@nyumc.org

Tension-type headache (TTH) is the most common and most socioeconomically costly headache.
Yet our knowledge regarding TTH pathophysiological mechanisms is still in its early stages. Psychological stress and weak coping mechanisms may initiate and propagate physiological pain via activation of second messengers in downstream substrates involved in pain.

It seems that peripheral mechanisms are predominant in the episodic type (ETTH), whereas central mechanisms are involved in the chronic type (CTTH) of tension headache.

The conversion from ETTH to CTTH is most relevant to the clinician and the patient, as CTTH is the most debilitating.

This paper focuses and summarizes our current understanding of central sensitization, the process by which this conversion occurs in TTH, and proposes an integrated model to explain how ETTH progresses into CTTH in genetically susceptible individuals.