Pure Tension-type Headache Versus Tension-type Headache in the Migraineur

Abstract

Primary headache disorders include tension-type headache and migraine. These headache types can be differentiated based on strict clinical definitions that depend on the patient's signs and symptoms. However, some of the clinical features can overlap, and in addition, the same comorbid conditions can occur in both headache types. Distinction between these headache types on occasion can be difficult due to comorbid conditions such as temporomandibular joint disorders and myofascial pain with forward head posturing, which may be present in both headache disorders, and thus result in similar features in both conditions. Furthermore, chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache. Finally, in some patients, both tension-type headache and migraine may occur at different times.

Are migraine and tension-type headache diagnostic types or points on a severity continuum? An exploration of the latent taxometric structure of headache

“…As migraine “chronification” occurs, protypical migraine features (i.e., nausea, photophobia, and phonophobia) can overlap with TTH symptoms as the latter become more prominent, convoluting the diagnostic process [5]. Given the well-established relation between headache frequency and medication overuse, migraineurs who overuse medications also commonly experience a progressive reduction in migraine-associated features and develop headaches that more closely resemble TTH [5,29].…”

“…As migraine “chronification” occurs, protypical migraine features (i.e., nausea, photophobia, and phonophobia) can overlap with TTH symptoms as the latter become more prominent, convoluting the diagnostic process [5]. Given the well-established relation between headache frequency and medication overuse, migraineurs who overuse medications also commonly experience a progressive reduction in migraine-associated features and develop headaches that more closely resemble TTH [5,29]. Rokicki and colleagues [43] found a mixed presentation of TTH and migraine symptoms among a college-aged sample, and others have shown a similar mixed pattern of headache symptoms in children and adolescents, with unilateral distribution becoming more prominent with age [22,53].…”

“…We hypothesized that historical clinical perceptions would be supported in that there would be evidence of taxometrically different ‘types’ of headaches. However, in light of data indicating less distinct phenotypes among individuals with frequent headaches [5] and those of younger age [43,53], we posited that diagnostic/symptomatic distinctions between headache types would be less prominent among the latter subgroups.…”

Tension‐Type Headache or Migraine? Adolescents' Pain Descriptions Are of Little Help

“…The results of higher pain intensity in adolescents with pure migraine compared with those with TTH plus migraine may also be explained by chronification. It was suggested previously that a chronification of migraine results in a decrease of migraine features 38 . In our sample, adolescents are suffering from pain for a long time, and according to the transformation hypothesis, a transformation in the phenotype of migraine might have taken place.…”

An individually tailored behavioral medicine treatment in physical therapy for tension-type headache – an experimental single-case study

“…In many group trials, P2 would have been excluded, since she could not always discriminate if she was having migraine or TTH 21. To suffer from both TTH and migraine is common,32 as it is that the patient cannot always identify which type of headache that is present 33. It is important that patients with two headache diagnoses are subject to research as well, and for that the experimental single-case design is most suitable.…”