Tension-type Headache (TTH) is prevalent in 24-37% of the adult population with a higher prevalence in women and represents approximately 80% of all headache diagnoses. It has significant socioeconomic costs and reduced quality of life with the World Health Organisation (WHO) ranking primary headache as one of the top ten disability causes.
According to the International Headache Society’s International Classification of Headache Disorders, TTH lasts from 30 minutes to 7 days and is characterized by bilateral pressure, tightening, or non-pulsating pain of mild to moderate intensity that is not worsened by physical exertion and photophobia and/or phonophobia occur in some cases.
TTH is classified as either episodic (ETTH) or chronic (CTTH). In ETTH, the severity of symptoms increases with frequency and CTTH occurs more than 15 days in a month. ETTH is bilateral, generalized, or located fronto-occipitally, and is characterized by a constant, dull pressure or band-like headache associated with neck and shoulder pain; difficulty sleeping; chronic fatigue; irritability; disturbed concentration; mild sensitivity to light or noise; and generalized muscle aches. CTTH is associated with insomnia, teeth grinding, difficulty concentrating, and muscular tightness or stiffness in the neck, occipital, or frontal regions and is not aggravated by physical activity.
Triggers for TTH include stress, irregular meals, high intake or caffeine withdrawal, dehydration, sleep problems, reduced exercise, psycho-behavioural problems and hormonal disturbances in the female menstrual cycle. Stress has been shown to induce more headaches in patients with chronic TTH than healthy controls which could be to do with the hyperalgesic effects on already sensitised pain pathways (Bendtsen & Jensen, 2011, Buckley & Schub, 2013, Cathcart et al., 2010). It has been thought that TTH pain was from excessive muscle contraction, ischemia and inflammation in the head and neck muscles. Pericranial myofascial tissues are more tender in patients with TTH than controls and that can be associated with the intensity and frequency of the TTH.Based on pain perception studies, central sensitisation has been suggested as a cause of TTH induced by continuous nociceptive input from pericranial muscles and myofascial tissues.
Overall the search strategy for TTH found four reviews of TTH trials (Davis, Kononowech, Rolin, & Spierings, 2008; Hao, Xue, Dong, & Zheng, 2013; E. Jedel & Carlsson, 2005; Linde et al., 2009). The updated Cochrane review on TTH included eleven trials with five being used for meta-analysis. Trials were compared to sham acupuncture, physiotherapy, massage or relaxation. The conclusion was that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic TTH.
In one case series (Sun, 2011), hand acupuncture was used on twenty-nine patients with TTH and was considered to be an effective treatment. Bahai (2012) found in a single case that after five treatments the patients’ headaches were resolved with acupuncture and chiropractic spinal manipulative therapy.
The UK’s National Institute for Health and Clinical Excellence (NICE) published clinical guidelines in 2012 that conclude that acupuncture is effective for the prevention of TTH and could be prescribed by doctors.