Tension-type headaches: what they are and how to treat them

Most clinicians and patients traditionally think of the tension-type headache (TTH) as the "unmigraine" or "nonmigraine." This view may be changing as distinctions between migraines and nonmigrainesdissolve. For many years, clinical diagnosis of TTH was based on nonthrobbing, bilateral pain. The mechanisms underlying the cause of TTH are still poorly understood. Some clinicians keep TTH and migraine in two separate clinical environments, while others see the two as a spectrum disorder with a common pathophysiology;however, there is not enough evidence to make anyone theory the clear-cut victor. Treatment strategies for TTH have evolved in favor of the patient. Newer categories of pharmacologic agents, often stabilizing to neuronal networks, are the modern mainstay of therapy for migraines and mixed headache disorders such as TTH.