Tension-type headache: psychosomatic clinical assessment and treatment

Tension-type headache (TTH) is an ill-defined nosographic entity. The classification of headaches according to the Headache Classification Committee of the International Headache Society is closer to clinical reality with respect to the past classification. From an aetiopathological standpoint, hypotheses trying to explain primary headache disorders in a unified way are interesting. The treatment of this disorder requires a thorough diagnostic framing, which should take into account its psychosomatic aspects, focusing on the individual patient and his history. In fact, the many studies which aimed at characterising the disorder from a psychological viewpoint are not able to provide generalizable indications. In the same way, as it appears that none of the currently available treatments (drugs, biofeedback and psychotherapy) demonstrates clear superiority over the others, the choice should involve an intervention targeted on those factors which are held to be most important in an individual patient. Finally, as for acupuncture and other physical therapies, although interesting results are reported, these treatments are difficult to assess and should be reserved to particular cases.