Objective:

To explore tension-type headache (TTH) as a multidimensional condition influenced by various interacting factors rather than a single mechanism.

Approach:

Key Findings:

• Tension-type headache is influenced by musculoskeletal, central neurophysiological, psychosocial, and lifestyle-related factors.
• Musculoskeletal dysfunction, such as craniocervical muscle issues and myofascial trigger points, is associated with headache expression.
• Chronic tension-type headache shows elevated resting muscle activity and impaired coordination even between episodes.
• Psychosocial factors like stress, anxiety, and sleep quality modulate headache burden.
• A proposed framework categorizes contributing factors into four domains: peripheral musculoskeletal, central neurophysiological, psychosocial, and behavioral/lifestyle, and supports a continuum model for understanding episodic versus chronic TTH.

Interpretation:

Tension-type headache should be viewed as a complex, multidimensional phenomenon rather than a homogeneous disorder, with various interacting factors influencing symptoms and treatment responses.

Limitations:

• Predominance of observational studies limits causal interpretation.
• Heterogeneous study designs and populations complicate findings.
• Lack of quantitative pooling and formal systematic review protocol.
• No standardized risk-of-bias assessment conducted.

Conclusion:

Future longitudinal and interventional studies are needed to validate the proposed model of tension-type headache and its assessment pathways.

Sources:

• Journal of Clinical Medicine
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