Depression and Anxiety Disorder in Tension-Type Headache

Gerilim Tipi Baş Ağrısında Depresyon ve Kaygı Bozukluğu

As per the International Headache Society, there are 118 different types of headaches observed in the society. Of those, tension-type headache is the most prevalent type of headache in the society. It is generally overlooked due to its light symptoms; however, severe ones can disrupt daily life.

What is tension-type headache?

Tension-type headache is a type of ache that encircles the head like a tape, causing heaviness in the forehead-temple areas, and tenseness on shoulders. The pain, similar to migraine, can spread from the rear to the front; nevertheless, it distinguishes from migraine in that it creates a sensation of the head being pulled backwards, with no throbbing. Moreover, tension-type headache can be caused primarily by stress, anxiety, and fear. Therefore, it is highly like that tension-type headache is accompanied by psychiatric disorders. Of these, anxiety disorder and depression have been more frequently associated with patients diagnosed with tension-type headache, compared to the group that does not experience pain (Puce et al., 1999; Holroyd et al., 2000).

Disorders accompanying tension-type headache

Tension-type headache being accompanied by depression and anxiety disorder varies based on the region. In a national study carried out with Korean citizens (Song et al., 2016), the rate of prevalence for tension-type headache was found as 21.12%, while this rate was within the range of 20-40% in North America, and 35-78% in Europe. Cultural factors, ethnicity, and economic status can be effective in interregional prevalence. The rate of anxiety disorder and depression accompanying tension-type headache also varies based on the region. For instance, in the example of Italy, anxiety disorder is observed in half of the patients diagnosed with tension-type headache, and depression in one third, while these rates are respectively 17% and 21% in North America.

Depression, anxiety, and tension-type headache

In the tension-type headache accompanied by depression and anxiety, the severity of the pain and the burden it caused were reported to be felt much more. Moreover, the prevalence of osmophobia and phonophobia in patients with tension-type headache is no less than those observed in patients with migraine. It was observed that both types of phobias could explain the depression and anxiety conditions accompanying the disorder (Song et al., 2016).

Psychiatric disorders like depression and anxiety accompanying tension-type headache may make it necessary to utilize the group of antidepressant drugs and alternative non-pharmacological treatment methods (biofeedback, acupuncture, etc.) for an optimum treatment. It was found that the concomitant use of tricyclic antidepressants and the stress management therapy both alleviated the severity of the pain and reduced the use of painkillers, particularly in chronic tension-type headache (Holroyd et al., 2001).

– Song, T. J., Cho, S. J., Kim, W. J., Yang, K. I., Yun, C. H., & Chu, M. K. (2016). Anxiety and depression in tension-type headache: a population-based study. PloS one11(10), e0165316.
– Puca, F., Genco, S., Prudenzano, M. P., Savarese, M., Bussone, G., D’Amico, D., … & Marabini, S. (1999). Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. Cephalalgia19(3), 159-164.
– Holroyd, K. A., Stensland, M., Lipchik, G. L., Hill, K. R., O’Donnell, F. S., & Cordingley, G. (2000). Psychosocial correlates and impact of chronic tension‐type headaches. Headache: The Journal of Head and Face Pain40(1), 3-16.
– Freitag, Frederick (2013). Managing and Treating Tension-type Headache. Medical Clinics of North America, 97(2), 281–292. doi:10.1016/j.mcna.2012.12.003.
– Holroyd, K. A., O’Donnell, F. J., Stensland, M., Lipchik, G. L., Cordingley, G. E., & Carlson, B. W. (2001). Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. Jama285(17), 2208-2215.