Hallmarks of primary headache: part 2- Tension-type headache

Li-Ling Hope Pan; Yu-Hsiang Ling; Shuu-Jiun Wang; Linda Al-Hassany; Wei-Ta Chen; Chia-Chun Chiang; Soo-Jin Cho; Min Kyung Chu; Gianluca Coppola; Adriana Della Pietra; Zhao Dong; Esme Ekizoglu; Charl Els; Fatemeh Farham; David Garcia-Azorin; Woo-Seok Ha; Fu-Jung Hsiao; Ryotaro Ishii; Byung-Kun Kim; Najib Kissani; Alejandro Labastida-Ramirez; Kristin Sophie Lange; Ellina Lytvyak; Dilara Onan; Aynur Ozge; Laura Papetti; Lanfranco Pellesi; Bianca Raffaelli; Alberto Raggi; Sebastian Straube; Tsubasa Takizawa; Surat Tanprawate; Derya Uğurlu Uludüz; Kiratikorn Vongvaivanich; Marta Waliszewska-Prosół; Yonggang Wang; Tissa Wijeratne; Jr-Wei Wu; Sophie Merve Yener; Paolo Martelletti

doi:10.1186/s10194-025-02098-w

Hallmarks of primary headache: part 2- Tension-type headache

Li-Ling Hope Pan
, Yu-Hsiang Ling
, Shuu-Jiun Wang
, Linda Al-Hassany
, Wei-Ta Chen
, Chia-Chun Chiang
, Soo-Jin Cho
, Min Kyung Chu
, Gianluca Coppola
, Adriana Della Pietra
, Zhao Dong
, Esme Ekizoglu
, Charl Els
, Fatemeh Farham
, David Garcia-Azorin
, Woo-Seok Ha
, Fu-Jung Hsiao
, Ryotaro Ishii
, Byung-Kun Kim
, Najib Kissani

Alejandro Labastida-Ramirez, Kristin Sophie Lange, Ellina Lytvyak, Dilara Onan, Aynur Ozge, Laura Papetti, Lanfranco Pellesi, Bianca Raffaelli, Alberto Raggi, Sebastian Straube, Tsubasa Takizawa, Surat Tanprawate, Derya Uğurlu Uludüz, Kiratikorn Vongvaivanich, Marta Waliszewska-Prosół, Yonggang Wang, Tissa Wijeratne, Jr-Wei Wu, Sophie Merve Yener, Paolo Martelletti

Division of Neuroscience

National Yang Ming Chiao Tung University
Taipei Veteran General Hospital
University Medical Center Rotterdam
Charite - Universitatsmedizin Berlin
Hallym University
Yonsei University College of Medicine
Sapienza University of Rome Polo Pontino - ICOT - Latina
The University of Iowa
The First Medical Center of Chinese PLA General Hospital
Istanbul University
University of Alberta
Tehran University of Medical Sciences
Hospital Universitario Rio Hortega
Kyoto Prefectural University of Medicine
Eulji University
Mohammed VI University Hospital Center of Marrakech
Yozgat Bozok University
Headache Clinic
Bambino Gesu Children's Hospital
University of Southern Denmark (SYDDANSK UNIVERISTET)
Neurology Outreach
Keio University
Chiang Mai University
Istanbul University Cerrahpasa
Bangkok International Hospital
Wroclaw Medical University
Capital University Of Medical Sciences
Sunshine Hospital
Migraine Foundation Australia
Università degli Studi di Roma La Sapienza

Research output: Contribution to journal › Review article › peer-review

Abstract

BACKGROUND AND AIM: Tension-type headache is the most prevalent primary headache disorder. While the episodic subtype is more common, chronic tension-type headache significantly impacts health-related quality of life and contribute to increased healthcare utilization and disability. Despite considerable advances in the understanding of tension-type headache, critical gaps persist. This paper aims to provide a comprehensive review of the hallmarks of tension-type headache, from its pathophysiology, comorbidities, treatment options, to psychosocial impact.

MAIN RESULTS: Multiple factors are associated with tension-type headache, including peripheral mechanisms (increased muscle tenderness and myofascial trigger points), central sensitization, genetic predisposition, and psychological comorbidities such as anxiety and depression. Neuroimaging and neurophysiological studies demonstrated altered pain processing in cortical and subcortical regions in patients with tension-type headache. Regarding treatment strategy, in addition to pharmacological treatment, novel insights into non-pharmacological interventions such as cognitive behavioral therapy, neuromodulation techniques, physical therapy, mindfulness, lifestyle management, and patient education were highlighted as valuable components of comprehensive management strategies.

CONCLUSIONS: A complex interplay between peripheral and central mechanisms and psychosocial stressors underpins tension-type headache. Integrated multidisciplinary approaches combining pharmacological and non-pharmacological interventions are critical for optimal patient outcomes. Further research should continue to refine the understanding of these mechanisms to improve targeted therapeutic strategies and reduce the global burden of tension-type headache.

Original language	English
Pages (from-to)	164
Journal	The journal of headache and pain
Volume	26
Issue number	1
DOIs	https://doi.org/10.1186/s10194-025-02098-w
Publication status	Published - 17 Jul 2025

Keywords

Humans
Tension-Type Headache/therapy

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10.1186/s10194-025-02098-w

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Pan, L.-L. H., Ling, Y.-H., Wang, S.-J., Al-Hassany, L., Chen, W.-T., Chiang, C.-C., Cho, S.-J., Chu, M. K., Coppola, G., Pietra, A. D., Dong, Z., Ekizoglu, E., Els, C., Farham, F., Garcia-Azorin, D., Ha, W.-S., Hsiao, F.-J., Ishii, R., Kim, B.-K., ... Martelletti, P. (2025). Hallmarks of primary headache: part 2- Tension-type headache. The journal of headache and pain, 26(1), 164. https://doi.org/10.1186/s10194-025-02098-w

@article{7c689efcb50c4ecd9b50a68a03717d80,

title = "Hallmarks of primary headache: part 2- Tension-type headache",

abstract = "BACKGROUND AND AIM: Tension-type headache is the most prevalent primary headache disorder. While the episodic subtype is more common, chronic tension-type headache significantly impacts health-related quality of life and contribute to increased healthcare utilization and disability. Despite considerable advances in the understanding of tension-type headache, critical gaps persist. This paper aims to provide a comprehensive review of the hallmarks of tension-type headache, from its pathophysiology, comorbidities, treatment options, to psychosocial impact.MAIN RESULTS: Multiple factors are associated with tension-type headache, including peripheral mechanisms (increased muscle tenderness and myofascial trigger points), central sensitization, genetic predisposition, and psychological comorbidities such as anxiety and depression. Neuroimaging and neurophysiological studies demonstrated altered pain processing in cortical and subcortical regions in patients with tension-type headache. Regarding treatment strategy, in addition to pharmacological treatment, novel insights into non-pharmacological interventions such as cognitive behavioral therapy, neuromodulation techniques, physical therapy, mindfulness, lifestyle management, and patient education were highlighted as valuable components of comprehensive management strategies.CONCLUSIONS: A complex interplay between peripheral and central mechanisms and psychosocial stressors underpins tension-type headache. Integrated multidisciplinary approaches combining pharmacological and non-pharmacological interventions are critical for optimal patient outcomes. Further research should continue to refine the understanding of these mechanisms to improve targeted therapeutic strategies and reduce the global burden of tension-type headache.",

keywords = "Humans, Tension-Type Headache/therapy",

author = "Pan, \{Li-Ling Hope\} and Yu-Hsiang Ling and Shuu-Jiun Wang and Linda Al-Hassany and Wei-Ta Chen and Chia-Chun Chiang and Soo-Jin Cho and Chu, \{Min Kyung\} and Gianluca Coppola and Pietra, \{Adriana Della\} and Zhao Dong and Esme Ekizoglu and Charl Els and Fatemeh Farham and David Garcia-Azorin and Woo-Seok Ha and Fu-Jung Hsiao and Ryotaro Ishii and Byung-Kun Kim and Najib Kissani and Alejandro Labastida-Ramirez and Lange, \{Kristin Sophie\} and Ellina Lytvyak and Dilara Onan and Aynur Ozge and Laura Papetti and Lanfranco Pellesi and Bianca Raffaelli and Alberto Raggi and Sebastian Straube and Tsubasa Takizawa and Surat Tanprawate and Ulud{\"u}z, \{Derya Uğurlu\} and Kiratikorn Vongvaivanich and Marta Waliszewska-Pros{\'o}{\l} and Yonggang Wang and Tissa Wijeratne and Jr-Wei Wu and Yener, \{Sophie Merve\} and Paolo Martelletti",

note = "{\textcopyright} 2025. The Author(s).",

year = "2025",

month = jul,

day = "17",

doi = "10.1186/s10194-025-02098-w",

language = "English",

volume = "26",

pages = "164",

journal = "The journal of headache and pain",

issn = "1129-2377",

publisher = "Springer Nature",

number = "1",

}

Pan, L-LH, Ling, Y-H, Wang, S-J, Al-Hassany, L, Chen, W-T, Chiang, C-C, Cho, S-J, Chu, MK, Coppola, G, Pietra, AD, Dong, Z, Ekizoglu, E, Els, C, Farham, F, Garcia-Azorin, D, Ha, W-S, Hsiao, F-J, Ishii, R, Kim, B-K, Kissani, N, Labastida-Ramirez, A, Lange, KS, Lytvyak, E, Onan, D, Ozge, A, Papetti, L, Pellesi, L, Raffaelli, B, Raggi, A, Straube, S, Takizawa, T, Tanprawate, S, Uludüz, DU, Vongvaivanich, K, Waliszewska-Prosół, M, Wang, Y, Wijeratne, T, Wu, J-W, Yener, SM & Martelletti, P 2025, 'Hallmarks of primary headache: part 2- Tension-type headache', The journal of headache and pain, vol. 26, no. 1, pp. 164. https://doi.org/10.1186/s10194-025-02098-w

TY - JOUR

T1 - Hallmarks of primary headache

T2 - part 2- Tension-type headache

AU - Pan, Li-Ling Hope

AU - Ling, Yu-Hsiang

AU - Wang, Shuu-Jiun

AU - Al-Hassany, Linda

AU - Chen, Wei-Ta

AU - Chiang, Chia-Chun

AU - Cho, Soo-Jin

AU - Chu, Min Kyung

AU - Coppola, Gianluca

AU - Pietra, Adriana Della

AU - Dong, Zhao

AU - Ekizoglu, Esme

AU - Els, Charl

AU - Farham, Fatemeh

AU - Garcia-Azorin, David

AU - Ha, Woo-Seok

AU - Hsiao, Fu-Jung

AU - Ishii, Ryotaro

AU - Kim, Byung-Kun

AU - Kissani, Najib

AU - Labastida-Ramirez, Alejandro

AU - Lange, Kristin Sophie

AU - Lytvyak, Ellina

AU - Onan, Dilara

AU - Ozge, Aynur

AU - Papetti, Laura

AU - Pellesi, Lanfranco

AU - Raffaelli, Bianca

AU - Raggi, Alberto

AU - Straube, Sebastian

AU - Takizawa, Tsubasa

AU - Tanprawate, Surat

AU - Uludüz, Derya Uğurlu

AU - Vongvaivanich, Kiratikorn

AU - Waliszewska-Prosół, Marta

AU - Wang, Yonggang

AU - Wijeratne, Tissa

AU - Wu, Jr-Wei

AU - Yener, Sophie Merve

AU - Martelletti, Paolo

PY - 2025/7/17

Y1 - 2025/7/17

N2 - BACKGROUND AND AIM: Tension-type headache is the most prevalent primary headache disorder. While the episodic subtype is more common, chronic tension-type headache significantly impacts health-related quality of life and contribute to increased healthcare utilization and disability. Despite considerable advances in the understanding of tension-type headache, critical gaps persist. This paper aims to provide a comprehensive review of the hallmarks of tension-type headache, from its pathophysiology, comorbidities, treatment options, to psychosocial impact.MAIN RESULTS: Multiple factors are associated with tension-type headache, including peripheral mechanisms (increased muscle tenderness and myofascial trigger points), central sensitization, genetic predisposition, and psychological comorbidities such as anxiety and depression. Neuroimaging and neurophysiological studies demonstrated altered pain processing in cortical and subcortical regions in patients with tension-type headache. Regarding treatment strategy, in addition to pharmacological treatment, novel insights into non-pharmacological interventions such as cognitive behavioral therapy, neuromodulation techniques, physical therapy, mindfulness, lifestyle management, and patient education were highlighted as valuable components of comprehensive management strategies.CONCLUSIONS: A complex interplay between peripheral and central mechanisms and psychosocial stressors underpins tension-type headache. Integrated multidisciplinary approaches combining pharmacological and non-pharmacological interventions are critical for optimal patient outcomes. Further research should continue to refine the understanding of these mechanisms to improve targeted therapeutic strategies and reduce the global burden of tension-type headache.

AB - BACKGROUND AND AIM: Tension-type headache is the most prevalent primary headache disorder. While the episodic subtype is more common, chronic tension-type headache significantly impacts health-related quality of life and contribute to increased healthcare utilization and disability. Despite considerable advances in the understanding of tension-type headache, critical gaps persist. This paper aims to provide a comprehensive review of the hallmarks of tension-type headache, from its pathophysiology, comorbidities, treatment options, to psychosocial impact.MAIN RESULTS: Multiple factors are associated with tension-type headache, including peripheral mechanisms (increased muscle tenderness and myofascial trigger points), central sensitization, genetic predisposition, and psychological comorbidities such as anxiety and depression. Neuroimaging and neurophysiological studies demonstrated altered pain processing in cortical and subcortical regions in patients with tension-type headache. Regarding treatment strategy, in addition to pharmacological treatment, novel insights into non-pharmacological interventions such as cognitive behavioral therapy, neuromodulation techniques, physical therapy, mindfulness, lifestyle management, and patient education were highlighted as valuable components of comprehensive management strategies.CONCLUSIONS: A complex interplay between peripheral and central mechanisms and psychosocial stressors underpins tension-type headache. Integrated multidisciplinary approaches combining pharmacological and non-pharmacological interventions are critical for optimal patient outcomes. Further research should continue to refine the understanding of these mechanisms to improve targeted therapeutic strategies and reduce the global burden of tension-type headache.

KW - Humans

KW - Tension-Type Headache/therapy

U2 - 10.1186/s10194-025-02098-w

DO - 10.1186/s10194-025-02098-w

M3 - Review article

C2 - 40676501

SN - 1129-2377

VL - 26

SP - 164

JO - The journal of headache and pain

JF - The journal of headache and pain

IS - 1

ER -

Hallmarks of primary headache: part 2- Tension-type headache

Abstract

Keywords

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