Prevalence of Trigger Factors and Associated Disorders in Tension-type Headache

Headache is most common pain suffered by
many. Tension-type headache is the most common primary headache disorder. As
per the Global Burden of Disease Study 2010, Tension-type headache is the
second most common disorder worldwide with an estimated prevalence of 20.8%. Trigger
factors have been widely studied in the context of migraine, but very few
studies have investigated trigger factors in the context of Tension-type

To study the prevalence of
trigger factors and associated disorders in tension-type headache researchers
conducted a study including a total of 400 patients above the age of 15 years
fulfilling the International Classification of Headache Disorders (ICHD 3)
criteria of frequent episodic tension-type headache (FETTH) and chronic
tension-type headache (CTTH). Details regarding demographics, headache
characteristics, triggers, and associated symptoms were obtained. Associated
psychiatric disorders were also recorded.

So the results showed that out of 400
patients, 360 (90%) were found to have triggers. The mean headache intensity on
visual analog scale (VAS) was 6.7. The most common trigger factor was emotional
stress among both males and females. There was a statistically significant
difference in the frequency of trigger factors between men and women for
emotional stress, sunlight, sleep deprivation/insomnia, noise, weather change,
studying, fried food, and hypersomnia. Psychiatric comorbidity was found in 29%
of individuals, with sleep disorder being the most common.

Tension-type headache has been an
underrated diagnosis despite being an extremely common disorder. The trigger
factors are less studied and their interactions are lesser known. The
diagnostic criteria as per International Classification of Headache Disorders 3
make tension-type headache a diagnosis of exclusion, rather than a positive
diagnosis of inclusion.

Therefore, the trigger factors must be
included in the diagnostic criteria and associated psychiatric disorders should
be sought for and treated simultaneously for better management and quality of


Jain D, Pandey G. A Study on
Prevalence of Trigger Factors and Associated Disorders in Tension-type
Headache. J Assoc Physicians India 2022;70(11):41–46.

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