Open Access

Pain and tension-type headache: a review of the possible pathophysiological mechanisms

The Journal of Headache and PainOfficial Journal of the Italian Society for the Study of Headaches5:61

DOI: 10.1007/s10194-004-0061-1

Received: 4 August 2003

Accepted: 15 December 2003


Tension-type headache represents a considerable health problem and is one of the most costly diseases in the modern society. However, the knowledge about the pathophysiological mechanisms leading to this disorder is limited. The review presents a summary of available research and experimental data on the pathophysiological mechanisms and the recent pathophysiological models. Although the pain in tension-type headache clinically resembles pain from myofascial tissues, both peripheral and central mechanisms are believed to be involved. It is likely that myofascial nociception is important in episodic tension-type headache and that central mechanisms are involved in the pathophysiology of the chronic form. Neurophysiological investigations are introduced to be the most suitable to confirm an involvement of trigeminal pathways, to substantiate recent theories on sensitization phenomena, and to disclose the exact pain-control mechanisms. More studies are needed to elucidate the mechanisms leading to central sensitization and to develop new therapeutic strategies.

Key words

Central sensitization Pathophysiology Tension-type headache