Aetiology

The aetiology of tension headache is unknown.

There is often a significant psychological component to the disease:

• psychological distress may precipitate the headaches
• the patient may inappropriately medicalise what is a normal response to stress

There is much interest in sustained involuntary muscle contraction of the neck and scalp muscles in the pathogenesis of tension headache:

• fibrillating muscle fascicles may irritate pain nerve fibres
• sustained contraction may cause local areas of painfull muscle ischaemia

A connective tissue bridge between the spinal dura and the rectus capitis posterior minor muscle has been reported. It has been proposed that muscle tension can stretch the dura, resulting in pain (1).

Abuse of analgesics can cause, or at least perpetuate, tension headaches.

Reference:

• Hack, GD. et al (1995). Anatomic relation between the rectus capitis posterior minor muscle and the dura mater. Spine. 20(23), 2484-6.