Many Chronic Tension Headache Patients Also May Have Mood Or Anxiety Disorders, Study Finds

June 27, 1998

SAN FRANCISCO -- People with chronic tension headaches often have pain 25 or more days a month, pain that is far more debilitating than scientists previously thought, according to an Ohio University researcher who is leading a study of 245 chronic tension headache sufferers. Results from the study found that 66 percent of participants have headaches nearly every day. Weekly records kept by patients indicate that more than 70 percent record disrupted sleep, fatigue and headache-related anxiety or stress. Forty-four percent say their headaches affect their performance at work or school and 72 percent said the pain caused them to miss work or school an average of 3.5 days in the last six months.

The research was presented June 27 at the annual meeting of the American Association for the Study of Headache in San Francisco.

"We were very surprised to see that two-thirds of our study participants have pain more than 25 days a month, and some have pain seven days a week, 52 weeks a year," says Kenneth Holroyd, professor of psychology at Ohio University and principal investigator on the study. "This type of chronic pain can ripple through your life and affect mood and function and your overall quality of life. That's definitely what we're seeing here."

The findings suggest chronic tension headaches, which affect 2 percent to 3 percent of the nation's population, are more debilitating than researchers previously thought, Holroyd says, which is important for physicians who treat these headache patients.

"I think the pain associated with chronic tension headaches tends to be underestimated because it is not as dramatic as it is in migraines," Holroyd says. "A migraine is very acute and most of the time, the impairment largely ends when the migraine ends. But with chronic tension headaches, the pain may persist all the time."

A migraine usually is accompanied by nausea, sensitivity to light and dizziness. Tension headache sufferers have bilateral pain in the head and neck; many compare the pressure to a vise. The pain may be brief or drag on for days, even weeks.

Nearly all of the study participants say stress can trigger a painful headache and 69 percent have a family history of problem headaches. But researchers were most surprised to find that 52 percent of study participants met criteria for impairment on either physical or social functioning scales of the Medical Outcomes Study (MOS), a national survey used by scientists and physicians to measure the impact of chronic diseases and therapy on patients.

"These headaches are disrupting their lives as much as or more as other chronic diseases that have been assessed with the MOS measure," Holroyd says. "Physicians treating patients with chronic tension headaches need to be aware that this pain reaches into many areas of patients' lives, and treatment should reflect that."

Of the 245 people in this study, 205 have been enrolled in a separate treatment research project under way at Ohio University. Supported by a $1.3 million National Institutes of Health grant, it is the largest-ever study of drug and nondrug therapies for chronic tension headaches.

Participants are randomly assigned to one of three treatment groups or a control group. One group receives an antidepressant that, when given in smaller doses than those used to treat depression, can sometimes prevent headaches. Another group uses stress management to control headache pain and a third group is a combination of the drug and nondrug therapies.

More than 2,000 people have been evaluated since the study began four years ago, most of them women. Holroyd says that isn't surprising, since women are two to three times more likely to have chronic tension headaches, although scientists aren't sure why.

Other study authors are Gay Lipchik and Cornelia Pinnell, project managers for the headache study and assistant research professors in psychology in the College of Arts and Sciences; Frank O'Donnell, clinical associate professor and Gary Cordingley, associate professor of neurology, both in the College of Osteopathic Medicine; and Michael Stensland and Kimberly Hill, graduate students in psychology, all at Ohio University.
Contact: Kenneth Holroyd, (740) 593-1085;
Written by: Kelli Whitlock, (740) 593-0383;

Ohio University

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