Behavioral and psychologic aspects of the pathophysiology and management of tension-type headache.

Behavioral and psychologic factors in tension-type headache are reviewed with reference to pathophysiology, comorbid psychiatric disorders, headache triggers, and behavioral treatment, including the efficacy of behavioral treatments, brief minimal contact administration of behavioral treatment, therapeutic mechanisms underlying the effectiveness of behavioral treatments, and the integration of drug and behavioral treatments. Anxiety or depression may contribute to central sensitization that underlies frequent tension-type headaches. Excessive analgesic use, comorbid psychiatric disorders, or persistent unaddressed headache triggers may limit the effectiveness of headache treatment. Available drug and behavioral treatments are effective for episodic tension-type headache, but are only moderately effective for chronic tension-type headaches. The combination of behavioral and preventive drug therapies may improve outcomes for patients with chronic tension-type headache.