Clinical pattern of chronic tension-type headache in patients with concomitant hypertension at different ages

BACKGROUND: Chronic tension-type headache (CTTH) is a common condition observed across different age groups. Hypertension, when concomitant with CTTH, may affect the clinical course of the disease and reduce treatment efficacy. Most studies investigating the prevalence of combined headache and hypertension have shown a higher occurrence of hypertension in patients with CTTH compared with those suffering from episodic tension-type headache. However, age-specific features of these associations remain insufficiently studied.

AIM: This study aimed to investigate age-related clinical features of CTTH in patients with concomitant hypertension.

METHODS: A single-center retrospective–prospective observational study was conducted, consecutively enrolling 97 patients diagnosed with CTTH (International Classification of Headache Disorders, 3rd edition, 2018) who consulted a neurologist in 2019–2023. No medical interventions were performed. Patients were divided into two age groups: 18–44 years (group 1, young adults) and 45–74 years (group 2, middle-aged and older adults). Pain intensity, number of headache days, pericranial muscle dysfunction on manual examination, provoking factors, presence of hypertension, and current emotional state (assessed by Hamilton and Beck screening scales) were evaluated. Statistical analysis was performed using SPSS Statistics 26.0; p < 0.05.

RESULTS: Hypertension was detected in 32% of patients with CTTH: 9.6% in group 1 and 57.7% in group 2 (p < 0.001). Among patients aged 18–44, pain intensity was higher in those with hypertension compared to those without (p = 0.0463). In patients aged 45–74, hypertension was associated with a higher number of headache days compared to peers without hypertension (p = 0.0281). Pericranial muscle dysfunction was observed in 93.8% of examined individuals, with more pericranial muscles affected in group 2 (p = 0.042). Isolated involvement of a single muscle was more common in patients aged 18–44 (p < 0.001). Specifically, in younger patients without concomitant hypertension, significant involvement of the right trapezius muscle was observed (p = 0.029). In patients aged 45–74, regardless of hypertension status, combined pericranial muscle involvement was more frequent than isolated dysfunction (p = 0.019).

CONCLUSION: CTTH in patients of different ages with concomitant hypertension demonstrates distinct clinical features, underscoring the need for personalized therapy.