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#TTH2022 Tension-type headache is the most prevalent neurological disorder worldwide with over 2 billion suffering from this headache. Chronic tension-type headache, a subtype of tension-type headcahe, alone has a global prevalence of 2 to 3%, and tension-type headache is ranked as the second most common cause of chronic disease and injury globally. Tension-type is more common in women than men, with a sex prevalence ratio of 1.2:1, far lower than the 3:1 ratio that is characteristic for migraine. Clinically, it is characterized by recurrent headaches which are normally bilateral, of tightening or pressing quality, and of mild or moderate intensity. The pain is generally not associated with nausea, photophobia or phonophobia, whereas pericranial tenderness (measured by manual palpation) and muscle hardness are common. In contrast to migraine, which represents its main differential diagnosis, the pain is also not typically aggravated by routine physical activity. TTH can be distinguished based on the frequency of attacks into infrequent episodic TTH, when headaches are present for less than 1 day per month or 12 per year, or frequent episodic TTH, when headache days are either between 1 to 14 in the month or above 12 and less than 180 in a year. Finally, in chronic TTH, more than 15 days per month or 180 days per year of headache are reported. TTH is often accompanied by a series of comorbidities, largely adding to the burden of the condition. These are most commonly anxiety, depression and sleep disturbances. Other forms of pain, such as neck and lower back pain, or migraine, are also more common in patients with TTH than the general population. Regardless of its very high prevalence worldwide, progression on the understanding of the underlying biology of TTH has been slow, mostly due to a lack of scientific studies and scarce recognition of the disorder, for which patients rarely seek medical attention. The pathophysiological mechanisms underlying TTH are still not fully understood. It is thought that peripheral myofascial and central mechanisms play an important role in the altered nociception at the basis of the disorder. Genetic factors may play a role in chronic tension-type headache. Of importance are also the mechanisms responsible for the transformation of tension-type headache from episodic into its chronic form, which is very debilitating for patients. Complex central brain mechanism such as sensitization of second-order brainstem neurons and altered top-down or descending pain modulation from the cortex, thalamus and limbic system, are most likely at the basis of this process. Become a member of the IHS to have access to more educational material on headache disorders and access to our journal of Cephalalgia and discount to the congress. Follow us in our social media channels to receive instant updates on grants, and other educational activities and career development opportunities. Encourage others to join us in the TTH campaign, visit our website to access material for your social media channels FOLLOW US • Website: www.ihs-headache.org • Twitter: ihs_official • Facebook: IHSheadache • Instagram: ihsheadache • LinkedIn: international-headache-society • YouTube: IHSInternationalHeadacheSociety JOIN US • Subscription to Cephalalgia • Online access to The Neuroscientist • Access to the IHS website Learning Centre • Early access to International Guidelines • Grants and fellowships • Network through the IHS Members Directory • Reduced registration to biennial International Headache Congress

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