Tension-type headache in women: hormonal influences and clinical implications

Tension-type headache (TTH) is the most common primary headache; however, studies specifically addressing its characteristics in women remain limited. We conducted a narrative review to explore the influence of hormonal fluctuations throughout a woman’s life on the course and clinical presentation of TTH. TTH is more prevalent in women than in men across all life stages, with a peak during the reproductive years. Several studies have identified menstruation as a potential trigger for TTH, and the existence of pure menstrual and menstrual-related TTH has been proposed as possible subtypes, although they have not yet been recognised in the International Classification of Headache Disorders. Evidence suggests that pregnancy, menopause (spontaneous or induced) and hormone therapy exert minimal influence on TTH, with some improvement observed during pregnancy. In pregnant women, non-pharmacological therapies should constitute the cornerstone of preventive management; among pharmacological options, amitriptyline, mirtazapine and venlafaxine remain the main preventive choices. The influence of female hormonal factors on TTH remains insufficiently investigated.