Investigating the relationships between headache characteristics and physical activity, autonomic function, psychological status, and quality of life in individuals with tension-type headache

Tension-type headache (TTH) is a highly prevalent primary headache disorder, yet its multidimensional associations remain incompletely understood. The aim of this study was to investigate the relationship between the characteristics of headaches in individuals with Tension-Type Headache (TTH) and physical activity, autonomic function, psychological state, and quality of life. This observational descriptive study included 93 individuals aged 18–65 years with TTH (mean age 25.6 years, 84.9% female), diagnosed by a neurologist in accordance with the International Classification of Headache Disorders (ICHD-3) criteria. Headache characteristics were recorded; physical activity was assessed using the International Physical Activity Questionnaire (IPAQ-7), autonomic function was measured using the Polar Verity Sense device to assess heart rate variability (RMSSD, LF/HF), psychological status was evaluated using the Depression Anxiety Stress Scale (DASS-21), and quality of life was assessed using the Headache Impact Scale. Relationships were analyzed using Spearman correlation analysis. The vast majority of individuals were inactive (33.3%) or minimally active (57%). Moderate to weak positive correlations were found between headache frequency and severity (resting, activity, and nighttime) and depression, anxiety, and stress scores (all p < 0.05). Additionally, headache frequency and severity were significantly associated with impaired quality of life (p < 0.01). In terms of autonomic function, longer headache duration and higher resting pain intensity were negatively correlated with the RMSSD value, an indicator of lower parasympathetic activity (both rho=-0.24, p = 0.018). A weak positive relationship was observed between headache onset time and physical activity (rho = 0.26, p = 0.011)., In this predominantly young adult and female cohort, TTH has been shown to be a multidimensional condition with weak to moderate associations to low physical activity, potentially decreased parasympathetic tone, psychological distress, and impaired quality of life. These findings map a cluster of biopsychosocial correlates in this demographic context and support the rationale for future research into integrating non-pharmacological, holistic approaches targeting physical activity, psychological support, and autonomic balance in the management of TTH. This crosssectional study has a design that does not require a clinical research record.