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Tension headache
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Tension headache
Other names Tension-type headache (TTH), stress headache
Tension-headache.jpg
A woman experiencing a tension headache
Specialty Neurology
Differential diagnosis Migraine
Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.

Pain medication, such as aspirin and ibuprofen, are effective for the treatment of tension headache.[1][2] Tricyclic antidepressants appear to be useful for prevention.[3] Evidence is poor for SSRIs, propranolol and muscle relaxants.[4][5]

As of 2016, tension headaches affect about 1.89 billion people[6] and are more common in women than men (23% to 18% respectively).[7]

Contents
1 Signs and symptoms
2 Risk factors
3 Mechanism
3.1 Neurotransmitters
3.2 Synapses
3.3 Stress
4 Diagnosis
4.1 Classification
4.2 Differential diagnosis
5 Prevention
5.1 Lifestyle
5.2 Medications
6 Treatment
6.1 Exercise
6.2 Medications
6.2.1 Episodic
6.2.2 Chronic
6.3 Manual therapy
7 Epidemiology
8 References
9 External links
Signs and symptoms
According to the third edition of the International Classification of Headache Disorders,[8] the attacks must meet the following criteria:

A duration of between 30 minutes and 7 days.
At least two of the following four characteristics:
bilateral location
pressing or tightening (non-pulsating) quality
mild or moderate intensity
not aggravated by routine physical activity such as walking or climbing stairs
Both of the following:
no nausea or vomiting
no more than one of photophobia (sensitivity to bright light) or phonophobia (sensitivity to loud sounds)
Tension-type headaches may be accompanied by tenderness of the scalp on manual pressure during an attack.

Risk factors
Various precipitating factors may cause tension-type headaches in susceptible individuals:[9]

Anxiety
Stress
Sleep problems
Young age
Poor health
Mechanism
Although the musculature of the head and neck and psychological factors such as stress may play a role in the overall pathophysiology of TTH, neither is currently believed to be the sole cause of the development of TTH.[10] The pathologic basis of TTH is most likely derived from a combination of personal factors, environmental factors, and alteration of both peripheral and central pain pathways.[11] Peripheral pain pathways receive pain signals from pericranial (around the head) myofascial tissue (protective tissue of muscles) and alteration of this pathway likely underlies episodic tension-type headache (ETTH).[11] In addition to these myofascial tissue pain signals, pericranial muscle tenderness, inflammation, and muscle ischemia have been postulated in headache literature to be causal factors in the peripheral pathophysiology of TTH.[9] However, multiple studies have failed to illustrate evidence for a pathologic role of either ischemia or inflammation within the muscles.[9] Pericranial tenderness is also not likely a peripheral causal factor for TTH, but may instead act to trigger a chronic pain cycle in which the peripheral pain response is transformed over time into a centralized pain response.[9] It is then these prolonged alterations in the peripheral pain pathways that lead to increased excitability of the central nervous system pain pathways, resulting in the transition of episodic tension-type headache into chronic tension type headache (CTTH).[11] Specifically, the hyperexcitability occurs in central nociceptive neurons (the trigeminal spinal nucleus, thalamus, and cerebral cortex) resulting in central sensitization, which manifests clinically as allodynia and hyperalgesia of CTTH.[9][12] Additionally, CTTH patients exhibit decreased thermal and pain thresholds which further bolsters support for central sensitization occurring in CTTH.[9]

The alterations in physiology that lead to overall process of central sensitization involve changes at the level of neural tracts, neurotransmitters and their receptors, the neural synapse, and the post-synaptic membrane. Evidence suggests dysfunction in supraspinal descending inhibitory pain pathways may contribute to the pathogenesis of central sensitization in CTTH.[9]

Neurotransmitters
Specific neuronal receptors and neurotransmitters thought to be most involved include NMDA and AMPA receptors, glutamate, serotonin (5-HT), β-endorphin, and nitric oxide (NO).[9] Of the neurotransmitters, NO plays a major role in central pain pathways and likely contributes to the process of central sensitization.[9] Briefly, the enzyme nitric oxide synthase (NOS) forms NO which ultimately results in vasodilatation and activation of central nervous system pain pathways.[9] Serotonin may also be of significant importance and involved in malfunctioning pain filter located in the brain stem. The view is that the brain misinterprets information—for example from the temporal muscle or other muscles—and interprets this signal as pain. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as nortriptyline. However, the analgesic effect of nortriptyline, as well as amitriptyline in chronic tension-type headache, is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved.[13][9]

Synapses
Regarding synaptic level changes, homosynaptic facilitation and heterosynaptic facilitation are both likely to be involved in central sensitization.[9] Homosynaptic facilitation occurs when synapses normally involved in pain pathways undergo changes involving receptors on the post-synaptic membrane as well as the molecular pathways activated upon synaptic transmission. Lower pain thresholds of CTTH result from this homosynaptic facilitation. In contrast, heterosynaptic facilitation occurs when synapses not normally involved in pain pathways become involved. Once this occurs innocuous signals are interpreted as painful signals. Allodynia and hyperalgesia of CTTH represent this heterosynaptic facilitation clinically.[9]

Stress
In the literature, stress is mentioned as a factor and may be implicated via the adrenal axis. This ultimately results in downstream activation of NMDA receptor activation, NFκB activation, and upregulation of iNOS with subsequent production of NO leading to pain as described above.[9]

Diagnosis
With TTH the physical exam is expected to be normal with perhaps the exception of either pericranial tenderness upon palpation of the cranial muscles, or presence of either photophobia or phonophobia.[14]

Classification

Classification system for tension-type headache.
The International Headache Society's most current classification system for headache disorders is the International Classification of Headache Disorders 3rd edition (ICHD-3) as of 2018. This classification system separates tension-type headache (TTH) into two main groups: episodic (ETTH) and chronic (CTTH). CTTH is defined as fifteen days or more per month with headache for greater than three months, or one-hundred eighty days or more, with headache per year.[15] ETTH is less than fifteen days per month with headache or less than one-hundred eighty days with headache per year.[16][17] However, ETTH is further sub-divided into frequent and infrequent TTH.[18] Frequent TTH is defined as ten or more episodes of headache over the course of one to fourteen days per month for greater than three months, or at least twelve days per year, but less than one-hundred eighty days per year.[17] Infrequent TTH is defined as ten or more episodes of headache for less than one day per month or less than twelve days per year.[16] Furthermore, all sub-classes of TTH can be classified as having presence or absence of pericranial tenderness, which is tenderness of the muscles of the head.[18] Probable TTH is utilized for patients with some characteristics, but not all characteristics of a given sub-type of TTH.[19]

Differential diagnosis
Extensive testing is not needed as TTH is diagnosed by history and physical. However, if symptoms indicative of a more serious diagnosis are present, a contrast enhanced MRI may be utilized. Furthermore, giant cell arteritis should be considered in those 50 years of age and beyond. Screening for giant cell arteritis involves the blood tests of erythrocyte sedimentation rate (ESR) and c-reactive protein.[14][10]

Migraine
Oromandibular dysfunction
Sinus disease
Eye disease
Cervical spine disease
Infection in immunocompromised
Intracranial mass
Idiopathic intracranial hypertension
Medication overuse headache
Secondary headache (headache due to other disorder)
Giant cell arteritis ( ≥50 years of age)
Dermatochalasis
Prevention
Lifestyle
Drinking water and avoiding dehydration helps in preventing tension headache.[20] Using stress management and relaxing often makes headaches less likely.[20] Drinking alcohol can make headaches more likely or severe.[20] Good posture might prevent headaches if there is neck pain.[20] People who have jaw clenching might develop headaches, and getting treatment from a dentist might prevent those headaches.[20] Biofeedback techniques may also help.[21]

Medications
People who have 15 or more headaches in a month may be treated with certain types of daily antidepressants which act to prevent continued tension headaches from occurring.[20] In those who are predisposed to tension type headaches the first-line preventative treatment is amitriptyline, whereas mirtazapine and venlafaxine are second-line treatment options.[22] Tricyclic antidepressants appear to be useful for prevention.[3] Tricyclic antidepressants have been found to be more effective than SSRIs but have greater side effects.[3] Evidence is poor for the use of SSRIs, propranolol, and muscle relaxants for prevention of tension headaches.[4][5]

Treatment
Treatment for a current tension headache is to drink water and confirm that there is no dehydration.[20] If symptoms do not resolve within an hour for a person who has had water, then stress reduction might resolve the issue.[20]

Exercise
Evidence supports simple neck and shoulder exercises in managing ETTH and CTTH for headaches associated with neck pain. Exercises include stretching, strengthening and range of motion exercises. CTTH can also benefit from combined therapy from stress therapy, exercises and postural correction.[23]

Medications
Episodic
Over-the-counter drugs, like paracetamol, aspirin, or NSAIDs (ibuprofen, naproxen, ketoprofen), can be effective but tend to only be helpful as a treatment for a few times in a week at most.[1][20][24][11] For those with gastrointestinal problems (ulcers and bleeding), acetaminophen is the better choice over aspirin, though both provide roughly equivalent pain relief.[11] It is important to note that large daily doses of paracetamol should be avoided as it may cause liver damage especially in those that consume 3 or more drinks/day and those with pre-existing liver disease.[11] Ibuprofen, one of the NSAIDs listed above, is a common choice for pain relief but may also lead to gastrointestinal discomfort.[11]

Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations, analgesic/barbiturate combinations such as Fiorinal).[2][22] In addition analgesic/caffeine combinations are popular such as the aspirin-caffeine combination or the aspirin, acetaminophen and caffeine combinations.[11] Frequent use (daily or skipping just one day in between use for 7–10 days) of any of the above analgesics may, however, lead to medication overuse headache.[2][22][11]

Muscle relaxants are typically used for and are helpful with acute post-traumatic TTH rather than ETTH.[11] Opioid medications are not utilized to treat ETTH.[11] Botulinum toxin does not appear to be helpful.[25]

Chronic
Classes of medications involved in treatment of CTTH include tricyclic antidepressants (TCAs), SSRIs, benzodiazepine (Clonazepam in small evening dose), and muscle relaxants. The most commonly utilized TCA is amitriptyline due to the postulated role in decreasing central sensitization and analgesic relief. Another popular TCA used is Doxepine. SSRIs may also be utilized for management of CTTH. For patients with concurrent muscle spasm and CTTH, the muscle relaxant Tizanidine can be a helpful option.[11]

These medications however, are not effective if concurrent overuse of over the counter medications or other analgesics is occurring.[11] Stopping overuse must occur prior to proceeding with other forms of treatment.[11]

Manual therapy
Current evidence for acupuncture is slight. A 2016 systematic review suggests better evidence among those with frequent tension headaches, but concludes that further trials comparing acupuncture with other treatment options are needed.[26]

People with tension-type headache often use spinal manipulation, soft tissue therapy, and myofascial trigger point treatment. Studies of effectiveness are mixed. A 2006 systematic review found no rigorous evidence supporting manual therapies for tension headache.[27] A 2005 structured review found only weak evidence for the effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[28] A 2004 Cochrane review found that spinal manipulation may be effective for migraine and tension headache, and that spinal manipulation and neck exercises may be effective for cervicogenic headache.[29] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of spinal manipulation.[30] A 2012 systematic review of manual therapy found that hands-on work may reduce both the frequency and the intensity of chronic tension-type headaches.[31] More current literature also appears to be mixed however, CTTH patients may benefit from massage and physiotherapy as suggested by a systemic review examining these modalities via RCTs specifically for this patient population[32] Despite being helpful, the review also makes a point to note that there is no difference in effectiveness long term (6 months) between those CTTH patients utilizing TCAs and physiotherapy.[32] Another systemic review comparing manual therapy to pharmacologic therapy also supports little long term difference in outcome regarding TTH frequency, duration, and intensity.[33]

Epidemiology
As of 2016 tension headaches affect about 1.89 billion people [34] and are more common in women than men (23% to 18% respectively).[7] Despite its benign character, tension-type headache, especially in its chronic form, can impart significant disability on patients as well as burden on society at large.[6]

References
Derry S, Wiffen PJ, Moore RA, Bendtsen L (July 2015). "Ibuprofen for acute treatment of episodic tension-type headache in adults". The Cochrane Database of Systematic Reviews. 7 (7): CD011474. doi:10.1002/14651858.CD011474.pub2. PMC 6457940. PMID 26230487.
Loder E, Rizzoli P (January 2008). "Tension-type headache". BMJ. 336 (7635): 88–92. doi:10.1136/bmj.39412.705868.AD. PMC 2190284. PMID 18187725.
Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O'Malley PG (October 2010). "Tricyclic antidepressants and headaches: systematic review and meta-analysis". BMJ. 341: c5222. doi:10.1136/bmj.c5222. PMC 2958257. PMID 20961988.
Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW (April 2010). "Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review". Family Practice. 27 (2): 151–65. doi:10.1093/fampra/cmp089. PMID 20028727.
Banzi R, Cusi C, Randazzo C, Sterzi R, Tedesco D, Moja L (May 2015). "Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults". The Cochrane Database of Systematic Reviews. 5 (5): CD011681. doi:10.1002/14651858.CD011681. PMC 6864942. PMID 25931277.
Lenaerts ME (December 2006). "Burden of tension-type headache". Current Pain and Headache Reports. 10 (6): 459–62. doi:10.1007/s11916-006-0078-z. PMID 17087872.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders,3rd edition. Cephalalgia 33(9) 629–808
Chen, Yaniv (2009). "Advances in the pathophysiology of tension-type headache: From stress to central sensitization". Current Pain and Headache Reports. 13 (6): 484–494. doi:10.1007/s11916-009-0078-x. ISSN 1531-3433. PMID 19889292.
Walls, Ron; Hockberger, Robert; Gausche-Hill, Marianne (2017-03-09). Rosen's emergency medicine : concepts and clinical practice. Walls, Ron M.; Hockberger, Robert S.; Gausche-Hill, Marianne (Ninth ed.). Philadelphia, PA. p. 1269. ISBN 9780323390163. OCLC 989157341.
Jay GW, Barkin RL (December 2017). "Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache". Disease-A-Month. 63 (12): 342–367. doi:10.1016/j.disamonth.2017.05.001. PMID 28886861.
Ashina S, Bendtsen L, Ashina M (December 2005). "Pathophysiology of tension-type headache". Current Pain and Headache Reports. 9 (6): 415–22. doi:10.1007/s11916-005-0021-8. PMID 16282042.
Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J (January 1999). "Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomised crossover trial". Lancet. 353 (9149): 287–9. doi:10.1016/S0140-6736(98)01079-4. PMID 9929022.
Smith, Jonathan (2019). Ferri's Clinical Advisor. Philadelphia: Elsevier. p. 1348. ISBN 978-0-323-53042-2.
Ihsclassification. "2.3 Chronic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.1 Infrequent episodic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.2 Frequent episodic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2. Tension-type headache (TTH)". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.4 Probable tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Consumer Reports (28 April 2016). "Tension Headache Treatment and Prevention". Consumer Reports. Retrieved 25 May 2016.
Nestoriuc Y, Rief W, Martin A (June 2008). "Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators". Journal of Consulting and Clinical Psychology. 76 (3): 379–96. doi:10.1037/0022-006X.76.3.379. PMID 18540732.
Bendtsen L, Jensen R (May 2011). "Treating tension-type headache -- an expert opinion". Expert Opinion on Pharmacotherapy. 12 (7): 1099–109. doi:10.1517/14656566.2011.548806. PMID 21247362.
Varatharajan, Sharanya; Ferguson, Brad; Chrobak, Karen; Shergill, Yaadwinder; Côté, Pierre; Wong, Jessica J.; Yu, Hainan; Shearer, Heather M.; Southerst, Danielle; Sutton, Deborah; Randhawa, Kristi (July 2016). "Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration". European Spine Journal. 25 (7): 1971–1999. doi:10.1007/s00586-016-4376-9. ISSN 0940-6719. PMID 26851953.
Derry S, Wiffen PJ, Moore RA (January 2017). "Aspirin for acute treatment of episodic tension-type headache in adults". The Cochrane Database of Systematic Reviews. 1: CD011888. doi:10.1002/14651858.CD011888.pub2. PMC 6464783. PMID 28084009.
Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, Armstrong MJ, Gloss D, Potrebic S, Jankovic J, Karp BP, Naumann M, So YT, Yablon SA (May 2016). "Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology". Neurology. 86 (19): 1818–26. doi:10.1212/WNL.0000000000002560. PMC 4862245. PMID 27164716.
Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin BC, Vickers A, White AR (April 2016). "Acupuncture for the prevention of tension-type headache". The Cochrane Database of Systematic Reviews. 4 (4): CD007587. doi:10.1002/14651858.CD007587.pub2. PMC 4955729. PMID 27092807.
Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". The Clinical Journal of Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.
Biondi DM (June 2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
Bronfort G, et al. (2004). Brønfort G (ed.). "Non-invasive physical treatments for chronic/recurrent headache". The Cochrane Database of Systematic Reviews (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. (Retracted, see doi:10.1002/14651858.cd001878.pub3. If this is an intentional citation to a retracted paper, please replace {{Retracted}} with {{Retracted|intentional=yes}}.)
Ernst E, Canter PH (April 2006). "A systematic review of systematic reviews of spinal manipulation". Journal of the Royal Society of Medicine. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMC 1420782. PMID 16574972.
Chaibi A, Russell MB (July 2012). "Manual therapies for cervicogenic headache: a systematic review". The Journal of Headache and Pain. 13 (5): 351–9. doi:10.1007/s10194-012-0436-7. PMC 3381059. PMID 22460941.
Chaibi A, Russell MB (October 2014). "Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials". The Journal of Headache and Pain. 15: 67. doi:10.1186/1129-2377-15-67. PMC 4194455. PMID 25278005.
Mesa-Jiménez JA, Lozano-López C, Angulo-Díaz-Parreño S, Rodríguez-Fernández ÁL, De-la-Hoz-Aizpurua JL, Fernández-de-Las-Peñas C (December 2015). "Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials". Cephalalgia. 35 (14): 1323–32. doi:10.1177/0333102415576226. PMID 25748428.
Stovner, Lars Jacob; Nichols, Emma; Steiner, Timothy J.; Abd-Allah, Foad; Abdelalim, Ahmed; Al-Raddadi, Rajaa M.; Ansha, Mustafa Geleto; Barac, Aleksandra; Bensenor, Isabela M.; Doan, Linh Phuong; Edessa, Dumessa; Endres, Matthias; Foreman, Kyle J.; Gankpe, Fortune Gbetoho; Gopalkrishna, Gururaj; Goulart, Alessandra C.; Gupta, Rahul; Hankey, Graeme J.; Hay, Simon I.; Hegazy, Mohamed I.; Hilawe, Esayas Haregot; Kasaeian, Amir; Kassa, Dessalegn H.; Khalil, Ibrahim; Khang, Young-Ho; Khubchandan, Jagdish; Kim, Yun Jin; Kokubo, Yoshihiro; Mohammed, Mohammed A.; et al. (November 2018). "Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016". The Lancet. Neurology. 17 (11): 954–976. doi:10.1016/S1474-4422(18)30322-3. PMC 6191530. PMID 30353868.
External links
Classification D
ICD-10: G44.2ICD-9-CM: 307.81, 339.1MeSH: D018781DiseasesDB: 12554
External resources
MedlinePlus: 000797eMedicine: article/1142908
American Council for Headache Education
National Headache Foundation
World Headache Alliance
vte
Diseases of the nervous system, primarily CNS
vte
Headache
Categories: Headaches
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gamatron332 · 2021-01-20 04:16:37

Thanks slinky! Hey everyone did you know that giving hugs actually makes you happier? Well if you didn’t you know now! So here is a friendly reminder to hug the important people in your life. It will make them and you feel amazing! As for now since we’re all quarantined here is a virtual hug for everyone reading this. (!hug! Feel the happiness? Now share it!)

DestinyCall · 2021-01-20 04:47:15

images?q=tbn:ANd9GcQVGw-YtwQ3gXDhxrX_n521PEP4fUaMXkMlOg&usqp=CAU

Fun fact - This Thursday, January 21st, is National Hug day in the US.

gamatron332 · 2021-01-20 04:53:05

DestinyCall wrote:

Fun fact - This Thursday, January 21st, is National Hug day in the US.

: D hug day!

TheRubyCart · 2021-01-20 05:27:13

DiscardedSlinky wrote:

Tension headache
From Wikipedia, the free encyclopedia
Jump to navigationJump to search
Tension headache
Other names Tension-type headache (TTH), stress headache
Tension-headache.jpg
A woman experiencing a tension headache
Specialty Neurology
Differential diagnosis Migraine
Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.
Pain medication, such as aspirin and ibuprofen, are effective for the treatment of tension headache.[1][2] Tricyclic antidepressants appear to be useful for prevention.[3] Evidence is poor for SSRIs, propranolol and muscle relaxants.[4][5]
As of 2016, tension headaches affect about 1.89 billion people[6] and are more common in women than men (23% to 18% respectively).[7]

Contents
1 Signs and symptoms
2 Risk factors
3 Mechanism
3.1 Neurotransmitters
3.2 Synapses
3.3 Stress
4 Diagnosis
4.1 Classification
4.2 Differential diagnosis
5 Prevention
5.1 Lifestyle
5.2 Medications
6 Treatment
6.1 Exercise
6.2 Medications
6.2.1 Episodic
6.2.2 Chronic
6.3 Manual therapy
7 Epidemiology
8 References
9 External links
Signs and symptoms
According to the third edition of the International Classification of Headache Disorders,[8] the attacks must meet the following criteria:
A duration of between 30 minutes and 7 days.
At least two of the following four characteristics:
bilateral location
pressing or tightening (non-pulsating) quality
mild or moderate intensity
not aggravated by routine physical activity such as walking or climbing stairs
Both of the following:
no nausea or vomiting
no more than one of photophobia (sensitivity to bright light) or phonophobia (sensitivity to loud sounds)
Tension-type headaches may be accompanied by tenderness of the scalp on manual pressure during an attack.
Risk factors
Various precipitating factors may cause tension-type headaches in susceptible individuals:[9]
Anxiety
Stress
Sleep problems
Young age
Poor health
Mechanism
Although the musculature of the head and neck and psychological factors such as stress may play a role in the overall pathophysiology of TTH, neither is currently believed to be the sole cause of the development of TTH.[10] The pathologic basis of TTH is most likely derived from a combination of personal factors, environmental factors, and alteration of both peripheral and central pain pathways.[11] Peripheral pain pathways receive pain signals from pericranial (around the head) myofascial tissue (protective tissue of muscles) and alteration of this pathway likely underlies episodic tension-type headache (ETTH).[11] In addition to these myofascial tissue pain signals, pericranial muscle tenderness, inflammation, and muscle ischemia have been postulated in headache literature to be causal factors in the peripheral pathophysiology of TTH.[9] However, multiple studies have failed to illustrate evidence for a pathologic role of either ischemia or inflammation within the muscles.[9] Pericranial tenderness is also not likely a peripheral causal factor for TTH, but may instead act to trigger a chronic pain cycle in which the peripheral pain response is transformed over time into a centralized pain response.[9] It is then these prolonged alterations in the peripheral pain pathways that lead to increased excitability of the central nervous system pain pathways, resulting in the transition of episodic tension-type headache into chronic tension type headache (CTTH).[11] Specifically, the hyperexcitability occurs in central nociceptive neurons (the trigeminal spinal nucleus, thalamus, and cerebral cortex) resulting in central sensitization, which manifests clinically as allodynia and hyperalgesia of CTTH.[9][12] Additionally, CTTH patients exhibit decreased thermal and pain thresholds which further bolsters support for central sensitization occurring in CTTH.[9]
The alterations in physiology that lead to overall process of central sensitization involve changes at the level of neural tracts, neurotransmitters and their receptors, the neural synapse, and the post-synaptic membrane. Evidence suggests dysfunction in supraspinal descending inhibitory pain pathways may contribute to the pathogenesis of central sensitization in CTTH.[9]
Neurotransmitters
Specific neuronal receptors and neurotransmitters thought to be most involved include NMDA and AMPA receptors, glutamate, serotonin (5-HT), β-endorphin, and nitric oxide (NO).[9] Of the neurotransmitters, NO plays a major role in central pain pathways and likely contributes to the process of central sensitization.[9] Briefly, the enzyme nitric oxide synthase (NOS) forms NO which ultimately results in vasodilatation and activation of central nervous system pain pathways.[9] Serotonin may also be of significant importance and involved in malfunctioning pain filter located in the brain stem. The view is that the brain misinterprets information—for example from the temporal muscle or other muscles—and interprets this signal as pain. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as nortriptyline. However, the analgesic effect of nortriptyline, as well as amitriptyline in chronic tension-type headache, is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved.[13][9]
Synapses
Regarding synaptic level changes, homosynaptic facilitation and heterosynaptic facilitation are both likely to be involved in central sensitization.[9] Homosynaptic facilitation occurs when synapses normally involved in pain pathways undergo changes involving receptors on the post-synaptic membrane as well as the molecular pathways activated upon synaptic transmission. Lower pain thresholds of CTTH result from this homosynaptic facilitation. In contrast, heterosynaptic facilitation occurs when synapses not normally involved in pain pathways become involved. Once this occurs innocuous signals are interpreted as painful signals. Allodynia and hyperalgesia of CTTH represent this heterosynaptic facilitation clinically.[9]
Stress
In the literature, stress is mentioned as a factor and may be implicated via the adrenal axis. This ultimately results in downstream activation of NMDA receptor activation, NFκB activation, and upregulation of iNOS with subsequent production of NO leading to pain as described above.[9]
Diagnosis
With TTH the physical exam is expected to be normal with perhaps the exception of either pericranial tenderness upon palpation of the cranial muscles, or presence of either photophobia or phonophobia.[14]

Classification
Classification system for tension-type headache.
The International Headache Society's most current classification system for headache disorders is the International Classification of Headache Disorders 3rd edition (ICHD-3) as of 2018. This classification system separates tension-type headache (TTH) into two main groups: episodic (ETTH) and chronic (CTTH). CTTH is defined as fifteen days or more per month with headache for greater than three months, or one-hundred eighty days or more, with headache per year.[15] ETTH is less than fifteen days per month with headache or less than one-hundred eighty days with headache per year.[16][17] However, ETTH is further sub-divided into frequent and infrequent TTH.[18] Frequent TTH is defined as ten or more episodes of headache over the course of one to fourteen days per month for greater than three months, or at least twelve days per year, but less than one-hundred eighty days per year.[17] Infrequent TTH is defined as ten or more episodes of headache for less than one day per month or less than twelve days per year.[16] Furthermore, all sub-classes of TTH can be classified as having presence or absence of pericranial tenderness, which is tenderness of the muscles of the head.[18] Probable TTH is utilized for patients with some characteristics, but not all characteristics of a given sub-type of TTH.[19]
Differential diagnosis
Extensive testing is not needed as TTH is diagnosed by history and physical. However, if symptoms indicative of a more serious diagnosis are present, a contrast enhanced MRI may be utilized. Furthermore, giant cell arteritis should be considered in those 50 years of age and beyond. Screening for giant cell arteritis involves the blood tests of erythrocyte sedimentation rate (ESR) and c-reactive protein.[14][10]
Migraine
Oromandibular dysfunction
Sinus disease
Eye disease
Cervical spine disease
Infection in immunocompromised
Intracranial mass
Idiopathic intracranial hypertension
Medication overuse headache
Secondary headache (headache due to other disorder)
Giant cell arteritis ( ≥50 years of age)
Dermatochalasis
Prevention
Lifestyle
Drinking water and avoiding dehydration helps in preventing tension headache.[20] Using stress management and relaxing often makes headaches less likely.[20] Drinking alcohol can make headaches more likely or severe.[20] Good posture might prevent headaches if there is neck pain.[20] People who have jaw clenching might develop headaches, and getting treatment from a dentist might prevent those headaches.[20] Biofeedback techniques may also help.[21]
Medications
People who have 15 or more headaches in a month may be treated with certain types of daily antidepressants which act to prevent continued tension headaches from occurring.[20] In those who are predisposed to tension type headaches the first-line preventative treatment is amitriptyline, whereas mirtazapine and venlafaxine are second-line treatment options.[22] Tricyclic antidepressants appear to be useful for prevention.[3] Tricyclic antidepressants have been found to be more effective than SSRIs but have greater side effects.[3] Evidence is poor for the use of SSRIs, propranolol, and muscle relaxants for prevention of tension headaches.[4][5]
Treatment
Treatment for a current tension headache is to drink water and confirm that there is no dehydration.[20] If symptoms do not resolve within an hour for a person who has had water, then stress reduction might resolve the issue.[20]
Exercise
Evidence supports simple neck and shoulder exercises in managing ETTH and CTTH for headaches associated with neck pain. Exercises include stretching, strengthening and range of motion exercises. CTTH can also benefit from combined therapy from stress therapy, exercises and postural correction.[23]
Medications
Episodic
Over-the-counter drugs, like paracetamol, aspirin, or NSAIDs (ibuprofen, naproxen, ketoprofen), can be effective but tend to only be helpful as a treatment for a few times in a week at most.[1][20][24][11] For those with gastrointestinal problems (ulcers and bleeding), acetaminophen is the better choice over aspirin, though both provide roughly equivalent pain relief.[11] It is important to note that large daily doses of paracetamol should be avoided as it may cause liver damage especially in those that consume 3 or more drinks/day and those with pre-existing liver disease.[11] Ibuprofen, one of the NSAIDs listed above, is a common choice for pain relief but may also lead to gastrointestinal discomfort.[11]
Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations, analgesic/barbiturate combinations such as Fiorinal).[2][22] In addition analgesic/caffeine combinations are popular such as the aspirin-caffeine combination or the aspirin, acetaminophen and caffeine combinations.[11] Frequent use (daily or skipping just one day in between use for 7–10 days) of any of the above analgesics may, however, lead to medication overuse headache.[2][22][11]
Muscle relaxants are typically used for and are helpful with acute post-traumatic TTH rather than ETTH.[11] Opioid medications are not utilized to treat ETTH.[11] Botulinum toxin does not appear to be helpful.[25]
Chronic
Classes of medications involved in treatment of CTTH include tricyclic antidepressants (TCAs), SSRIs, benzodiazepine (Clonazepam in small evening dose), and muscle relaxants. The most commonly utilized TCA is amitriptyline due to the postulated role in decreasing central sensitization and analgesic relief. Another popular TCA used is Doxepine. SSRIs may also be utilized for management of CTTH. For patients with concurrent muscle spasm and CTTH, the muscle relaxant Tizanidine can be a helpful option.[11]
These medications however, are not effective if concurrent overuse of over the counter medications or other analgesics is occurring.[11] Stopping overuse must occur prior to proceeding with other forms of treatment.[11]
Manual therapy
Current evidence for acupuncture is slight. A 2016 systematic review suggests better evidence among those with frequent tension headaches, but concludes that further trials comparing acupuncture with other treatment options are needed.[26]
People with tension-type headache often use spinal manipulation, soft tissue therapy, and myofascial trigger point treatment. Studies of effectiveness are mixed. A 2006 systematic review found no rigorous evidence supporting manual therapies for tension headache.[27] A 2005 structured review found only weak evidence for the effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[28] A 2004 Cochrane review found that spinal manipulation may be effective for migraine and tension headache, and that spinal manipulation and neck exercises may be effective for cervicogenic headache.[29] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of spinal manipulation.[30] A 2012 systematic review of manual therapy found that hands-on work may reduce both the frequency and the intensity of chronic tension-type headaches.[31] More current literature also appears to be mixed however, CTTH patients may benefit from massage and physiotherapy as suggested by a systemic review examining these modalities via RCTs specifically for this patient population[32] Despite being helpful, the review also makes a point to note that there is no difference in effectiveness long term (6 months) between those CTTH patients utilizing TCAs and physiotherapy.[32] Another systemic review comparing manual therapy to pharmacologic therapy also supports little long term difference in outcome regarding TTH frequency, duration, and intensity.[33]
Epidemiology
As of 2016 tension headaches affect about 1.89 billion people [34] and are more common in women than men (23% to 18% respectively).[7] Despite its benign character, tension-type headache, especially in its chronic form, can impart significant disability on patients as well as burden on society at large.[6]
References
Derry S, Wiffen PJ, Moore RA, Bendtsen L (July 2015). "Ibuprofen for acute treatment of episodic tension-type headache in adults". The Cochrane Database of Systematic Reviews. 7 (7): CD011474. doi:10.1002/14651858.CD011474.pub2. PMC 6457940. PMID 26230487.
Loder E, Rizzoli P (January 2008). "Tension-type headache". BMJ. 336 (7635): 88–92. doi:10.1136/bmj.39412.705868.AD. PMC 2190284. PMID 18187725.
Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O'Malley PG (October 2010). "Tricyclic antidepressants and headaches: systematic review and meta-analysis". BMJ. 341: c5222. doi:10.1136/bmj.c5222. PMC 2958257. PMID 20961988.
Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW (April 2010). "Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review". Family Practice. 27 (2): 151–65. doi:10.1093/fampra/cmp089. PMID 20028727.
Banzi R, Cusi C, Randazzo C, Sterzi R, Tedesco D, Moja L (May 2015). "Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults". The Cochrane Database of Systematic Reviews. 5 (5): CD011681. doi:10.1002/14651858.CD011681. PMC 6864942. PMID 25931277.
Lenaerts ME (December 2006). "Burden of tension-type headache". Current Pain and Headache Reports. 10 (6): 459–62. doi:10.1007/s11916-006-0078-z. PMID 17087872.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders,3rd edition. Cephalalgia 33(9) 629–808
Chen, Yaniv (2009). "Advances in the pathophysiology of tension-type headache: From stress to central sensitization". Current Pain and Headache Reports. 13 (6): 484–494. doi:10.1007/s11916-009-0078-x. ISSN 1531-3433. PMID 19889292.
Walls, Ron; Hockberger, Robert; Gausche-Hill, Marianne (2017-03-09). Rosen's emergency medicine : concepts and clinical practice. Walls, Ron M.; Hockberger, Robert S.; Gausche-Hill, Marianne (Ninth ed.). Philadelphia, PA. p. 1269. ISBN 9780323390163. OCLC 989157341.
Jay GW, Barkin RL (December 2017). "Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache". Disease-A-Month. 63 (12): 342–367. doi:10.1016/j.disamonth.2017.05.001. PMID 28886861.
Ashina S, Bendtsen L, Ashina M (December 2005). "Pathophysiology of tension-type headache". Current Pain and Headache Reports. 9 (6): 415–22. doi:10.1007/s11916-005-0021-8. PMID 16282042.
Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J (January 1999). "Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomised crossover trial". Lancet. 353 (9149): 287–9. doi:10.1016/S0140-6736(98)01079-4. PMID 9929022.
Smith, Jonathan (2019). Ferri's Clinical Advisor. Philadelphia: Elsevier. p. 1348. ISBN 978-0-323-53042-2.
Ihsclassification. "2.3 Chronic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.1 Infrequent episodic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.2 Frequent episodic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2. Tension-type headache (TTH)". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.4 Probable tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Consumer Reports (28 April 2016). "Tension Headache Treatment and Prevention". Consumer Reports. Retrieved 25 May 2016.
Nestoriuc Y, Rief W, Martin A (June 2008). "Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators". Journal of Consulting and Clinical Psychology. 76 (3): 379–96. doi:10.1037/0022-006X.76.3.379. PMID 18540732.
Bendtsen L, Jensen R (May 2011). "Treating tension-type headache -- an expert opinion". Expert Opinion on Pharmacotherapy. 12 (7): 1099–109. doi:10.1517/14656566.2011.548806. PMID 21247362.
Varatharajan, Sharanya; Ferguson, Brad; Chrobak, Karen; Shergill, Yaadwinder; Côté, Pierre; Wong, Jessica J.; Yu, Hainan; Shearer, Heather M.; Southerst, Danielle; Sutton, Deborah; Randhawa, Kristi (July 2016). "Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration". European Spine Journal. 25 (7): 1971–1999. doi:10.1007/s00586-016-4376-9. ISSN 0940-6719. PMID 26851953.
Derry S, Wiffen PJ, Moore RA (January 2017). "Aspirin for acute treatment of episodic tension-type headache in adults". The Cochrane Database of Systematic Reviews. 1: CD011888. doi:10.1002/14651858.CD011888.pub2. PMC 6464783. PMID 28084009.
Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, Armstrong MJ, Gloss D, Potrebic S, Jankovic J, Karp BP, Naumann M, So YT, Yablon SA (May 2016). "Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology". Neurology. 86 (19): 1818–26. doi:10.1212/WNL.0000000000002560. PMC 4862245. PMID 27164716.
Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin BC, Vickers A, White AR (April 2016). "Acupuncture for the prevention of tension-type headache". The Cochrane Database of Systematic Reviews. 4 (4): CD007587. doi:10.1002/14651858.CD007587.pub2. PMC 4955729. PMID 27092807.
Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". The Clinical Journal of Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.
Biondi DM (June 2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
Bronfort G, et al. (2004). Brønfort G (ed.). "Non-invasive physical treatments for chronic/recurrent headache". The Cochrane Database of Systematic Reviews (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. (Retracted, see doi:10.1002/14651858.cd001878.pub3. If this is an intentional citation to a retracted paper, please replace {{Retracted}} with {{Retracted|intentional=yes}}.)
Ernst E, Canter PH (April 2006). "A systematic review of systematic reviews of spinal manipulation". Journal of the Royal Society of Medicine. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMC 1420782. PMID 16574972.
Chaibi A, Russell MB (July 2012). "Manual therapies for cervicogenic headache: a systematic review". The Journal of Headache and Pain. 13 (5): 351–9. doi:10.1007/s10194-012-0436-7. PMC 3381059. PMID 22460941.
Chaibi A, Russell MB (October 2014). "Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials". The Journal of Headache and Pain. 15: 67. doi:10.1186/1129-2377-15-67. PMC 4194455. PMID 25278005.
Mesa-Jiménez JA, Lozano-López C, Angulo-Díaz-Parreño S, Rodríguez-Fernández ÁL, De-la-Hoz-Aizpurua JL, Fernández-de-Las-Peñas C (December 2015). "Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials". Cephalalgia. 35 (14): 1323–32. doi:10.1177/0333102415576226. PMID 25748428.
Stovner, Lars Jacob; Nichols, Emma; Steiner, Timothy J.; Abd-Allah, Foad; Abdelalim, Ahmed; Al-Raddadi, Rajaa M.; Ansha, Mustafa Geleto; Barac, Aleksandra; Bensenor, Isabela M.; Doan, Linh Phuong; Edessa, Dumessa; Endres, Matthias; Foreman, Kyle J.; Gankpe, Fortune Gbetoho; Gopalkrishna, Gururaj; Goulart, Alessandra C.; Gupta, Rahul; Hankey, Graeme J.; Hay, Simon I.; Hegazy, Mohamed I.; Hilawe, Esayas Haregot; Kasaeian, Amir; Kassa, Dessalegn H.; Khalil, Ibrahim; Khang, Young-Ho; Khubchandan, Jagdish; Kim, Yun Jin; Kokubo, Yoshihiro; Mohammed, Mohammed A.; et al. (November 2018). "Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016". The Lancet. Neurology. 17 (11): 954–976. doi:10.1016/S1474-4422(18)30322-3. PMC 6191530. PMID 30353868.
External links
Classification D
ICD-10: G44.2ICD-9-CM: 307.81, 339.1MeSH: D018781DiseasesDB: 12554
External resources
MedlinePlus: 000797eMedicine: article/1142908
American Council for Headache Education
National Headache Foundation
World Headache Alliance
vte
Diseases of the nervous system, primarily CNS
vte
Headache
Categories: Headaches
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Roblox
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Not to be confused with Robox.
Roblox
The current Roblox logo in black Gill Sans Ultra Bold font, with both Os replaced by squares
The Roblox logo
Developer(s) Roblox Corporation
Publisher(s) Roblox Corporation
Director(s) David Baszucki,
Erik Cassel[1]
Engine Roblox Studio
Platform(s) Windows, macOS, iOS, Android, Xbox One
Release PC
September 1, 2006[2][3]
iOS
December 11, 2012[4]
Android
July 16, 2014[5]
Xbox One
November 20, 2015[6]
Genre(s) Game creation system, massively multiplayer online
Mode(s) Multi-player, Single-player

Roblox is an online game platform and game creation system that allows users to program games and play games created by other users. Founded by David Baszucki and Erik Cassel in 2004 and released in 2006, the platform hosts user-created games of multiple genres coded in the programming language Lua. For most of Roblox's history, it was relatively small, both as a platform and a company, due to both co-founder Baszucki's lack of interest in press coverage and it being "lost among the crowd" in a large number of platforms released around the same time. Roblox began to grow rapidly in the second half of the 2010s, and this growth has been accentuated by the COVID-19 pandemic.[7][8]

Roblox is free-to-play, with in-game purchases available through a virtual currency called "Robux". As of August 2020, Roblox has over 164 million monthly active users, with it being played by over half of all children aged under 16 in the United States.[9][10] The Roblox Corporation, which develops, publishes, and operates the game, has an estimated $29.5 billion valuation as a result of this large playbase.[11]

Roblox has received generally positive reviews from critics.
Contents

1 Overview
1.1 Roblox Studio
1.2 Items and currency
1.3 Events
2 History and development
3 Community and culture
3.1 Activism
3.2 Effects of the COVID-19 pandemic
3.3 "Oof" sound effect
4 Reception and revenue
4.1 Overall reception
4.1.1 Criticism
4.2 Popular games
4.2.1 Adopt Me!
4.2.2 Jailbreak
4.2.3 MeepCity
4.2.4 Murder Mystery 2
4.2.5 Natural Disaster Survival
4.2.6 Piggy
4.2.7 Royale High
4.2.8 Welcome to Bloxburg
4.2.9 Work at a Pizza Place
4.3 Revenue
5 Toy line
6 Awards and recognition
7 See also
8 References
9 External links

Overview
The Roblox Studio application icon
Roblox Studio

Roblox allows players to create their own games using its proprietary engine, Roblox Studio, which can then be played by other users.[12] Games are coded under an object-oriented programming system utilizing the programming language Lua to manipulate the environment of the game.[13][14] Users are able to create purchasable content through one-time purchases, known as "game passes", as well as microtransactions which can be purchased more than once, known as "developer products" or "products". A percentage of the revenue from purchases is split between the developer and the Roblox Corporation.[15][16] The majority of games produced using Roblox Studio are developed by children, and a total of 20 million games a year are produced using it.[17][9]
Items and currency

Roblox allows players to buy, sell, and create virtual items which can be used to decorate their virtual character that serves as their avatar on the platform.[9] Clothes can be bought by anyone, but only players with a premium membership can sell them.[18] Only Roblox administrators can sell accessories, body parts, gear, and packages under the official Roblox user account;[19] virtual hats and accessories can also be published by a select few users with past experience working with the Roblox Corporation.[20][21] There are several individuals who design items as a full-time job, with the highest-earning creators making over $100,000 a year off item sales.[22] Items with a limited edition status can only be traded between or sold by users with premium membership status.[23]

Robux is the virtual currency in Roblox that allows players to buy various items. Players can obtain Robux by purchasing it with real currency, from a recurring stipend given to members with premium membership, and from other players by producing and selling virtual content in Roblox.[15][24] Robux acquired through the sale of user-generated content can be exchanged into real-world currency through the website's Developer Exchange system.[25] There are a sizeable amount of scams relating to Robux, largely revolving around automated messages promoting scam websites, scam games designed to appear to give out free Robux, and invalid Robux codes.[26][27]
Events

Roblox occasionally hosts real-life and virtual events. They have in the past hosted events such as BloxCon, which was a convention for ordinary players on the platform.[15] Roblox operates annual Easter egg hunts,[28] and also hosts an annual event called the “Bloxy Awards”, an awards ceremony which also functions as a fundraiser. The 2020 edition of the Bloxy Awards, held virtually on the platform, drew 600,000 viewers.[29][30] The Roblox Corporation annually hosts the Roblox Developers Conference, a three-day invite-only event in San Francisco where top content creators on the site learn of upcoming changes to the platform.[31] Roblox Corp. has also hosted similar events in London and Amsterdam.[32][33]

Roblox occasionally engages in events to promote films, such as ones held to promote Wonder Woman 1984 and Aquaman.[34][35] In 2020, Roblox hosted its first virtual concert, which has been compared to that of American rapper Travis Scott's virtual concert in Fortnite,[36] during which American rapper Lil Nas X debuted his song Holiday to an audience of Roblox players.[36][37][38]
History and development
The first Roblox logo, designed in 2004[39]
The Roblox logo from 2005–2006[39]
The Roblox logo from 2006–2017; it had numerous variations, but mostly remained the same.[39]
The Roblox logo as of 2017[39]

The beta version of Roblox was created by co-founders David Baszucki and Erik Cassel in 2004, originally under the name DynaBlocks.[40] Baszucki started testing the first demos that year.[41] In 2005, the company changed its name to Roblox,[41] and it officially launched on September 1, 2006.[2] In March 2007, Roblox became compliant with COPPA, with the addition of safe chat, a change that limited the communication ability of users under the age of thirteen by restricting them to selecting predefined messages from a menu.[42] In August, Roblox applied server improvements and released a premium membership service named "Builders Club".[43] This paid membership feature was rebranded as Roblox Premium in September 2019.[44]

In December 2011, Roblox held their first Hack Week, an annual event where Roblox developers work on outside-the-box ideas for new developments to present to the company.[45][46] On December 11, 2012, an iOS version of Roblox was released,[4] and on July 16, 2014, an Android version was released.[5] On October 1, 2013, Roblox released its Developer Exchange program, allowing developers to exchange Robux earned from their games into real-world currencies.[47]

On May 31, 2015, a feature called 'Smooth Terrain' was added, increasing the graphical fidelity of the terrain and changing the physics engine from a block-oriented style to a smoother and more realistic style.[48] On November 20, Roblox was launched on Xbox One, with an initial selection of 15 games chosen by Roblox staff.[6] New Roblox games for the Xbox One have to go through an approval process, and are subject to the Entertainment Software Ratings Board standards.[49]

In April 2016, Roblox launched Roblox VR for Oculus Rift. At the time of release, more than ten million games were available in 3D.[50] Around the same time period, the safe chat feature was removed and replaced by a system based on a whitelist with a set of acceptable words for users under 13 years old and a set of blacklisted words for other users.[51] In June, the company launched a version compatible with Windows 10. While the game platform has had a presence on the PC since 2004, when its web version was created, this was the first time it was upgraded with a standalone launcher built for Windows.[52] Also in June, the Roblox Corporation was sued by Cinemark Theatres for alleged trademark violations.[53]

Throughout 2017, Roblox engaged in a number of updates to its server technology, as the technology they were operating on until that point was out of date and led to frequent outages.[54] In February 2019, Roblox entered into a joint venture with Songhua River Investment Limited, an affiliate of Tencent, in order to create a localised version of the platform. As of November 2020, the Chinese National Radio and Television Administration had not yet issued the license required to make Roblox available in China.[55][56] In July 2020, Roblox announced the creation of “Party Place”, which functions as an online hangout. The feature was created using new technology that had been used during the 2020 Bloxy Awards, and was designed in response to the COVID-19 pandemic.[57]

In November 2020, the Roblox Corporation announced its intentions to become a public company with appropriate filings with the U.S. Securities and Exchange Commission.[58][59] Following a $520 million investment round in January 2021, Roblox announced it would be issuing a direct public offering in the near future.[11]
Community and culture
Activism

Users of Roblox have been noted for their efforts against racism, with numerous regular users and co-founder Baszucki having declared their support for the George Floyd protests and Black Lives Matter.[60][61] However in August 2019, an investigation by NBC News revealed over 100 accounts linked to far-right and neo-Nazi groups. After being contacted about the accounts by NBC, Roblox moderators removed them.[62]
Effects of the COVID-19 pandemic

The COVID-19 pandemic has affected Roblox in numerous ways. Due to quarantines imposed by the pandemic limiting social interaction, Roblox is being used as a way for children to communicate with each other.[63] One of the most noted ways that this method of communication is being carried out is the phenomenon of birthday parties being held on the platform.[64][65] On May 1, 2020, Roblox Corp. announced a virtual fundraiser to raise money for charities that are battling COVID-19.[66] COVID-19 has caused a substantial increase in both the platform's revenue and the number of players on it, in line with similar effects experienced by the majority of the gaming industry.[67][68]
"Oof" sound effect

From its release to November 2020, Roblox's sound effect for when a character dies was an "oof" sound, which became a substantial part of the platform's reputation due to its status as a meme.[69] The sound was originally produced by video game composer Tommy Tallarico for the 2000 video game Messiah, and he and Roblox entered into a copyright dispute. The dispute ended when Roblox agreed to pull the sound from their platform and replace it with another death sound, and Tallarico agreed to allow Roblox to release the sound again at a later date on its marketplace, which game developers on the platform would be able to purchase for a price of US$1.[70][71]
Reception and revenue
Overall reception

Roblox has received generally positive reviews. Common Sense Media gave it 4 out of 5 stars, praising the website's variety of games and ability to encourage creativity in children, while finding that the decentralized nature of the platform meant game quality varied, and recommended disabling chat functions for young players to prevent possibly harmful interactions.[72] Patricia E. Vance of the Family Online Safety Institute advised parents to monitor their child's interactions on the platform, but praised the platform for "allow[ing] kids to play, explore, socialize, create and learn in a self-directed way", and granted especial praise to Roblox Studio for its ability to encourage children to experience game development.[73] Trusted Reviews, in its overview of the platform, also praised Roblox Studio, stating that “for anyone seeking to develop their computer science skills, or create projects that will instantly receive feedback from a huge audience, the appeal is obvious”.[74] Craig Hurda, writing in Android Guys, gave a more moderate review, praising the number of games available and finding that the game was entertaining for children, while also finding that the platform's audio was "hit-or-miss" and declaring that it had limited appeal for adult players.[75]
Criticism

Roblox has received widespread criticism for its chat filtration system.[76][77] Although Roblox's filtration system censors and removes most inappropriate messages and content, some can still avoid the system. To combat these issues, Roblox has 1,600 people working to remove such content from the platform.[76] Roblox offers privacy settings; parents can limit what people a user can contact, restricting access to private servers, and turning on parental control.[78]

Though sexual content is prohibited on Roblox, the platform has received substantial criticism for the presence of sexually explicit games and imagery within it. This content includes items like virtual sex clubs and nightclubs, with creators of said content largely communicating through third-party platforms which cannot be regulated by Roblox moderators.[79] A 2020 investigation by Fast Company found that sexual content was still prevalent within Roblox, with attempts by moderators to remove it being likened to "whack-a-mole",[80][81] though it was also found that the situation had generally improved in the recent years prior to the report.[80]
Popular games

Due to its status as a games platform, Roblox has a variety of popular games. As of May 2020, the most popular games on Roblox have over 10 million monthly active players each. As of August 2020, at least 20 games have been played more than one billion times, and at least 5,000 have been played more than one million times.[82] Some of the more notable games include:
Adopt Me!
Main article: Adopt Me!

Adopt Me! is a massively multiplayer online role-playing game where the nominal focus is players pretending to be either parents adopting a child, or children getting adopted, though the de facto focus is around adopting and caring for many different pets, who can be traded with other players.[83] As of July 2020, the game had been played upwards of ten billion times.[84] Adopt Me! was averaging 600,000 concurrent players as of June 2020, making it the most popular game on Roblox.[83] Due to the high cost of pets within the game, with some rare pets selling for up to US$100, a large subculture of scammers has risen up within the game. As the primary user base of Adopt Me! is on average younger than the rest of Roblox, they are especially susceptible to falling for scams.[85][86] DreamCraft, the organization behind the game, has accumulated over $16 million in revenue, mostly from microtransactions.[87][88]
Jailbreak
Some games on Roblox, such as Jailbreak (pictured), have been popular enough to receive media attention

Jailbreak is a cops and robbers game which is among the most popular games on the site, accumulating tens of thousands of concurrent players daily, and which has been played a total of 4 billion times as of August 2020.[9][89] Jailbreak was featured in Roblox's Ready Player One event, based around the release of the film.[90] Alex Balfanz, a co-creator of Jailbreak, covered his undergraduate education at Duke University using funds from the game.[91][9] Jailbreak was conceived and created as a more fleshed-out version of an earlier Roblox game called Prison Life.[92]
MeepCity

MeepCity is a massively multiplayer online role-playing game with noted similarities to Club Penguin and Toontown Online.[93] In addition to its role-playing quantities, MeepCity also features customizable pets, called "Meeps".[94] MeepCity's creator, Alex Bidello, stated in 2018 that he was making enough money off the game to pay two employees and support his mother and brother.[95] Bidello is noted for his development techniques, which include playing the game on alt accounts to gauge the reactions of new players.[96] MeepCity was the first game on Roblox to pass 1 billion total visits.[96] The game was averaging 100,000 concurrent players in July 2018.[95]
Murder Mystery 2

Murder Mystery 2 is a game where players are randomly assigned roles to play each round. One player is selected to be a murderer, who must kill everyone to win, while another player is selected to be a sheriff, and must kill the murderer to win; all remaining players are selected as innocents whose goal is to survive.[96] The game's level design has been praised by critics.[13]
Natural Disaster Survival

Natural Disaster Survival is a game where players are tasked with the role of surviving a litany of natural disasters thrown against them.[97] The game has been positively compared to PlayerUnknown's Battlegrounds.[13] Along with Work at a Pizza Place, Natural Disaster Survival is one of the oldest games on Roblox that still manages to maintain any degree of popularity.[98]
Piggy

Piggy is an episodic horror game that incorporates elements from Peppa Pig and the indie horror game Granny into a zombie apocalypse setting.[99] The games' style of episodic storytelling resulted in a significant fanbase developing prior to the game's finale on May 25, 2020.[100] Piggy was uploaded to the site in January 2020, and had been played nearly 5 billion times as of July 2020.[84] A sequel, titled Piggy: Book 2, released on September 12, 2020.[101]
Royale High

Royale High (originally called Fairies and Mermaids Winx High School)[102] is a massively multiplayer online role-playing game developed by Callmehbob.[96] The game is set in a magical universe and deals with a fantasy school where players dress-up as royalty and as supernatural creatures.[102] Launched in 2017, Royale High had more than 3.5 billion total visits as of July 2020, regularly achieving thousands of concurrent players, making it one of the most popular games on the platform.[103][104]
Welcome to Bloxburg

Welcome to Bloxburg is a game based on The Sims, noted for being a Roblox game which players have to purchase with Robux before playing.[105] As of December 2019, the game had been played 1.4 billion times.[96] Welcome to Bloxburg was used as a demonstrative tool at a summer camp called the Junior Builder Camp in order to teach children about homebuilding.[106]
Work at a Pizza Place

Work at a Pizza Place is a game in which players work together to fulfill orders at a pizza parlor.[13] The game is considered a classic among the Roblox userbase, with the creator attributing its success to the game's ability to encourage socializing.[96] The game has received praise for its driving mechanics.[13]
Revenue

During the 2017 Roblox Developers Conference, officials said that creators on the game platform, of which there were about 1.7 million as of 2017,[107] collectively earned at least $30 million in 2017.[108] The iOS version of Roblox passed $1 billion of lifetime revenue in November 2019, $1.5 billion in June 2020 and $2 billion in October 2020, making it the iOS app with the second-highest revenue.[109][7] Several individual games on Roblox have accumulated revenues of over $10 million,[87] while developers as a whole on the platform are collectively projected to earn around $250 million over the course of 2020.[110] Roblox Corp. itself is valued at $29.5 billion, with venture capital firm Andreessen Horowitz being noted as a substantial investor.[11][111]
Toy line

In January 2017, toy fabricator Jazwares partnered with the Roblox Corporation to produce toy minifigures based on user-generated content created by developers on the platform.[112] The minifigures have limbs and joints similar to that of Lego minifigures, though they are about twice the size.[113] The minifigures have limbs and accessories that are interchangeable. The sets included a code that was used to redeem virtual items, as well are blind boxes that contained random minifigures.[114][115] In 2019, Roblox Corp. released a new line of toys, branded the "Roblox Desktop" series.[116]
Awards and recognition

Roblox has received the following accolades:

Inc. 5000 List of America's Fastest-Growing Private Companies (2016, 2017)[117][118]
San Mateo County Economic Development Association (SAMCEDA) Award of Excellence (2017)[119]
San Francisco Business Times Tech & Innovation Award – Gaming/eSports (2017)[19]
Fast Company's World's 50 Most Innovative Companies – #1 in Gaming and #9 Overall (2020)[120]

See also

Pokémon Brick Bronze

References

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Tension headache
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Tension headache
Other names Tension-type headache (TTH), stress headache
Tension-headache.jpg
A woman experiencing a tension headache
Specialty Neurology
Differential diagnosis Migraine
Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.
Pain medication, such as aspirin and ibuprofen, are effective for the treatment of tension headache.[1][2] Tricyclic antidepressants appear to be useful for prevention.[3] Evidence is poor for SSRIs, propranolol and muscle relaxants.[4][5]
As of 2016, tension headaches affect about 1.89 billion people[6] and are more common in women than men (23% to 18% respectively).[7]

Contents
1 Signs and symptoms
2 Risk factors
3 Mechanism
3.1 Neurotransmitters
3.2 Synapses
3.3 Stress
4 Diagnosis
4.1 Classification
4.2 Differential diagnosis
5 Prevention
5.1 Lifestyle
5.2 Medications
6 Treatment
6.1 Exercise
6.2 Medications
6.2.1 Episodic
6.2.2 Chronic
6.3 Manual therapy
7 Epidemiology
8 References
9 External links
Signs and symptoms
According to the third edition of the International Classification of Headache Disorders,[8] the attacks must meet the following criteria:
A duration of between 30 minutes and 7 days.
At least two of the following four characteristics:
bilateral location
pressing or tightening (non-pulsating) quality
mild or moderate intensity
not aggravated by routine physical activity such as walking or climbing stairs
Both of the following:
no nausea or vomiting
no more than one of photophobia (sensitivity to bright light) or phonophobia (sensitivity to loud sounds)
Tension-type headaches may be accompanied by tenderness of the scalp on manual pressure during an attack.
Risk factors
Various precipitating factors may cause tension-type headaches in susceptible individuals:[9]
Anxiety
Stress
Sleep problems
Young age
Poor health
Mechanism
Although the musculature of the head and neck and psychological factors such as stress may play a role in the overall pathophysiology of TTH, neither is currently believed to be the sole cause of the development of TTH.[10] The pathologic basis of TTH is most likely derived from a combination of personal factors, environmental factors, and alteration of both peripheral and central pain pathways.[11] Peripheral pain pathways receive pain signals from pericranial (around the head) myofascial tissue (protective tissue of muscles) and alteration of this pathway likely underlies episodic tension-type headache (ETTH).[11] In addition to these myofascial tissue pain signals, pericranial muscle tenderness, inflammation, and muscle ischemia have been postulated in headache literature to be causal factors in the peripheral pathophysiology of TTH.[9] However, multiple studies have failed to illustrate evidence for a pathologic role of either ischemia or inflammation within the muscles.[9] Pericranial tenderness is also not likely a peripheral causal factor for TTH, but may instead act to trigger a chronic pain cycle in which the peripheral pain response is transformed over time into a centralized pain response.[9] It is then these prolonged alterations in the peripheral pain pathways that lead to increased excitability of the central nervous system pain pathways, resulting in the transition of episodic tension-type headache into chronic tension type headache (CTTH).[11] Specifically, the hyperexcitability occurs in central nociceptive neurons (the trigeminal spinal nucleus, thalamus, and cerebral cortex) resulting in central sensitization, which manifests clinically as allodynia and hyperalgesia of CTTH.[9][12] Additionally, CTTH patients exhibit decreased thermal and pain thresholds which further bolsters support for central sensitization occurring in CTTH.[9]
The alterations in physiology that lead to overall process of central sensitization involve changes at the level of neural tracts, neurotransmitters and their receptors, the neural synapse, and the post-synaptic membrane. Evidence suggests dysfunction in supraspinal descending inhibitory pain pathways may contribute to the pathogenesis of central sensitization in CTTH.[9]
Neurotransmitters
Specific neuronal receptors and neurotransmitters thought to be most involved include NMDA and AMPA receptors, glutamate, serotonin (5-HT), β-endorphin, and nitric oxide (NO).[9] Of the neurotransmitters, NO plays a major role in central pain pathways and likely contributes to the process of central sensitization.[9] Briefly, the enzyme nitric oxide synthase (NOS) forms NO which ultimately results in vasodilatation and activation of central nervous system pain pathways.[9] Serotonin may also be of significant importance and involved in malfunctioning pain filter located in the brain stem. The view is that the brain misinterprets information—for example from the temporal muscle or other muscles—and interprets this signal as pain. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as nortriptyline. However, the analgesic effect of nortriptyline, as well as amitriptyline in chronic tension-type headache, is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved.[13][9]
Synapses
Regarding synaptic level changes, homosynaptic facilitation and heterosynaptic facilitation are both likely to be involved in central sensitization.[9] Homosynaptic facilitation occurs when synapses normally involved in pain pathways undergo changes involving receptors on the post-synaptic membrane as well as the molecular pathways activated upon synaptic transmission. Lower pain thresholds of CTTH result from this homosynaptic facilitation. In contrast, heterosynaptic facilitation occurs when synapses not normally involved in pain pathways become involved. Once this occurs innocuous signals are interpreted as painful signals. Allodynia and hyperalgesia of CTTH represent this heterosynaptic facilitation clinically.[9]
Stress
In the literature, stress is mentioned as a factor and may be implicated via the adrenal axis. This ultimately results in downstream activation of NMDA receptor activation, NFκB activation, and upregulation of iNOS with subsequent production of NO leading to pain as described above.[9]
Diagnosis
With TTH the physical exam is expected to be normal with perhaps the exception of either pericranial tenderness upon palpation of the cranial muscles, or presence of either photophobia or phonophobia.[14]

Classification
Classification system for tension-type headache.
The International Headache Society's most current classification system for headache disorders is the International Classification of Headache Disorders 3rd edition (ICHD-3) as of 2018. This classification system separates tension-type headache (TTH) into two main groups: episodic (ETTH) and chronic (CTTH). CTTH is defined as fifteen days or more per month with headache for greater than three months, or one-hundred eighty days or more, with headache per year.[15] ETTH is less than fifteen days per month with headache or less than one-hundred eighty days with headache per year.[16][17] However, ETTH is further sub-divided into frequent and infrequent TTH.[18] Frequent TTH is defined as ten or more episodes of headache over the course of one to fourteen days per month for greater than three months, or at least twelve days per year, but less than one-hundred eighty days per year.[17] Infrequent TTH is defined as ten or more episodes of headache for less than one day per month or less than twelve days per year.[16] Furthermore, all sub-classes of TTH can be classified as having presence or absence of pericranial tenderness, which is tenderness of the muscles of the head.[18] Probable TTH is utilized for patients with some characteristics, but not all characteristics of a given sub-type of TTH.[19]
Differential diagnosis
Extensive testing is not needed as TTH is diagnosed by history and physical. However, if symptoms indicative of a more serious diagnosis are present, a contrast enhanced MRI may be utilized. Furthermore, giant cell arteritis should be considered in those 50 years of age and beyond. Screening for giant cell arteritis involves the blood tests of erythrocyte sedimentation rate (ESR) and c-reactive protein.[14][10]
Migraine
Oromandibular dysfunction
Sinus disease
Eye disease
Cervical spine disease
Infection in immunocompromised
Intracranial mass
Idiopathic intracranial hypertension
Medication overuse headache
Secondary headache (headache due to other disorder)
Giant cell arteritis ( ≥50 years of age)
Dermatochalasis
Prevention
Lifestyle
Drinking water and avoiding dehydration helps in preventing tension headache.[20] Using stress management and relaxing often makes headaches less likely.[20] Drinking alcohol can make headaches more likely or severe.[20] Good posture might prevent headaches if there is neck pain.[20] People who have jaw clenching might develop headaches, and getting treatment from a dentist might prevent those headaches.[20] Biofeedback techniques may also help.[21]
Medications
People who have 15 or more headaches in a month may be treated with certain types of daily antidepressants which act to prevent continued tension headaches from occurring.[20] In those who are predisposed to tension type headaches the first-line preventative treatment is amitriptyline, whereas mirtazapine and venlafaxine are second-line treatment options.[22] Tricyclic antidepressants appear to be useful for prevention.[3] Tricyclic antidepressants have been found to be more effective than SSRIs but have greater side effects.[3] Evidence is poor for the use of SSRIs, propranolol, and muscle relaxants for prevention of tension headaches.[4][5]
Treatment
Treatment for a current tension headache is to drink water and confirm that there is no dehydration.[20] If symptoms do not resolve within an hour for a person who has had water, then stress reduction might resolve the issue.[20]
Exercise
Evidence supports simple neck and shoulder exercises in managing ETTH and CTTH for headaches associated with neck pain. Exercises include stretching, strengthening and range of motion exercises. CTTH can also benefit from combined therapy from stress therapy, exercises and postural correction.[23]
Medications
Episodic
Over-the-counter drugs, like paracetamol, aspirin, or NSAIDs (ibuprofen, naproxen, ketoprofen), can be effective but tend to only be helpful as a treatment for a few times in a week at most.[1][20][24][11] For those with gastrointestinal problems (ulcers and bleeding), acetaminophen is the better choice over aspirin, though both provide roughly equivalent pain relief.[11] It is important to note that large daily doses of paracetamol should be avoided as it may cause liver damage especially in those that consume 3 or more drinks/day and those with pre-existing liver disease.[11] Ibuprofen, one of the NSAIDs listed above, is a common choice for pain relief but may also lead to gastrointestinal discomfort.[11]
Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations, analgesic/barbiturate combinations such as Fiorinal).[2][22] In addition analgesic/caffeine combinations are popular such as the aspirin-caffeine combination or the aspirin, acetaminophen and caffeine combinations.[11] Frequent use (daily or skipping just one day in between use for 7–10 days) of any of the above analgesics may, however, lead to medication overuse headache.[2][22][11]
Muscle relaxants are typically used for and are helpful with acute post-traumatic TTH rather than ETTH.[11] Opioid medications are not utilized to treat ETTH.[11] Botulinum toxin does not appear to be helpful.[25]
Chronic
Classes of medications involved in treatment of CTTH include tricyclic antidepressants (TCAs), SSRIs, benzodiazepine (Clonazepam in small evening dose), and muscle relaxants. The most commonly utilized TCA is amitriptyline due to the postulated role in decreasing central sensitization and analgesic relief. Another popular TCA used is Doxepine. SSRIs may also be utilized for management of CTTH. For patients with concurrent muscle spasm and CTTH, the muscle relaxant Tizanidine can be a helpful option.[11]
These medications however, are not effective if concurrent overuse of over the counter medications or other analgesics is occurring.[11] Stopping overuse must occur prior to proceeding with other forms of treatment.[11]
Manual therapy
Current evidence for acupuncture is slight. A 2016 systematic review suggests better evidence among those with frequent tension headaches, but concludes that further trials comparing acupuncture with other treatment options are needed.[26]
People with tension-type headache often use spinal manipulation, soft tissue therapy, and myofascial trigger point treatment. Studies of effectiveness are mixed. A 2006 systematic review found no rigorous evidence supporting manual therapies for tension headache.[27] A 2005 structured review found only weak evidence for the effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[28] A 2004 Cochrane review found that spinal manipulation may be effective for migraine and tension headache, and that spinal manipulation and neck exercises may be effective for cervicogenic headache.[29] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of spinal manipulation.[30] A 2012 systematic review of manual therapy found that hands-on work may reduce both the frequency and the intensity of chronic tension-type headaches.[31] More current literature also appears to be mixed however, CTTH patients may benefit from massage and physiotherapy as suggested by a systemic review examining these modalities via RCTs specifically for this patient population[32] Despite being helpful, the review also makes a point to note that there is no difference in effectiveness long term (6 months) between those CTTH patients utilizing TCAs and physiotherapy.[32] Another systemic review comparing manual therapy to pharmacologic therapy also supports little long term difference in outcome regarding TTH frequency, duration, and intensity.[33]
Epidemiology
As of 2016 tension headaches affect about 1.89 billion people [34] and are more common in women than men (23% to 18% respectively).[7] Despite its benign character, tension-type headache, especially in its chronic form, can impart significant disability on patients as well as burden on society at large.[6]
References
Derry S, Wiffen PJ, Moore RA, Bendtsen L (July 2015). "Ibuprofen for acute treatment of episodic tension-type headache in adults". The Cochrane Database of Systematic Reviews. 7 (7): CD011474. doi:10.1002/14651858.CD011474.pub2. PMC 6457940. PMID 26230487.
Loder E, Rizzoli P (January 2008). "Tension-type headache". BMJ. 336 (7635): 88–92. doi:10.1136/bmj.39412.705868.AD. PMC 2190284. PMID 18187725.
Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O'Malley PG (October 2010). "Tricyclic antidepressants and headaches: systematic review and meta-analysis". BMJ. 341: c5222. doi:10.1136/bmj.c5222. PMC 2958257. PMID 20961988.
Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW (April 2010). "Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review". Family Practice. 27 (2): 151–65. doi:10.1093/fampra/cmp089. PMID 20028727.
Banzi R, Cusi C, Randazzo C, Sterzi R, Tedesco D, Moja L (May 2015). "Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults". The Cochrane Database of Systematic Reviews. 5 (5): CD011681. doi:10.1002/14651858.CD011681. PMC 6864942. PMID 25931277.
Lenaerts ME (December 2006). "Burden of tension-type headache". Current Pain and Headache Reports. 10 (6): 459–62. doi:10.1007/s11916-006-0078-z. PMID 17087872.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders,3rd edition. Cephalalgia 33(9) 629–808
Chen, Yaniv (2009). "Advances in the pathophysiology of tension-type headache: From stress to central sensitization". Current Pain and Headache Reports. 13 (6): 484–494. doi:10.1007/s11916-009-0078-x. ISSN 1531-3433. PMID 19889292.
Walls, Ron; Hockberger, Robert; Gausche-Hill, Marianne (2017-03-09). Rosen's emergency medicine : concepts and clinical practice. Walls, Ron M.; Hockberger, Robert S.; Gausche-Hill, Marianne (Ninth ed.). Philadelphia, PA. p. 1269. ISBN 9780323390163. OCLC 989157341.
Jay GW, Barkin RL (December 2017). "Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache". Disease-A-Month. 63 (12): 342–367. doi:10.1016/j.disamonth.2017.05.001. PMID 28886861.
Ashina S, Bendtsen L, Ashina M (December 2005). "Pathophysiology of tension-type headache". Current Pain and Headache Reports. 9 (6): 415–22. doi:10.1007/s11916-005-0021-8. PMID 16282042.
Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J (January 1999). "Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomised crossover trial". Lancet. 353 (9149): 287–9. doi:10.1016/S0140-6736(98)01079-4. PMID 9929022.
Smith, Jonathan (2019). Ferri's Clinical Advisor. Philadelphia: Elsevier. p. 1348. ISBN 978-0-323-53042-2.
Ihsclassification. "2.3 Chronic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.1 Infrequent episodic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.2 Frequent episodic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2. Tension-type headache (TTH)". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.4 Probable tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Consumer Reports (28 April 2016). "Tension Headache Treatment and Prevention". Consumer Reports. Retrieved 25 May 2016.
Nestoriuc Y, Rief W, Martin A (June 2008). "Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators". Journal of Consulting and Clinical Psychology. 76 (3): 379–96. doi:10.1037/0022-006X.76.3.379. PMID 18540732.
Bendtsen L, Jensen R (May 2011). "Treating tension-type headache -- an expert opinion". Expert Opinion on Pharmacotherapy. 12 (7): 1099–109. doi:10.1517/14656566.2011.548806. PMID 21247362.
Varatharajan, Sharanya; Ferguson, Brad; Chrobak, Karen; Shergill, Yaadwinder; Côté, Pierre; Wong, Jessica J.; Yu, Hainan; Shearer, Heather M.; Southerst, Danielle; Sutton, Deborah; Randhawa, Kristi (July 2016). "Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration". European Spine Journal. 25 (7): 1971–1999. doi:10.1007/s00586-016-4376-9. ISSN 0940-6719. PMID 26851953.
Derry S, Wiffen PJ, Moore RA (January 2017). "Aspirin for acute treatment of episodic tension-type headache in adults". The Cochrane Database of Systematic Reviews. 1: CD011888. doi:10.1002/14651858.CD011888.pub2. PMC 6464783. PMID 28084009.
Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, Armstrong MJ, Gloss D, Potrebic S, Jankovic J, Karp BP, Naumann M, So YT, Yablon SA (May 2016). "Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology". Neurology. 86 (19): 1818–26. doi:10.1212/WNL.0000000000002560. PMC 4862245. PMID 27164716.
Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin BC, Vickers A, White AR (April 2016). "Acupuncture for the prevention of tension-type headache". The Cochrane Database of Systematic Reviews. 4 (4): CD007587. doi:10.1002/14651858.CD007587.pub2. PMC 4955729. PMID 27092807.
Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". The Clinical Journal of Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.
Biondi DM (June 2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
Bronfort G, et al. (2004). Brønfort G (ed.). "Non-invasive physical treatments for chronic/recurrent headache". The Cochrane Database of Systematic Reviews (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. (Retracted, see doi:10.1002/14651858.cd001878.pub3. If this is an intentional citation to a retracted paper, please replace {{Retracted}} with {{Retracted|intentional=yes}}.)
Ernst E, Canter PH (April 2006). "A systematic review of systematic reviews of spinal manipulation". Journal of the Royal Society of Medicine. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMC 1420782. PMID 16574972.
Chaibi A, Russell MB (July 2012). "Manual therapies for cervicogenic headache: a systematic review". The Journal of Headache and Pain. 13 (5): 351–9. doi:10.1007/s10194-012-0436-7. PMC 3381059. PMID 22460941.
Chaibi A, Russell MB (October 2014). "Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials". The Journal of Headache and Pain. 15: 67. doi:10.1186/1129-2377-15-67. PMC 4194455. PMID 25278005.
Mesa-Jiménez JA, Lozano-López C, Angulo-Díaz-Parreño S, Rodríguez-Fernández ÁL, De-la-Hoz-Aizpurua JL, Fernández-de-Las-Peñas C (December 2015). "Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials". Cephalalgia. 35 (14): 1323–32. doi:10.1177/0333102415576226. PMID 25748428.
Stovner, Lars Jacob; Nichols, Emma; Steiner, Timothy J.; Abd-Allah, Foad; Abdelalim, Ahmed; Al-Raddadi, Rajaa M.; Ansha, Mustafa Geleto; Barac, Aleksandra; Bensenor, Isabela M.; Doan, Linh Phuong; Edessa, Dumessa; Endres, Matthias; Foreman, Kyle J.; Gankpe, Fortune Gbetoho; Gopalkrishna, Gururaj; Goulart, Alessandra C.; Gupta, Rahul; Hankey, Graeme J.; Hay, Simon I.; Hegazy, Mohamed I.; Hilawe, Esayas Haregot; Kasaeian, Amir; Kassa, Dessalegn H.; Khalil, Ibrahim; Khang, Young-Ho; Khubchandan, Jagdish; Kim, Yun Jin; Kokubo, Yoshihiro; Mohammed, Mohammed A.; et al. (November 2018). "Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016". The Lancet. Neurology. 17 (11): 954–976. doi:10.1016/S1474-4422(18)30322-3. PMC 6191530. PMID 30353868.
External links
Classification D
ICD-10: G44.2ICD-9-CM: 307.81, 339.1MeSH: D018781DiseasesDB: 12554
External resources
MedlinePlus: 000797eMedicine: article/1142908
American Council for Headache Education
National Headache Foundation
World Headache Alliance
vte
Diseases of the nervous system, primarily CNS
vte
Headache
Categories: Headaches
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Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.
Roblox
From Wikipedia, the free encyclopedia
Jump to navigation
Jump to search
Not to be confused with Robox.
Roblox
The current Roblox logo in black Gill Sans Ultra Bold font, with both Os replaced by squares
The Roblox logo
Developer(s) Roblox Corporation
Publisher(s) Roblox Corporation
Director(s) David Baszucki,
Erik Cassel[1]
Engine Roblox Studio
Platform(s) Windows, macOS, iOS, Android, Xbox One
Release PC
September 1, 2006[2][3]
iOS
December 11, 2012[4]
Android
July 16, 2014[5]
Xbox One
November 20, 2015[6]
Genre(s) Game creation system, massively multiplayer online
Mode(s) Multi-player, Single-player
Roblox is an online game platform and game creation system that allows users to program games and play games created by other users. Founded by David Baszucki and Erik Cassel in 2004 and released in 2006, the platform hosts user-created games of multiple genres coded in the programming language Lua. For most of Roblox's history, it was relatively small, both as a platform and a company, due to both co-founder Baszucki's lack of interest in press coverage and it being "lost among the crowd" in a large number of platforms released around the same time. Roblox began to grow rapidly in the second half of the 2010s, and this growth has been accentuated by the COVID-19 pandemic.[7][8]
Roblox is free-to-play, with in-game purchases available through a virtual currency called "Robux". As of August 2020, Roblox has over 164 million monthly active users, with it being played by over half of all children aged under 16 in the United States.[9][10] The Roblox Corporation, which develops, publishes, and operates the game, has an estimated $29.5 billion valuation as a result of this large playbase.[11]
Roblox has received generally positive reviews from critics.
Contents
1 Overview
1.1 Roblox Studio
1.2 Items and currency
1.3 Events
2 History and development
3 Community and culture
3.1 Activism
3.2 Effects of the COVID-19 pandemic
3.3 "Oof" sound effect
4 Reception and revenue
4.1 Overall reception
4.1.1 Criticism
4.2 Popular games
4.2.1 Adopt Me!
4.2.2 Jailbreak
4.2.3 MeepCity
4.2.4 Murder Mystery 2
4.2.5 Natural Disaster Survival
4.2.6 Piggy
4.2.7 Royale High
4.2.8 Welcome to Bloxburg
4.2.9 Work at a Pizza Place
4.3 Revenue
5 Toy line
6 Awards and recognition
7 See also
8 References
9 External links
Overview
The Roblox Studio application icon
Roblox Studio
Roblox allows players to create their own games using its proprietary engine, Roblox Studio, which can then be played by other users.[12] Games are coded under an object-oriented programming system utilizing the programming language Lua to manipulate the environment of the game.[13][14] Users are able to create purchasable content through one-time purchases, known as "game passes", as well as microtransactions which can be purchased more than once, known as "developer products" or "products". A percentage of the revenue from purchases is split between the developer and the Roblox Corporation.[15][16] The majority of games produced using Roblox Studio are developed by children, and a total of 20 million games a year are produced using it.[17][9]
Items and currency
Roblox allows players to buy, sell, and create virtual items which can be used to decorate their virtual character that serves as their avatar on the platform.[9] Clothes can be bought by anyone, but only players with a premium membership can sell them.[18] Only Roblox administrators can sell accessories, body parts, gear, and packages under the official Roblox user account;[19] virtual hats and accessories can also be published by a select few users with past experience working with the Roblox Corporation.[20][21] There are several individuals who design items as a full-time job, with the highest-earning creators making over $100,000 a year off item sales.[22] Items with a limited edition status can only be traded between or sold by users with premium membership status.[23]
Robux is the virtual currency in Roblox that allows players to buy various items. Players can obtain Robux by purchasing it with real currency, from a recurring stipend given to members with premium membership, and from other players by producing and selling virtual content in Roblox.[15][24] Robux acquired through the sale of user-generated content can be exchanged into real-world currency through the website's Developer Exchange system.[25] There are a sizeable amount of scams relating to Robux, largely revolving around automated messages promoting scam websites, scam games designed to appear to give out free Robux, and invalid Robux codes.[26][27]
Events
Roblox occasionally hosts real-life and virtual events. They have in the past hosted events such as BloxCon, which was a convention for ordinary players on the platform.[15] Roblox operates annual Easter egg hunts,[28] and also hosts an annual event called the “Bloxy Awards”, an awards ceremony which also functions as a fundraiser. The 2020 edition of the Bloxy Awards, held virtually on the platform, drew 600,000 viewers.[29][30] The Roblox Corporation annually hosts the Roblox Developers Conference, a three-day invite-only event in San Francisco where top content creators on the site learn of upcoming changes to the platform.[31] Roblox Corp. has also hosted similar events in London and Amsterdam.[32][33]
Roblox occasionally engages in events to promote films, such as ones held to promote Wonder Woman 1984 and Aquaman.[34][35] In 2020, Roblox hosted its first virtual concert, which has been compared to that of American rapper Travis Scott's virtual concert in Fortnite,[36] during which American rapper Lil Nas X debuted his song Holiday to an audience of Roblox players.[36][37][38]
History and development
The first Roblox logo, designed in 2004[39]
The Roblox logo from 2005–2006[39]
The Roblox logo from 2006–2017; it had numerous variations, but mostly remained the same.[39]
The Roblox logo as of 2017[39]
The beta version of Roblox was created by co-founders David Baszucki and Erik Cassel in 2004, originally under the name DynaBlocks.[40] Baszucki started testing the first demos that year.[41] In 2005, the company changed its name to Roblox,[41] and it officially launched on September 1, 2006.[2] In March 2007, Roblox became compliant with COPPA, with the addition of safe chat, a change that limited the communication ability of users under the age of thirteen by restricting them to selecting predefined messages from a menu.[42] In August, Roblox applied server improvements and released a premium membership service named "Builders Club".[43] This paid membership feature was rebranded as Roblox Premium in September 2019.[44]
In December 2011, Roblox held their first Hack Week, an annual event where Roblox developers work on outside-the-box ideas for new developments to present to the company.[45][46] On December 11, 2012, an iOS version of Roblox was released,[4] and on July 16, 2014, an Android version was released.[5] On October 1, 2013, Roblox released its Developer Exchange program, allowing developers to exchange Robux earned from their games into real-world currencies.[47]
On May 31, 2015, a feature called 'Smooth Terrain' was added, increasing the graphical fidelity of the terrain and changing the physics engine from a block-oriented style to a smoother and more realistic style.[48] On November 20, Roblox was launched on Xbox One, with an initial selection of 15 games chosen by Roblox staff.[6] New Roblox games for the Xbox One have to go through an approval process, and are subject to the Entertainment Software Ratings Board standards.[49]
In April 2016, Roblox launched Roblox VR for Oculus Rift. At the time of release, more than ten million games were available in 3D.[50] Around the same time period, the safe chat feature was removed and replaced by a system based on a whitelist with a set of acceptable words for users under 13 years old and a set of blacklisted words for other users.[51] In June, the company launched a version compatible with Windows 10. While the game platform has had a presence on the PC since 2004, when its web version was created, this was the first time it was upgraded with a standalone launcher built for Windows.[52] Also in June, the Roblox Corporation was sued by Cinemark Theatres for alleged trademark violations.[53]
Throughout 2017, Roblox engaged in a number of updates to its server technology, as the technology they were operating on until that point was out of date and led to frequent outages.[54] In February 2019, Roblox entered into a joint venture with Songhua River Investment Limited, an affiliate of Tencent, in order to create a localised version of the platform. As of November 2020, the Chinese National Radio and Television Administration had not yet issued the license required to make Roblox available in China.[55][56] In July 2020, Roblox announced the creation of “Party Place”, which functions as an online hangout. The feature was created using new technology that had been used during the 2020 Bloxy Awards, and was designed in response to the COVID-19 pandemic.[57]
In November 2020, the Roblox Corporation announced its intentions to become a public company with appropriate filings with the U.S. Securities and Exchange Commission.[58][59] Following a $520 million investment round in January 2021, Roblox announced it would be issuing a direct public offering in the near future.[11]
Community and culture
Activism
Users of Roblox have been noted for their efforts against racism, with numerous regular users and co-founder Baszucki having declared their support for the George Floyd protests and Black Lives Matter.[60][61] However in August 2019, an investigation by NBC News revealed over 100 accounts linked to far-right and neo-Nazi groups. After being contacted about the accounts by NBC, Roblox moderators removed them.[62]
Effects of the COVID-19 pandemic
The COVID-19 pandemic has affected Roblox in numerous ways. Due to quarantines imposed by the pandemic limiting social interaction, Roblox is being used as a way for children to communicate with each other.[63] One of the most noted ways that this method of communication is being carried out is the phenomenon of birthday parties being held on the platform.[64][65] On May 1, 2020, Roblox Corp. announced a virtual fundraiser to raise money for charities that are battling COVID-19.[66] COVID-19 has caused a substantial increase in both the platform's revenue and the number of players on it, in line with similar effects experienced by the majority of the gaming industry.[67][68]
"Oof" sound effect
From its release to November 2020, Roblox's sound effect for when a character dies was an "oof" sound, which became a substantial part of the platform's reputation due to its status as a meme.[69] The sound was originally produced by video game composer Tommy Tallarico for the 2000 video game Messiah, and he and Roblox entered into a copyright dispute. The dispute ended when Roblox agreed to pull the sound from their platform and replace it with another death sound, and Tallarico agreed to allow Roblox to release the sound again at a later date on its marketplace, which game developers on the platform would be able to purchase for a price of US$1.[70][71]
Reception and revenue
Overall reception
Roblox has received generally positive reviews. Common Sense Media gave it 4 out of 5 stars, praising the website's variety of games and ability to encourage creativity in children, while finding that the decentralized nature of the platform meant game quality varied, and recommended disabling chat functions for young players to prevent possibly harmful interactions.[72] Patricia E. Vance of the Family Online Safety Institute advised parents to monitor their child's interactions on the platform, but praised the platform for "allow[ing] kids to play, explore, socialize, create and learn in a self-directed way", and granted especial praise to Roblox Studio for its ability to encourage children to experience game development.[73] Trusted Reviews, in its overview of the platform, also praised Roblox Studio, stating that “for anyone seeking to develop their computer science skills, or create projects that will instantly receive feedback from a huge audience, the appeal is obvious”.[74] Craig Hurda, writing in Android Guys, gave a more moderate review, praising the number of games available and finding that the game was entertaining for children, while also finding that the platform's audio was "hit-or-miss" and declaring that it had limited appeal for adult players.[75]
Criticism
Roblox has received widespread criticism for its chat filtration system.[76][77] Although Roblox's filtration system censors and removes most inappropriate messages and content, some can still avoid the system. To combat these issues, Roblox has 1,600 people working to remove such content from the platform.[76] Roblox offers privacy settings; parents can limit what people a user can contact, restricting access to private servers, and turning on parental control.[78]
Though sexual content is prohibited on Roblox, the platform has received substantial criticism for the presence of sexually explicit games and imagery within it. This content includes items like virtual sex clubs and nightclubs, with creators of said content largely communicating through third-party platforms which cannot be regulated by Roblox moderators.[79] A 2020 investigation by Fast Company found that sexual content was still prevalent within Roblox, with attempts by moderators to remove it being likened to "whack-a-mole",[80][81] though it was also found that the situation had generally improved in the recent years prior to the report.[80]
Popular games
Due to its status as a games platform, Roblox has a variety of popular games. As of May 2020, the most popular games on Roblox have over 10 million monthly active players each. As of August 2020, at least 20 games have been played more than one billion times, and at least 5,000 have been played more than one million times.[82] Some of the more notable games include:
Adopt Me!
Main article: Adopt Me!
Adopt Me! is a massively multiplayer online role-playing game where the nominal focus is players pretending to be either parents adopting a child, or children getting adopted, though the de facto focus is around adopting and caring for many different pets, who can be traded with other players.[83] As of July 2020, the game had been played upwards of ten billion times.[84] Adopt Me! was averaging 600,000 concurrent players as of June 2020, making it the most popular game on Roblox.[83] Due to the high cost of pets within the game, with some rare pets selling for up to US$100, a large subculture of scammers has risen up within the game. As the primary user base of Adopt Me! is on average younger than the rest of Roblox, they are especially susceptible to falling for scams.[85][86] DreamCraft, the organization behind the game, has accumulated over $16 million in revenue, mostly from microtransactions.[87][88]
Jailbreak
Some games on Roblox, such as Jailbreak (pictured), have been popular enough to receive media attention
Jailbreak is a cops and robbers game which is among the most popular games on the site, accumulating tens of thousands of concurrent players daily, and which has been played a total of 4 billion times as of August 2020.[9][89] Jailbreak was featured in Roblox's Ready Player One event, based around the release of the film.[90] Alex Balfanz, a co-creator of Jailbreak, covered his undergraduate education at Duke University using funds from the game.[91][9] Jailbreak was conceived and created as a more fleshed-out version of an earlier Roblox game called Prison Life.[92]
MeepCity
MeepCity is a massively multiplayer online role-playing game with noted similarities to Club Penguin and Toontown Online.[93] In addition to its role-playing quantities, MeepCity also features customizable pets, called "Meeps".[94] MeepCity's creator, Alex Bidello, stated in 2018 that he was making enough money off the game to pay two employees and support his mother and brother.[95] Bidello is noted for his development techniques, which include playing the game on alt accounts to gauge the reactions of new players.[96] MeepCity was the first game on Roblox to pass 1 billion total visits.[96] The game was averaging 100,000 concurrent players in July 2018.[95]
Murder Mystery 2
Murder Mystery 2 is a game where players are randomly assigned roles to play each round. One player is selected to be a murderer, who must kill everyone to win, while another player is selected to be a sheriff, and must kill the murderer to win; all remaining players are selected as innocents whose goal is to survive.[96] The game's level design has been praised by critics.[13]
Natural Disaster Survival
Natural Disaster Survival is a game where players are tasked with the role of surviving a litany of natural disasters thrown against them.[97] The game has been positively compared to PlayerUnknown's Battlegrounds.[13] Along with Work at a Pizza Place, Natural Disaster Survival is one of the oldest games on Roblox that still manages to maintain any degree of popularity.[98]
Piggy
Piggy is an episodic horror game that incorporates elements from Peppa Pig and the indie horror game Granny into a zombie apocalypse setting.[99] The games' style of episodic storytelling resulted in a significant fanbase developing prior to the game's finale on May 25, 2020.[100] Piggy was uploaded to the site in January 2020, and had been played nearly 5 billion times as of July 2020.[84] A sequel, titled Piggy: Book 2, released on September 12, 2020.[101]
Royale High
Royale High (originally called Fairies and Mermaids Winx High School)[102] is a massively multiplayer online role-playing game developed by Callmehbob.[96] The game is set in a magical universe and deals with a fantasy school where players dress-up as royalty and as supernatural creatures.[102] Launched in 2017, Royale High had more than 3.5 billion total visits as of July 2020, regularly achieving thousands of concurrent players, making it one of the most popular games on the platform.[103][104]
Welcome to Bloxburg
Welcome to Bloxburg is a game based on The Sims, noted for being a Roblox game which players have to purchase with Robux before playing.[105] As of December 2019, the game had been played 1.4 billion times.[96] Welcome to Bloxburg was used as a demonstrative tool at a summer camp called the Junior Builder Camp in order to teach children about homebuilding.[106]
Work at a Pizza Place
Work at a Pizza Place is a game in which players work together to fulfill orders at a pizza parlor.[13] The game is considered a classic among the Roblox userbase, with the creator attributing its success to the game's ability to encourage socializing.[96] The game has received praise for its driving mechanics.[13]
Revenue
During the 2017 Roblox Developers Conference, officials said that creators on the game platform, of which there were about 1.7 million as of 2017,[107] collectively earned at least $30 million in 2017.[108] The iOS version of Roblox passed $1 billion of lifetime revenue in November 2019, $1.5 billion in June 2020 and $2 billion in October 2020, making it the iOS app with the second-highest revenue.[109][7] Several individual games on Roblox have accumulated revenues of over $10 million,[87] while developers as a whole on the platform are collectively projected to earn around $250 million over the course of 2020.[110] Roblox Corp. itself is valued at $29.5 billion, with venture capital firm Andreessen Horowitz being noted as a substantial investor.[11][111]
Toy line
In January 2017, toy fabricator Jazwares partnered with the Roblox Corporation to produce toy minifigures based on user-generated content created by developers on the platform.[112] The minifigures have limbs and joints similar to that of Lego minifigures, though they are about twice the size.[113] The minifigures have limbs and accessories that are interchangeable. The sets included a code that was used to redeem virtual items, as well are blind boxes that contained random minifigures.[114][115] In 2019, Roblox Corp. released a new line of toys, branded the "Roblox Desktop" series.[116]
Awards and recognition
Roblox has received the following accolades:
Inc. 5000 List of America's Fastest-Growing Private Companies (2016, 2017)[117][118]
San Mateo County Economic Development Association (SAMCEDA) Award of Excellence (2017)[119]
San Francisco Business Times Tech & Innovation Award – Gaming/eSports (2017)[19]
Fast Company's World's 50 Most Innovative Companies – #1 in Gaming and #9 Overall (2020)[120]
See also
Pokémon Brick Bronze
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McKellop, Mario (February 27, 2020). "Roblox secures $150 million in funding, $4 billion valuation". The Burn-In. Retrieved January 18, 2021.
Scholz, Karsten (July 15, 2020). "Roblox stellt Minecraft und Fortnite in den Schatten - und kaum einer merkt's". Buffed (in German). Retrieved January 18, 2021.
Suckley, Matt (March 7, 2018). "How one student's The Sims-like Roblox game racked up 160 million play sessions". Pocket Gamer. Retrieved May 2, 2020.
Collins, Jeff (May 1, 2019). "Building Industry offering summer camp for 'junior builders'". Orange County Register. Retrieved May 2, 2020.
Weinberger, Matt (May 9, 2017). "This game turned players into $50,000-a-month entrepreneurs – now it has a plan to help them make $1.68 million a year". Business Insider. Archived from the original on November 30, 2018. Retrieved October 10, 2017.
Conditt, Jessica (July 22, 2017). "Hobbyist developers will make $30 million via 'Roblox' this year". Engadget. Archived from the original on November 29, 2018. Retrieved October 10, 2017.
Shanley, Patrick (November 25, 2019). "'Roblox Mobile' Crosses $1B in Lifetime Revenue". The Hollywood Reporter. Retrieved June 15, 2020.
Partleton, Kayleigh (June 26, 2020). "Roblox Mobile hits $1.5 billion in lifetime revenue". Pocket Gamer. Retrieved June 26, 2020.
Partleton, Kayleigh (October 22, 2020). "Roblox surpasses $2 billion in player spending on mobile". Pocket Gamer. Retrieved October 23, 2020.
Lawver, Bryan (July 28, 2020). "Roblox Developers To Make $250 Million In 2020 Thanks To Explosive Growth". ScreenRant. Retrieved August 6, 2020.
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Takahashi, Dean (January 10, 2017). "Roblox launches toys based on its user-generated games". VentureBeat. Archived from the original on November 30, 2018. Retrieved November 7, 2017.
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Redundancy (linguistics)
From Wikipedia, the free encyclopedia
Jump to navigationJump to search
For other uses, see Redundancy.
Look up redundancy in Wiktionary, the free dictionary.
In linguistics, redundancy refers to information that is expressed more than once.[1][2]

Examples of redundancies include multiple agreement features in morphology,[1] multiple features distinguishing phonemes in phonology,[2] or the use of multiple words to express a single idea in rhetoric.[1]

Contents
1 Grammar
2 Rhetoric
3 Redundancy versus repetition
4 See also
5 References
Grammar
Redundancy may occur at any level of grammar. Because of agreement – a requirement in many languages that the form of different words in a phrase or clause correspond with one another – the same semantic information may be expressed several times. In the Spanish phrase los árboles verdes ("the green trees"), for example, the article los, the noun árboles, and the adjective verdes are all inflected to show that the phrase is plural.[1] An English example would be: that man is a soldier versus those men are soldiers.

In phonology, a minimal pair is a pair of words or phrases that differs by only one phoneme, the smallest distinctive unit of the sound system. Even so, phonemes may differ on several phonetic features. For example, the English phonemes /p/ and /b/ in the words pin and bin feature different voicing, aspiration, and muscular tension. Any one of these features is sufficient to differentiate /p/ from /b/ in English.[2]

Generative grammar uses such redundancy to simplify the form of grammatical description. Any feature that can be predicted on the basis of other features (such as aspiration on the basis of voicing) need not be indicated in the grammatical rule. Features that are not redundant and therefore must be indicated by rule are called distinctive features.[2]

As with agreement in morphology, phonologically conditioned alternation, such as coarticulation and assimilation add redundancy on the phonological level. The redundancy of phonological rules may clarify some vagueness in spoken communication. According to psychologist Steven Pinker, "In the comprehension of speech, the redundancy conferred by phonological rules can compensate for some of the ambiguity of the sound wave. For example, a speaker may know that thisrip must be this rip and not the srip because in English the initial consonant cluster sr is illegal."[3]

Rhetoric

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Often, redundancies occur in speech unintentionally, but redundant phrases can also be deliberately constructed for emphasis, to reduce the chance that a phrase will be misinterpreted. In rhetoric, the term "redundancy" tends to have a negative connotation and may be perceived as improper because of its use of duplicative or unnecessary wording (and some people expand the definition to include self-contradictory wording, similar to double negation); however, it remains a linguistically valid way of placing emphasis on some expressed idea. Through the use of repetition of certain concepts, redundancy increases the odds of predictability of a message's meaning and understanding to others.

Redundancy typically takes the form of tautology: phrases that repeat a meaning with different though semantically similar words. Common examples are: "a variety of different items", "an added bonus", "to over-exaggerate", "and etc.", "end result", "free gift", "future plans", "unconfirmed rumor", "to kill or murder someone to death", "past history", "safe haven", "potential hazard", "completely surrounded", "false pretense", and so on. There is also the self-referential "joke organization" called "The Redundancy Society of Redundancy", also called "Society of Redundancy Society".

A subset of tautology is RAS syndrome in which one of the words represented by an acronym is then repeated outside the acronym: "ATM machine", "HIV virus", "PIN number", "RIP in peace" and "RAID array". These phases expand to "automated teller machine machine", "human immunodeficiency virus virus", "personal identification number number", "rest in peace in peace" and "redundant array of independent disks array", respectively. "RAS syndrome" is itself a tongue-in-cheek example of the RAS syndrome in action; it expands to "Redundant Acronym Syndrome syndrome". Another common redundancy is the phrase "i ily you", an 'msn speak' phrase which literally means "i i love you you".

A more general classification of redundancy is pleonasm, which can be any unnecessary words (or even word parts). Subsuming both rhetorical tautology and RAS syndrome, it also includes dialectal usage of technically unnecessary parts, as in "off of" vs. "off". Pleonasm can also take the form of purely semantic redundancies that are a part of the de facto standard usage in a language and "transparent" to the user (e.g., the French question "Qu'est-ce que c'est?" meaning "What's that?" or "What is it?", which translates very literally as "What is it that it is?"). The term pleonasm is most often, however, employed as synonymous with tautology.

Redundancy versus repetition
Writing guides, especially for technical writing, usually advise to avoid redundancy, "especially the use of two expressions that mean the same thing. Such repetition works against readability and conciseness."[4] Others make a distinction between redundancy and repetition:

Repetition, if used well, can be a good tool to use in your writing. It can add emphasis to what you are trying to say and strengthen a point. There are many types of useful repetition. Redundancy, on the other hand, cannot be a good thing. Redundancy happens when the repetition of a word or idea does not add anything to the previous usage; it just restates what has already been said, takes up space, and gets in the way without adding meaning.[5]

Computer scientist Donald E. Knuth, author of highly acclaimed textbooks, recommends "to state things twice, in complementary ways, especially when giving a definition. This reinforces the reader’s understanding."[6]

See also
icon Linguistics portal
Markedness
Oxymoron
Pleonasm
RAS syndrome
Redundancy check
Bilingual tautological expressions
Tautology (language)
References
Bussmann, Hadumod (2006). Routledge Dictionary of Language and Linguistics. Routledge. pp. 399–400. ISBN 978-1-134-63038-7.
Crystal, David (2009). Dictionary of Linguistics and Phonetics. John Wiley & Sons. pp. 406–407. ISBN 978-1-4443-0278-3.
Pinker, Steven (1994). The Language Instinct: How the Mind Creates Language. William Morrow. p. 181. ISBN 0-688-12141-1.
J. H. Dawson, "Avoid Redundancy in Writing", in the column "Helpful Hints for Technical Writing", Weed Technology 6:782 (1992).
Nick Jobe and Sophia Stevens: "Repetition and Redundancy", April 2009
Donald E. Knuth, Tracy Larrabee, and Paul M. Roberts: "Mathematical Writing" (1987)

TheRubyCart · 2021-01-20 05:55:47

DestinyCall wrote:

TheRubyCart wrote:
DiscardedSlinky wrote:
Tension headache
From Wikipedia, the free encyclopedia
Jump to navigationJump to search
Tension headache
Other names Tension-type headache (TTH), stress headache
Tension-headache.jpg
A woman experiencing a tension headache
Specialty Neurology
Differential diagnosis Migraine
Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.
Pain medication, such as aspirin and ibuprofen, are effective for the treatment of tension headache.[1][2] Tricyclic antidepressants appear to be useful for prevention.[3] Evidence is poor for SSRIs, propranolol and muscle relaxants.[4][5]
As of 2016, tension headaches affect about 1.89 billion people[6] and are more common in women than men (23% to 18% respectively).[7]

Contents
1 Signs and symptoms
2 Risk factors
3 Mechanism
3.1 Neurotransmitters
3.2 Synapses
3.3 Stress
4 Diagnosis
4.1 Classification
4.2 Differential diagnosis
5 Prevention
5.1 Lifestyle
5.2 Medications
6 Treatment
6.1 Exercise
6.2 Medications
6.2.1 Episodic
6.2.2 Chronic
6.3 Manual therapy
7 Epidemiology
8 References
9 External links
Signs and symptoms
According to the third edition of the International Classification of Headache Disorders,[8] the attacks must meet the following criteria:
A duration of between 30 minutes and 7 days.
At least two of the following four characteristics:
bilateral location
pressing or tightening (non-pulsating) quality
mild or moderate intensity
not aggravated by routine physical activity such as walking or climbing stairs
Both of the following:
no nausea or vomiting
no more than one of photophobia (sensitivity to bright light) or phonophobia (sensitivity to loud sounds)
Tension-type headaches may be accompanied by tenderness of the scalp on manual pressure during an attack.
Risk factors
Various precipitating factors may cause tension-type headaches in susceptible individuals:[9]
Anxiety
Stress
Sleep problems
Young age
Poor health
Mechanism
Although the musculature of the head and neck and psychological factors such as stress may play a role in the overall pathophysiology of TTH, neither is currently believed to be the sole cause of the development of TTH.[10] The pathologic basis of TTH is most likely derived from a combination of personal factors, environmental factors, and alteration of both peripheral and central pain pathways.[11] Peripheral pain pathways receive pain signals from pericranial (around the head) myofascial tissue (protective tissue of muscles) and alteration of this pathway likely underlies episodic tension-type headache (ETTH).[11] In addition to these myofascial tissue pain signals, pericranial muscle tenderness, inflammation, and muscle ischemia have been postulated in headache literature to be causal factors in the peripheral pathophysiology of TTH.[9] However, multiple studies have failed to illustrate evidence for a pathologic role of either ischemia or inflammation within the muscles.[9] Pericranial tenderness is also not likely a peripheral causal factor for TTH, but may instead act to trigger a chronic pain cycle in which the peripheral pain response is transformed over time into a centralized pain response.[9] It is then these prolonged alterations in the peripheral pain pathways that lead to increased excitability of the central nervous system pain pathways, resulting in the transition of episodic tension-type headache into chronic tension type headache (CTTH).[11] Specifically, the hyperexcitability occurs in central nociceptive neurons (the trigeminal spinal nucleus, thalamus, and cerebral cortex) resulting in central sensitization, which manifests clinically as allodynia and hyperalgesia of CTTH.[9][12] Additionally, CTTH patients exhibit decreased thermal and pain thresholds which further bolsters support for central sensitization occurring in CTTH.[9]
The alterations in physiology that lead to overall process of central sensitization involve changes at the level of neural tracts, neurotransmitters and their receptors, the neural synapse, and the post-synaptic membrane. Evidence suggests dysfunction in supraspinal descending inhibitory pain pathways may contribute to the pathogenesis of central sensitization in CTTH.[9]
Neurotransmitters
Specific neuronal receptors and neurotransmitters thought to be most involved include NMDA and AMPA receptors, glutamate, serotonin (5-HT), β-endorphin, and nitric oxide (NO).[9] Of the neurotransmitters, NO plays a major role in central pain pathways and likely contributes to the process of central sensitization.[9] Briefly, the enzyme nitric oxide synthase (NOS) forms NO which ultimately results in vasodilatation and activation of central nervous system pain pathways.[9] Serotonin may also be of significant importance and involved in malfunctioning pain filter located in the brain stem. The view is that the brain misinterprets information—for example from the temporal muscle or other muscles—and interprets this signal as pain. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as nortriptyline. However, the analgesic effect of nortriptyline, as well as amitriptyline in chronic tension-type headache, is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved.[13][9]
Synapses
Regarding synaptic level changes, homosynaptic facilitation and heterosynaptic facilitation are both likely to be involved in central sensitization.[9] Homosynaptic facilitation occurs when synapses normally involved in pain pathways undergo changes involving receptors on the post-synaptic membrane as well as the molecular pathways activated upon synaptic transmission. Lower pain thresholds of CTTH result from this homosynaptic facilitation. In contrast, heterosynaptic facilitation occurs when synapses not normally involved in pain pathways become involved. Once this occurs innocuous signals are interpreted as painful signals. Allodynia and hyperalgesia of CTTH represent this heterosynaptic facilitation clinically.[9]
Stress
In the literature, stress is mentioned as a factor and may be implicated via the adrenal axis. This ultimately results in downstream activation of NMDA receptor activation, NFκB activation, and upregulation of iNOS with subsequent production of NO leading to pain as described above.[9]
Diagnosis
With TTH the physical exam is expected to be normal with perhaps the exception of either pericranial tenderness upon palpation of the cranial muscles, or presence of either photophobia or phonophobia.[14]

Classification
Classification system for tension-type headache.
The International Headache Society's most current classification system for headache disorders is the International Classification of Headache Disorders 3rd edition (ICHD-3) as of 2018. This classification system separates tension-type headache (TTH) into two main groups: episodic (ETTH) and chronic (CTTH). CTTH is defined as fifteen days or more per month with headache for greater than three months, or one-hundred eighty days or more, with headache per year.[15] ETTH is less than fifteen days per month with headache or less than one-hundred eighty days with headache per year.[16][17] However, ETTH is further sub-divided into frequent and infrequent TTH.[18] Frequent TTH is defined as ten or more episodes of headache over the course of one to fourteen days per month for greater than three months, or at least twelve days per year, but less than one-hundred eighty days per year.[17] Infrequent TTH is defined as ten or more episodes of headache for less than one day per month or less than twelve days per year.[16] Furthermore, all sub-classes of TTH can be classified as having presence or absence of pericranial tenderness, which is tenderness of the muscles of the head.[18] Probable TTH is utilized for patients with some characteristics, but not all characteristics of a given sub-type of TTH.[19]
Differential diagnosis
Extensive testing is not needed as TTH is diagnosed by history and physical. However, if symptoms indicative of a more serious diagnosis are present, a contrast enhanced MRI may be utilized. Furthermore, giant cell arteritis should be considered in those 50 years of age and beyond. Screening for giant cell arteritis involves the blood tests of erythrocyte sedimentation rate (ESR) and c-reactive protein.[14][10]
Migraine
Oromandibular dysfunction
Sinus disease
Eye disease
Cervical spine disease
Infection in immunocompromised
Intracranial mass
Idiopathic intracranial hypertension
Medication overuse headache
Secondary headache (headache due to other disorder)
Giant cell arteritis ( ≥50 years of age)
Dermatochalasis
Prevention
Lifestyle
Drinking water and avoiding dehydration helps in preventing tension headache.[20] Using stress management and relaxing often makes headaches less likely.[20] Drinking alcohol can make headaches more likely or severe.[20] Good posture might prevent headaches if there is neck pain.[20] People who have jaw clenching might develop headaches, and getting treatment from a dentist might prevent those headaches.[20] Biofeedback techniques may also help.[21]
Medications
People who have 15 or more headaches in a month may be treated with certain types of daily antidepressants which act to prevent continued tension headaches from occurring.[20] In those who are predisposed to tension type headaches the first-line preventative treatment is amitriptyline, whereas mirtazapine and venlafaxine are second-line treatment options.[22] Tricyclic antidepressants appear to be useful for prevention.[3] Tricyclic antidepressants have been found to be more effective than SSRIs but have greater side effects.[3] Evidence is poor for the use of SSRIs, propranolol, and muscle relaxants for prevention of tension headaches.[4][5]
Treatment
Treatment for a current tension headache is to drink water and confirm that there is no dehydration.[20] If symptoms do not resolve within an hour for a person who has had water, then stress reduction might resolve the issue.[20]
Exercise
Evidence supports simple neck and shoulder exercises in managing ETTH and CTTH for headaches associated with neck pain. Exercises include stretching, strengthening and range of motion exercises. CTTH can also benefit from combined therapy from stress therapy, exercises and postural correction.[23]
Medications
Episodic
Over-the-counter drugs, like paracetamol, aspirin, or NSAIDs (ibuprofen, naproxen, ketoprofen), can be effective but tend to only be helpful as a treatment for a few times in a week at most.[1][20][24][11] For those with gastrointestinal problems (ulcers and bleeding), acetaminophen is the better choice over aspirin, though both provide roughly equivalent pain relief.[11] It is important to note that large daily doses of paracetamol should be avoided as it may cause liver damage especially in those that consume 3 or more drinks/day and those with pre-existing liver disease.[11] Ibuprofen, one of the NSAIDs listed above, is a common choice for pain relief but may also lead to gastrointestinal discomfort.[11]
Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations, analgesic/barbiturate combinations such as Fiorinal).[2][22] In addition analgesic/caffeine combinations are popular such as the aspirin-caffeine combination or the aspirin, acetaminophen and caffeine combinations.[11] Frequent use (daily or skipping just one day in between use for 7–10 days) of any of the above analgesics may, however, lead to medication overuse headache.[2][22][11]
Muscle relaxants are typically used for and are helpful with acute post-traumatic TTH rather than ETTH.[11] Opioid medications are not utilized to treat ETTH.[11] Botulinum toxin does not appear to be helpful.[25]
Chronic
Classes of medications involved in treatment of CTTH include tricyclic antidepressants (TCAs), SSRIs, benzodiazepine (Clonazepam in small evening dose), and muscle relaxants. The most commonly utilized TCA is amitriptyline due to the postulated role in decreasing central sensitization and analgesic relief. Another popular TCA used is Doxepine. SSRIs may also be utilized for management of CTTH. For patients with concurrent muscle spasm and CTTH, the muscle relaxant Tizanidine can be a helpful option.[11]
These medications however, are not effective if concurrent overuse of over the counter medications or other analgesics is occurring.[11] Stopping overuse must occur prior to proceeding with other forms of treatment.[11]
Manual therapy
Current evidence for acupuncture is slight. A 2016 systematic review suggests better evidence among those with frequent tension headaches, but concludes that further trials comparing acupuncture with other treatment options are needed.[26]
People with tension-type headache often use spinal manipulation, soft tissue therapy, and myofascial trigger point treatment. Studies of effectiveness are mixed. A 2006 systematic review found no rigorous evidence supporting manual therapies for tension headache.[27] A 2005 structured review found only weak evidence for the effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[28] A 2004 Cochrane review found that spinal manipulation may be effective for migraine and tension headache, and that spinal manipulation and neck exercises may be effective for cervicogenic headache.[29] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of spinal manipulation.[30] A 2012 systematic review of manual therapy found that hands-on work may reduce both the frequency and the intensity of chronic tension-type headaches.[31] More current literature also appears to be mixed however, CTTH patients may benefit from massage and physiotherapy as suggested by a systemic review examining these modalities via RCTs specifically for this patient population[32] Despite being helpful, the review also makes a point to note that there is no difference in effectiveness long term (6 months) between those CTTH patients utilizing TCAs and physiotherapy.[32] Another systemic review comparing manual therapy to pharmacologic therapy also supports little long term difference in outcome regarding TTH frequency, duration, and intensity.[33]
Epidemiology
As of 2016 tension headaches affect about 1.89 billion people [34] and are more common in women than men (23% to 18% respectively).[7] Despite its benign character, tension-type headache, especially in its chronic form, can impart significant disability on patients as well as burden on society at large.[6]
References
Derry S, Wiffen PJ, Moore RA, Bendtsen L (July 2015). "Ibuprofen for acute treatment of episodic tension-type headache in adults". The Cochrane Database of Systematic Reviews. 7 (7): CD011474. doi:10.1002/14651858.CD011474.pub2. PMC 6457940. PMID 26230487.
Loder E, Rizzoli P (January 2008). "Tension-type headache". BMJ. 336 (7635): 88–92. doi:10.1136/bmj.39412.705868.AD. PMC 2190284. PMID 18187725.
Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O'Malley PG (October 2010). "Tricyclic antidepressants and headaches: systematic review and meta-analysis". BMJ. 341: c5222. doi:10.1136/bmj.c5222. PMC 2958257. PMID 20961988.
Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW (April 2010). "Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review". Family Practice. 27 (2): 151–65. doi:10.1093/fampra/cmp089. PMID 20028727.
Banzi R, Cusi C, Randazzo C, Sterzi R, Tedesco D, Moja L (May 2015). "Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults". The Cochrane Database of Systematic Reviews. 5 (5): CD011681. doi:10.1002/14651858.CD011681. PMC 6864942. PMID 25931277.
Lenaerts ME (December 2006). "Burden of tension-type headache". Current Pain and Headache Reports. 10 (6): 459–62. doi:10.1007/s11916-006-0078-z. PMID 17087872.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders,3rd edition. Cephalalgia 33(9) 629–808
Chen, Yaniv (2009). "Advances in the pathophysiology of tension-type headache: From stress to central sensitization". Current Pain and Headache Reports. 13 (6): 484–494. doi:10.1007/s11916-009-0078-x. ISSN 1531-3433. PMID 19889292.
Walls, Ron; Hockberger, Robert; Gausche-Hill, Marianne (2017-03-09). Rosen's emergency medicine : concepts and clinical practice. Walls, Ron M.; Hockberger, Robert S.; Gausche-Hill, Marianne (Ninth ed.). Philadelphia, PA. p. 1269. ISBN 9780323390163. OCLC 989157341.
Jay GW, Barkin RL (December 2017). "Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache". Disease-A-Month. 63 (12): 342–367. doi:10.1016/j.disamonth.2017.05.001. PMID 28886861.
Ashina S, Bendtsen L, Ashina M (December 2005). "Pathophysiology of tension-type headache". Current Pain and Headache Reports. 9 (6): 415–22. doi:10.1007/s11916-005-0021-8. PMID 16282042.
Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J (January 1999). "Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomised crossover trial". Lancet. 353 (9149): 287–9. doi:10.1016/S0140-6736(98)01079-4. PMID 9929022.
Smith, Jonathan (2019). Ferri's Clinical Advisor. Philadelphia: Elsevier. p. 1348. ISBN 978-0-323-53042-2.
Ihsclassification. "2.3 Chronic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.1 Infrequent episodic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.2 Frequent episodic tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2. Tension-type headache (TTH)". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Ihsclassification. "2.4 Probable tension-type headache". ICHD-3 The International Classification of Headache Disorders 3rd edition. Retrieved 2019-01-12.
Consumer Reports (28 April 2016). "Tension Headache Treatment and Prevention". Consumer Reports. Retrieved 25 May 2016.
Nestoriuc Y, Rief W, Martin A (June 2008). "Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators". Journal of Consulting and Clinical Psychology. 76 (3): 379–96. doi:10.1037/0022-006X.76.3.379. PMID 18540732.
Bendtsen L, Jensen R (May 2011). "Treating tension-type headache -- an expert opinion". Expert Opinion on Pharmacotherapy. 12 (7): 1099–109. doi:10.1517/14656566.2011.548806. PMID 21247362.
Varatharajan, Sharanya; Ferguson, Brad; Chrobak, Karen; Shergill, Yaadwinder; Côté, Pierre; Wong, Jessica J.; Yu, Hainan; Shearer, Heather M.; Southerst, Danielle; Sutton, Deborah; Randhawa, Kristi (July 2016). "Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration". European Spine Journal. 25 (7): 1971–1999. doi:10.1007/s00586-016-4376-9. ISSN 0940-6719. PMID 26851953.
Derry S, Wiffen PJ, Moore RA (January 2017). "Aspirin for acute treatment of episodic tension-type headache in adults". The Cochrane Database of Systematic Reviews. 1: CD011888. doi:10.1002/14651858.CD011888.pub2. PMC 6464783. PMID 28084009.
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External links
Classification D
ICD-10: G44.2ICD-9-CM: 307.81, 339.1MeSH: D018781DiseasesDB: 12554
External resources
MedlinePlus: 000797eMedicine: article/1142908
American Council for Headache Education
National Headache Foundation
World Headache Alliance
vte
Diseases of the nervous system, primarily CNS
vte
Headache
Categories: Headaches
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Roblox
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Not to be confused with Robox.
Roblox
The current Roblox logo in black Gill Sans Ultra Bold font, with both Os replaced by squares
The Roblox logo
Developer(s) Roblox Corporation
Publisher(s) Roblox Corporation
Director(s) David Baszucki,
Erik Cassel[1]
Engine Roblox Studio
Platform(s) Windows, macOS, iOS, Android, Xbox One
Release PC
September 1, 2006[2][3]
iOS
December 11, 2012[4]
Android
July 16, 2014[5]
Xbox One
November 20, 2015[6]
Genre(s) Game creation system, massively multiplayer online
Mode(s) Multi-player, Single-player
Roblox is an online game platform and game creation system that allows users to program games and play games created by other users. Founded by David Baszucki and Erik Cassel in 2004 and released in 2006, the platform hosts user-created games of multiple genres coded in the programming language Lua. For most of Roblox's history, it was relatively small, both as a platform and a company, due to both co-founder Baszucki's lack of interest in press coverage and it being "lost among the crowd" in a large number of platforms released around the same time. Roblox began to grow rapidly in the second half of the 2010s, and this growth has been accentuated by the COVID-19 pandemic.[7][8]
Roblox is free-to-play, with in-game purchases available through a virtual currency called "Robux". As of August 2020, Roblox has over 164 million monthly active users, with it being played by over half of all children aged under 16 in the United States.[9][10] The Roblox Corporation, which develops, publishes, and operates the game, has an estimated $29.5 billion valuation as a result of this large playbase.[11]
Roblox has received generally positive reviews from critics.
Contents
1 Overview
1.1 Roblox Studio
1.2 Items and currency
1.3 Events
2 History and development
3 Community and culture
3.1 Activism
3.2 Effects of the COVID-19 pandemic
3.3 "Oof" sound effect
4 Reception and revenue
4.1 Overall reception
4.1.1 Criticism
4.2 Popular games
4.2.1 Adopt Me!
4.2.2 Jailbreak
4.2.3 MeepCity
4.2.4 Murder Mystery 2
4.2.5 Natural Disaster Survival
4.2.6 Piggy
4.2.7 Royale High
4.2.8 Welcome to Bloxburg
4.2.9 Work at a Pizza Place
4.3 Revenue
5 Toy line
6 Awards and recognition
7 See also
8 References
9 External links
Overview
The Roblox Studio application icon
Roblox Studio
Roblox allows players to create their own games using its proprietary engine, Roblox Studio, which can then be played by other users.[12] Games are coded under an object-oriented programming system utilizing the programming language Lua to manipulate the environment of the game.[13][14] Users are able to create purchasable content through one-time purchases, known as "game passes", as well as microtransactions which can be purchased more than once, known as "developer products" or "products". A percentage of the revenue from purchases is split between the developer and the Roblox Corporation.[15][16] The majority of games produced using Roblox Studio are developed by children, and a total of 20 million games a year are produced using it.[17][9]
Items and currency
Roblox allows players to buy, sell, and create virtual items which can be used to decorate their virtual character that serves as their avatar on the platform.[9] Clothes can be bought by anyone, but only players with a premium membership can sell them.[18] Only Roblox administrators can sell accessories, body parts, gear, and packages under the official Roblox user account;[19] virtual hats and accessories can also be published by a select few users with past experience working with the Roblox Corporation.[20][21] There are several individuals who design items as a full-time job, with the highest-earning creators making over $100,000 a year off item sales.[22] Items with a limited edition status can only be traded between or sold by users with premium membership status.[23]
Robux is the virtual currency in Roblox that allows players to buy various items. Players can obtain Robux by purchasing it with real currency, from a recurring stipend given to members with premium membership, and from other players by producing and selling virtual content in Roblox.[15][24] Robux acquired through the sale of user-generated content can be exchanged into real-world currency through the website's Developer Exchange system.[25] There are a sizeable amount of scams relating to Robux, largely revolving around automated messages promoting scam websites, scam games designed to appear to give out free Robux, and invalid Robux codes.[26][27]
Events
Roblox occasionally hosts real-life and virtual events. They have in the past hosted events such as BloxCon, which was a convention for ordinary players on the platform.[15] Roblox operates annual Easter egg hunts,[28] and also hosts an annual event called the “Bloxy Awards”, an awards ceremony which also functions as a fundraiser. The 2020 edition of the Bloxy Awards, held virtually on the platform, drew 600,000 viewers.[29][30] The Roblox Corporation annually hosts the Roblox Developers Conference, a three-day invite-only event in San Francisco where top content creators on the site learn of upcoming changes to the platform.[31] Roblox Corp. has also hosted similar events in London and Amsterdam.[32][33]
Roblox occasionally engages in events to promote films, such as ones held to promote Wonder Woman 1984 and Aquaman.[34][35] In 2020, Roblox hosted its first virtual concert, which has been compared to that of American rapper Travis Scott's virtual concert in Fortnite,[36] during which American rapper Lil Nas X debuted his song Holiday to an audience of Roblox players.[36][37][38]
History and development
The first Roblox logo, designed in 2004[39]
The Roblox logo from 2005–2006[39]
The Roblox logo from 2006–2017; it had numerous variations, but mostly remained the same.[39]
The Roblox logo as of 2017[39]
The beta version of Roblox was created by co-founders David Baszucki and Erik Cassel in 2004, originally under the name DynaBlocks.[40] Baszucki started testing the first demos that year.[41] In 2005, the company changed its name to Roblox,[41] and it officially launched on September 1, 2006.[2] In March 2007, Roblox became compliant with COPPA, with the addition of safe chat, a change that limited the communication ability of users under the age of thirteen by restricting them to selecting predefined messages from a menu.[42] In August, Roblox applied server improvements and released a premium membership service named "Builders Club".[43] This paid membership feature was rebranded as Roblox Premium in September 2019.[44]
In December 2011, Roblox held their first Hack Week, an annual event where Roblox developers work on outside-the-box ideas for new developments to present to the company.[45][46] On December 11, 2012, an iOS version of Roblox was released,[4] and on July 16, 2014, an Android version was released.[5] On October 1, 2013, Roblox released its Developer Exchange program, allowing developers to exchange Robux earned from their games into real-world currencies.[47]
On May 31, 2015, a feature called 'Smooth Terrain' was added, increasing the graphical fidelity of the terrain and changing the physics engine from a block-oriented style to a smoother and more realistic style.[48] On November 20, Roblox was launched on Xbox One, with an initial selection of 15 games chosen by Roblox staff.[6] New Roblox games for the Xbox One have to go through an approval process, and are subject to the Entertainment Software Ratings Board standards.[49]
In April 2016, Roblox launched Roblox VR for Oculus Rift. At the time of release, more than ten million games were available in 3D.[50] Around the same time period, the safe chat feature was removed and replaced by a system based on a whitelist with a set of acceptable words for users under 13 years old and a set of blacklisted words for other users.[51] In June, the company launched a version compatible with Windows 10. While the game platform has had a presence on the PC since 2004, when its web version was created, this was the first time it was upgraded with a standalone launcher built for Windows.[52] Also in June, the Roblox Corporation was sued by Cinemark Theatres for alleged trademark violations.[53]
Throughout 2017, Roblox engaged in a number of updates to its server technology, as the technology they were operating on until that point was out of date and led to frequent outages.[54] In February 2019, Roblox entered into a joint venture with Songhua River Investment Limited, an affiliate of Tencent, in order to create a localised version of the platform. As of November 2020, the Chinese National Radio and Television Administration had not yet issued the license required to make Roblox available in China.[55][56] In July 2020, Roblox announced the creation of “Party Place”, which functions as an online hangout. The feature was created using new technology that had been used during the 2020 Bloxy Awards, and was designed in response to the COVID-19 pandemic.[57]
In November 2020, the Roblox Corporation announced its intentions to become a public company with appropriate filings with the U.S. Securities and Exchange Commission.[58][59] Following a $520 million investment round in January 2021, Roblox announced it would be issuing a direct public offering in the near future.[11]
Community and culture
Activism
Users of Roblox have been noted for their efforts against racism, with numerous regular users and co-founder Baszucki having declared their support for the George Floyd protests and Black Lives Matter.[60][61] However in August 2019, an investigation by NBC News revealed over 100 accounts linked to far-right and neo-Nazi groups. After being contacted about the accounts by NBC, Roblox moderators removed them.[62]
Effects of the COVID-19 pandemic
The COVID-19 pandemic has affected Roblox in numerous ways. Due to quarantines imposed by the pandemic limiting social interaction, Roblox is being used as a way for children to communicate with each other.[63] One of the most noted ways that this method of communication is being carried out is the phenomenon of birthday parties being held on the platform.[64][65] On May 1, 2020, Roblox Corp. announced a virtual fundraiser to raise money for charities that are battling COVID-19.[66] COVID-19 has caused a substantial increase in both the platform's revenue and the number of players on it, in line with similar effects experienced by the majority of the gaming industry.[67][68]
"Oof" sound effect
From its release to November 2020, Roblox's sound effect for when a character dies was an "oof" sound, which became a substantial part of the platform's reputation due to its status as a meme.[69] The sound was originally produced by video game composer Tommy Tallarico for the 2000 video game Messiah, and he and Roblox entered into a copyright dispute. The dispute ended when Roblox agreed to pull the sound from their platform and replace it with another death sound, and Tallarico agreed to allow Roblox to release the sound again at a later date on its marketplace, which game developers on the platform would be able to purchase for a price of US$1.[70][71]
Reception and revenue
Overall reception
Roblox has received generally positive reviews. Common Sense Media gave it 4 out of 5 stars, praising the website's variety of games and ability to encourage creativity in children, while finding that the decentralized nature of the platform meant game quality varied, and recommended disabling chat functions for young players to prevent possibly harmful interactions.[72] Patricia E. Vance of the Family Online Safety Institute advised parents to monitor their child's interactions on the platform, but praised the platform for "allow[ing] kids to play, explore, socialize, create and learn in a self-directed way", and granted especial praise to Roblox Studio for its ability to encourage children to experience game development.[73] Trusted Reviews, in its overview of the platform, also praised Roblox Studio, stating that “for anyone seeking to develop their computer science skills, or create projects that will instantly receive feedback from a huge audience, the appeal is obvious”.[74] Craig Hurda, writing in Android Guys, gave a more moderate review, praising the number of games available and finding that the game was entertaining for children, while also finding that the platform's audio was "hit-or-miss" and declaring that it had limited appeal for adult players.[75]
Criticism
Roblox has received widespread criticism for its chat filtration system.[76][77] Although Roblox's filtration system censors and removes most inappropriate messages and content, some can still avoid the system. To combat these issues, Roblox has 1,600 people working to remove such content from the platform.[76] Roblox offers privacy settings; parents can limit what people a user can contact, restricting access to private servers, and turning on parental control.[78]
Though sexual content is prohibited on Roblox, the platform has received substantial criticism for the presence of sexually explicit games and imagery within it. This content includes items like virtual sex clubs and nightclubs, with creators of said content largely communicating through third-party platforms which cannot be regulated by Roblox moderators.[79] A 2020 investigation by Fast Company found that sexual content was still prevalent within Roblox, with attempts by moderators to remove it being likened to "whack-a-mole",[80][81] though it was also found that the situation had generally improved in the recent years prior to the report.[80]
Popular games
Due to its status as a games platform, Roblox has a variety of popular games. As of May 2020, the most popular games on Roblox have over 10 million monthly active players each. As of August 2020, at least 20 games have been played more than one billion times, and at least 5,000 have been played more than one million times.[82] Some of the more notable games include:
Adopt Me!
Main article: Adopt Me!
Adopt Me! is a massively multiplayer online role-playing game where the nominal focus is players pretending to be either parents adopting a child, or children getting adopted, though the de facto focus is around adopting and caring for many different pets, who can be traded with other players.[83] As of July 2020, the game had been played upwards of ten billion times.[84] Adopt Me! was averaging 600,000 concurrent players as of June 2020, making it the most popular game on Roblox.[83] Due to the high cost of pets within the game, with some rare pets selling for up to US$100, a large subculture of scammers has risen up within the game. As the primary user base of Adopt Me! is on average younger than the rest of Roblox, they are especially susceptible to falling for scams.[85][86] DreamCraft, the organization behind the game, has accumulated over $16 million in revenue, mostly from microtransactions.[87][88]
Jailbreak
Some games on Roblox, such as Jailbreak (pictured), have been popular enough to receive media attention
Jailbreak is a cops and robbers game which is among the most popular games on the site, accumulating tens of thousands of concurrent players daily, and which has been played a total of 4 billion times as of August 2020.[9][89] Jailbreak was featured in Roblox's Ready Player One event, based around the release of the film.[90] Alex Balfanz, a co-creator of Jailbreak, covered his undergraduate education at Duke University using funds from the game.[91][9] Jailbreak was conceived and created as a more fleshed-out version of an earlier Roblox game called Prison Life.[92]
MeepCity
MeepCity is a massively multiplayer online role-playing game with noted similarities to Club Penguin and Toontown Online.[93] In addition to its role-playing quantities, MeepCity also features customizable pets, called "Meeps".[94] MeepCity's creator, Alex Bidello, stated in 2018 that he was making enough money off the game to pay two employees and support his mother and brother.[95] Bidello is noted for his development techniques, which include playing the game on alt accounts to gauge the reactions of new players.[96] MeepCity was the first game on Roblox to pass 1 billion total visits.[96] The game was averaging 100,000 concurrent players in July 2018.[95]
Murder Mystery 2
Murder Mystery 2 is a game where players are randomly assigned roles to play each round. One player is selected to be a murderer, who must kill everyone to win, while another player is selected to be a sheriff, and must kill the murderer to win; all remaining players are selected as innocents whose goal is to survive.[96] The game's level design has been praised by critics.[13]
Natural Disaster Survival
Natural Disaster Survival is a game where players are tasked with the role of surviving a litany of natural disasters thrown against them.[97] The game has been positively compared to PlayerUnknown's Battlegrounds.[13] Along with Work at a Pizza Place, Natural Disaster Survival is one of the oldest games on Roblox that still manages to maintain any degree of popularity.[98]
Piggy
Piggy is an episodic horror game that incorporates elements from Peppa Pig and the indie horror game Granny into a zombie apocalypse setting.[99] The games' style of episodic storytelling resulted in a significant fanbase developing prior to the game's finale on May 25, 2020.[100] Piggy was uploaded to the site in January 2020, and had been played nearly 5 billion times as of July 2020.[84] A sequel, titled Piggy: Book 2, released on September 12, 2020.[101]
Royale High
Royale High (originally called Fairies and Mermaids Winx High School)[102] is a massively multiplayer online role-playing game developed by Callmehbob.[96] The game is set in a magical universe and deals with a fantasy school where players dress-up as royalty and as supernatural creatures.[102] Launched in 2017, Royale High had more than 3.5 billion total visits as of July 2020, regularly achieving thousands of concurrent players, making it one of the most popular games on the platform.[103][104]
Welcome to Bloxburg
Welcome to Bloxburg is a game based on The Sims, noted for being a Roblox game which players have to purchase with Robux before playing.[105] As of December 2019, the game had been played 1.4 billion times.[96] Welcome to Bloxburg was used as a demonstrative tool at a summer camp called the Junior Builder Camp in order to teach children about homebuilding.[106]
Work at a Pizza Place
Work at a Pizza Place is a game in which players work together to fulfill orders at a pizza parlor.[13] The game is considered a classic among the Roblox userbase, with the creator attributing its success to the game's ability to encourage socializing.[96] The game has received praise for its driving mechanics.[13]
Revenue
During the 2017 Roblox Developers Conference, officials said that creators on the game platform, of which there were about 1.7 million as of 2017,[107] collectively earned at least $30 million in 2017.[108] The iOS version of Roblox passed $1 billion of lifetime revenue in November 2019, $1.5 billion in June 2020 and $2 billion in October 2020, making it the iOS app with the second-highest revenue.[109][7] Several individual games on Roblox have accumulated revenues of over $10 million,[87] while developers as a whole on the platform are collectively projected to earn around $250 million over the course of 2020.[110] Roblox Corp. itself is valued at $29.5 billion, with venture capital firm Andreessen Horowitz being noted as a substantial investor.[11][111]
Toy line
In January 2017, toy fabricator Jazwares partnered with the Roblox Corporation to produce toy minifigures based on user-generated content created by developers on the platform.[112] The minifigures have limbs and joints similar to that of Lego minifigures, though they are about twice the size.[113] The minifigures have limbs and accessories that are interchangeable. The sets included a code that was used to redeem virtual items, as well are blind boxes that contained random minifigures.[114][115] In 2019, Roblox Corp. released a new line of toys, branded the "Roblox Desktop" series.[116]
Awards and recognition
Roblox has received the following accolades:
Inc. 5000 List of America's Fastest-Growing Private Companies (2016, 2017)[117][118]
San Mateo County Economic Development Association (SAMCEDA) Award of Excellence (2017)[119]
San Francisco Business Times Tech & Innovation Award – Gaming/eSports (2017)[19]
Fast Company's World's 50 Most Innovative Companies – #1 in Gaming and #9 Overall (2020)[120]
See also
Pokémon Brick Bronze
References
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Redundancy (linguistics)
From Wikipedia, the free encyclopedia
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For other uses, see Redundancy.
Look up redundancy in Wiktionary, the free dictionary.
In linguistics, redundancy refers to information that is expressed more than once.[1][2]
Examples of redundancies include multiple agreement features in morphology,[1] multiple features distinguishing phonemes in phonology,[2] or the use of multiple words to express a single idea in rhetoric.[1]

Contents
1 Grammar
2 Rhetoric
3 Redundancy versus repetition
4 See also
5 References
Grammar
Redundancy may occur at any level of grammar. Because of agreement – a requirement in many languages that the form of different words in a phrase or clause correspond with one another – the same semantic information may be expressed several times. In the Spanish phrase los árboles verdes ("the green trees"), for example, the article los, the noun árboles, and the adjective verdes are all inflected to show that the phrase is plural.[1] An English example would be: that man is a soldier versus those men are soldiers.
In phonology, a minimal pair is a pair of words or phrases that differs by only one phoneme, the smallest distinctive unit of the sound system. Even so, phonemes may differ on several phonetic features. For example, the English phonemes /p/ and /b/ in the words pin and bin feature different voicing, aspiration, and muscular tension. Any one of these features is sufficient to differentiate /p/ from /b/ in English.[2]
Generative grammar uses such redundancy to simplify the form of grammatical description. Any feature that can be predicted on the basis of other features (such as aspiration on the basis of voicing) need not be indicated in the grammatical rule. Features that are not redundant and therefore must be indicated by rule are called distinctive features.[2]
As with agreement in morphology, phonologically conditioned alternation, such as coarticulation and assimilation add redundancy on the phonological level. The redundancy of phonological rules may clarify some vagueness in spoken communication. According to psychologist Steven Pinker, "In the comprehension of speech, the redundancy conferred by phonological rules can compensate for some of the ambiguity of the sound wave. For example, a speaker may know that thisrip must be this rip and not the srip because in English the initial consonant cluster sr is illegal."[3]
Rhetoric
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Often, redundancies occur in speech unintentionally, but redundant phrases can also be deliberately constructed for emphasis, to reduce the chance that a phrase will be misinterpreted. In rhetoric, the term "redundancy" tends to have a negative connotation and may be perceived as improper because of its use of duplicative or unnecessary wording (and some people expand the definition to include self-contradictory wording, similar to double negation); however, it remains a linguistically valid way of placing emphasis on some expressed idea. Through the use of repetition of certain concepts, redundancy increases the odds of predictability of a message's meaning and understanding to others.
Redundancy typically takes the form of tautology: phrases that repeat a meaning with different though semantically similar words. Common examples are: "a variety of different items", "an added bonus", "to over-exaggerate", "and etc.", "end result", "free gift", "future plans", "unconfirmed rumor", "to kill or murder someone to death", "past history", "safe haven", "potential hazard", "completely surrounded", "false pretense", and so on. There is also the self-referential "joke organization" called "The Redundancy Society of Redundancy", also called "Society of Redundancy Society".
A subset of tautology is RAS syndrome in which one of the words represented by an acronym is then repeated outside the acronym: "ATM machine", "HIV virus", "PIN number", "RIP in peace" and "RAID array". These phases expand to "automated teller machine machine", "human immunodeficiency virus virus", "personal identification number number", "rest in peace in peace" and "redundant array of independent disks array", respectively. "RAS syndrome" is itself a tongue-in-cheek example of the RAS syndrome in action; it expands to "Redundant Acronym Syndrome syndrome". Another common redundancy is the phrase "i ily you", an 'msn speak' phrase which literally means "i i love you you".
A more general classification of redundancy is pleonasm, which can be any unnecessary words (or even word parts). Subsuming both rhetorical tautology and RAS syndrome, it also includes dialectal usage of technically unnecessary parts, as in "off of" vs. "off". Pleonasm can also take the form of purely semantic redundancies that are a part of the de facto standard usage in a language and "transparent" to the user (e.g., the French question "Qu'est-ce que c'est?" meaning "What's that?" or "What is it?", which translates very literally as "What is it that it is?"). The term pleonasm is most often, however, employed as synonymous with tautology.
Redundancy versus repetition
Writing guides, especially for technical writing, usually advise to avoid redundancy, "especially the use of two expressions that mean the same thing. Such repetition works against readability and conciseness."[4] Others make a distinction between redundancy and repetition:
Repetition, if used well, can be a good tool to use in your writing. It can add emphasis to what you are trying to say and strengthen a point. There are many types of useful repetition. Redundancy, on the other hand, cannot be a good thing. Redundancy happens when the repetition of a word or idea does not add anything to the previous usage; it just restates what has already been said, takes up space, and gets in the way without adding meaning.[5]
Computer scientist Donald E. Knuth, author of highly acclaimed textbooks, recommends "to state things twice, in complementary ways, especially when giving a definition. This reinforces the reader’s understanding."[6]
See also
icon Linguistics portal
Markedness
Oxymoron
Pleonasm
RAS syndrome
Redundancy check
Bilingual tautological expressions
Tautology (language)
References
Bussmann, Hadumod (2006). Routledge Dictionary of Language and Linguistics. Routledge. pp. 399–400. ISBN 978-1-134-63038-7.
Crystal, David (2009). Dictionary of Linguistics and Phonetics. John Wiley & Sons. pp. 406–407. ISBN 978-1-4443-0278-3.
Pinker, Steven (1994). The Language Instinct: How the Mind Creates Language. William Morrow. p. 181. ISBN 0-688-12141-1.
J. H. Dawson, "Avoid Redundancy in Writing", in the column "Helpful Hints for Technical Writing", Weed Technology 6:782 (1992).
Nick Jobe and Sophia Stevens: "Repetition and Redundancy", April 2009
Donald E. Knuth, Tracy Larrabee, and Paul M. Roberts: "Mathematical Writing" (1987)

Obesity
From Wikipedia, the free encyclopedia
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For the medical journal, see Obesity (journal).
Obesity
Three silhouettes depicting the outlines of an optimally sized (left), overweight (middle), and obese person (right).
Silhouettes and waist circumferences representing optimal, overweight, and obese
Specialty Endocrinology
Symptoms Increased fat[1]
Complications Cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, osteoarthritis, depression[2][3]
Causes Excessive food, lack of exercise, genetics[1][4]
Diagnostic method BMI > 30 kg/m2[1]
Prevention Societal changes, personal choices[1]
Treatment Diet, exercise, medications, surgery[1][5][6]
Prognosis Reduced life expectancy[2]
Frequency 700 million / 12% (2015)[7]
Part of a series on
Human body weight
General concepts
[show]
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[show]
Measurements
[show]
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[show]
Obesity-associated morbidity
[show]
Management of obesity
[show]
Social aspects
[show]

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Obesity is a medical condition in which excess body fat has accumulated to an extent that it may have a negative effect on health.[1] People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight by the square of the person's height—despite known allometric inaccuracies[a]—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight.[1] Some East Asian countries use lower values.[10] Obesity is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.[2] High BMI is a marker of risk, but not proven to be a direct cause, for diseases caused by diet, physical activity, and environmental factors.[11] A reciprocal link has been found between obesity and depression, with obesity increasing the risk of clinical depression and also depression leading to a higher chance of developing obesity.[3]

Obesity has individual, socioeconomic, and environmental causes, including diet, physical activity, automation, urbanization, genetic susceptibility, medications, mental disorders, economic policies, endocrine disorders, and exposure to endocrine-disrupting chemicals.[1][4][12][13] While a majority of obese individuals at any given time are attempting to lose weight and often successful, research shows that maintaining that weight loss over the long term proves to be rare.[14] The reasons for weight cycling are not fully understood but may include decreased energy expenditure combined with increased biological urge to eat during and after caloric restriction.[14] More studies are needed to determine if weight cycling and yo-yo dieting contribute to inflammation and disease risk in obese individuals.[14]

Obesity prevention requires a complex approach, including interventions at community, family, and individual levels.[1][11] Changes to diet and exercising are the main treatments recommended by health professionals.[2] Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat or sugars, and by increasing the intake of dietary fiber.[1] However, large-scale analyses have found an inverse relationship between energy density and energy cost of foods in developed nations.[15] Low-income populations are more likely to live in neighborhoods that are considered "food deserts" or "food swamps" where nutritional groceries are less available.[16] Medications can be used, along with a suitable diet, to reduce appetite or decrease fat absorption.[5] If diet, exercise, and medication are not effective, a gastric balloon or surgery may be performed to reduce stomach volume or length of the intestines, leading to feeling full earlier or a reduced ability to absorb nutrients from food.[6][17]

Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children.[1][18] In 2015, 600 million adults (12%) and 100 million children were obese in 195 countries.[7] Obesity is more common in women than in men.[1] Authorities view it as one of the most serious public health problems of the 21st century.[19] Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was seen as a symbol of wealth and fertility at other times in history and still is in some parts of the world.[2][20] In 2013, several medical societies, including the American Medical Association and the American Heart Association, classified obesity as a disease.[21][22][23]
Contents

1 Classification
2 Effects on health
2.1 Mortality
2.2 Morbidity
2.3 Survival paradox
3 Causes
3.1 Diet
3.2 Sedentary lifestyle
3.3 Genetics
3.4 Other illnesses
3.5 Social determinants
3.6 Gut bacteria
3.7 Other factors
4 Pathophysiology
5 Public health
5.1 Reports
6 Management
7 Medical interventions
8 Epidemiology
9 History
9.1 Etymology
9.2 Historical attitudes
9.3 The arts
10 Society and culture
10.1 Economic impact
10.2 Size acceptance
10.3 Industry influence on research
11 Childhood obesity
12 Other animals
13 References

Classification
Main article: Classification of obesity
BMI (kg/m2) Classification[24]
from up to
18.5 underweight
18.5 25.0 normal weight
25.0 30.0 overweight
30.0 35.0 class I obesity
35.0 40.0 class II obesity
40.0 class III obesity
A front and side view of a "super obese" male torso. Stretch marks of the skin are visible along with gynecomastia.
A "super obese" male with a BMI of 53 kg/m2: weight 182 kg (400 lb), height 185 cm (6 ft 1 in). He presents with stretch marks and enlarged breasts.

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health.[25] It is defined by body mass index (BMI) and further evaluated in terms of fat distribution via the waist–hip ratio and total cardiovascular risk factors.[26][27] BMI is closely related to both percentage body fat and total body fat.[28] In children, a healthy weight varies with age and sex. Obesity in children and adolescents is defined not as an absolute number but in relation to a historical normal group, such that obesity is a BMI greater than the 95th percentile.[29] The reference data on which these percentiles were based date from 1963 to 1994, and thus have not been affected by the recent increases in weight.[30] BMI is defined as the subject's weight divided by the square of their height and is calculated as follows.

B M I = m h 2 {\displaystyle \mathrm {BMI} ={\frac {m}{h^{2}}}} {\mathrm {BMI}}={\frac {m}{h^{2}}},

where m and h are the subject's weight and height respectively.

BMI is usually expressed in kilograms of weight per metre squared of height. To convert from pounds per inch squared multiply by 703 (kg/m2)/(lb/sq in).[31]

The most commonly used definitions, established by the World Health Organization (WHO) in 1997 and published in 2000, provide the values listed in the table.[32][33]

Some modifications to the WHO definitions have been made by particular organizations.[34] The surgical literature breaks down class II and III obesity into further categories whose exact values are still disputed.[35]

Any BMI ≥ 35 or 40 kg/m2 is severe obesity.
A BMI of ≥ 35 kg/m2 and experiencing obesity-related health conditions or ≥40–44.9 kg/m2 is morbid obesity.
A BMI of ≥ 45 or 50 kg/m2 is super obesity.

As Asian populations develop negative health consequences at a lower BMI than Caucasians, some nations have redefined obesity; Japan has defined obesity as any BMI greater than 25 kg/m2[10] while China uses a BMI of greater than 28 kg/m2.[34]
Effects on health

Excessive body weight is associated with various diseases and conditions, particularly cardiovascular diseases, diabetes mellitus type 2, obstructive sleep apnea, certain types of cancer, osteoarthritis,[2] and asthma.[2][36] As a result, obesity has been found to reduce life expectancy.[2]
Mortality

Relative risk of death over 10 years in white people who have never smoked in the United States by BMI. The BMI range 22.5 to 24.9 is set as the reference.[37]

Obesity is one of the leading preventable causes of death worldwide.[38][39][40] A number of reviews have found that mortality risk is lowest at a BMI of 20–25 kg/m2[41][42][43] in non-smokers and at 24–27 kg/m2 in current smokers, with risk increasing along with changes in either direction.[44][45] This appears to apply in at least four continents.[43] In contrast, a 2013 review found that grade 1 obesity (BMI 30–35) was not associated with higher mortality than normal weight, and that overweight (BMI 25–30) was associated with "lower" mortality than was normal weight (BMI 18.5–25).[46] Other evidence suggests that the association of BMI and waist circumference with mortality is U- or J-shaped, while the association between waist-to-hip ratio and waist-to-height ratio with mortality is more positive.[47] In Asians the risk of negative health effects begins to increase between 22–25 kg/m2.[48] A BMI above 32 kg/m2 has been associated with a doubled mortality rate among women over a 16-year period.[49] In the United States, obesity is estimated to cause 111,909 to 365,000 deaths per year,[2][40] while 1 million (7.7%) of deaths in Europe are attributed to excess weight.[50][51] On average, obesity reduces life expectancy by six to seven years,[2][52] a BMI of 30–35 kg/m2 reduces life expectancy by two to four years,[42] while severe obesity (BMI > 40 kg/m2) reduces life expectancy by ten years.[42]
Morbidity
Main article: Obesity-associated morbidity

Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in metabolic syndrome,[2] a combination of medical disorders which includes: diabetes mellitus type 2, high blood pressure, high blood cholesterol, and high triglyceride levels.[53]

Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a sedentary lifestyle. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with type 2 diabetes. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.[54]

Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as osteoarthritis, obstructive sleep apnea, social stigmatization) and those due to the increased number of fat cells (diabetes, cancer, cardiovascular disease, non-alcoholic fatty liver disease).[2][55] Increases in body fat alter the body's response to insulin, potentially leading to insulin resistance. Increased fat also creates a proinflammatory state,[56][57] and a prothrombotic state.[55][58]

Obesity increases the risk of developing serious illness from coronavirus disease 2019.[59]
Medical field Condition Medical field Condition
Cardiology

coronary heart disease:[60] angina and myocardial infarction
congestive heart failure[2][61]
high blood pressure[2]
abnormal cholesterol levels[2]
deep vein thrombosis and pulmonary embolism[62]

Dermatology

stretch marks[63]
acanthosis nigricans[63]
lymphedema[63]
cellulitis[63]
hirsutism[63]
intertrigo[64]

Endocrinology and Reproductive medicine

diabetes mellitus[2]
polycystic ovarian syndrome[2]
menstrual disorders[2]
infertility[2][65]
complications during pregnancy[2][65]
birth defects[2]
intrauterine fetal death[65]

Gastroenterology

gastroesophageal reflux disease[19]
fatty liver disease[19]
cholelithiasis (gallstones)[19]

Neurology

stroke[2]
meralgia paresthetica[66]
migraines[67]
carpal tunnel syndrome[68]
dementia[69]
idiopathic intracranial hypertension[70]
multiple sclerosis[71]

Oncology[72]

esophageal
colorectal
pancreatic
gallbladder
endometrial
kidney
Leukemia
Hepatocellular carcinoma[19]
malignant melanoma

Psychiatry

depression in women[2]
social stigmatization[2]

Respirology

obstructive sleep apnea[2][36]
obesity hypoventilation syndrome[2][36]
asthma[2][36]
increased complications during general anaesthesia[2]

Rheumatology and Orthopedics

gout[73]
poor mobility[74]
osteoarthritis[2]
low back pain[75]

Urology and Nephrology

erectile dysfunction[76]
urinary incontinence[77]
chronic renal failure[78]
hypogonadism[79]
buried penis[80]

Survival paradox
See also: Obesity paradox

Although the negative health consequences of obesity in the general population are well supported by the available evidence, health outcomes in certain subgroups seem to be improved at an increased BMI, a phenomenon known as the obesity survival paradox.[81] The paradox was first described in 1999 in overweight and obese people undergoing hemodialysis,[81] and has subsequently been found in those with heart failure and peripheral artery disease (PAD).[82]

In people with heart failure, those with a BMI between 30.0 and 34.9 had lower mortality than those with a normal weight. This has been attributed to the fact that people often lose weight as they become progressively more ill.[83] Similar findings have been made in other types of heart disease. People with class I obesity and heart disease do not have greater rates of further heart problems than people of normal weight who also have heart disease. In people with greater degrees of obesity, however, the risk of further cardiovascular events is increased.[84][85] Even after cardiac bypass surgery, no increase in mortality is seen in the overweight and obese.[86] One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event.[87] Another study found that if one takes into account chronic obstructive pulmonary disease (COPD) in those with PAD, the benefit of obesity no longer exists.[82]
Causes

At an individual level, a combination of excessive food energy intake and a lack of physical activity is thought to explain most cases of obesity.[88] A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness.[13] In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet,[89] increased reliance on cars, and mechanized manufacturing.[90][91]

A 2006 review identified ten other possible contributors to the recent increase of obesity: (1) insufficient sleep, (2) endocrine disruptors (environmental pollutants that interfere with lipid metabolism), (3) decreased variability in ambient temperature, (4) decreased rates of smoking, because smoking suppresses appetite, (5) increased use of medications that can cause weight gain (e.g., atypical antipsychotics), (6) proportional increases in ethnic and age groups that tend to be heavier, (7) pregnancy at a later age (which may cause susceptibility to obesity in children), (8) epigenetic risk factors passed on generationally, (9) natural selection for higher BMI, and (10) assortative mating leading to increased concentration of obesity risk factors (this would increase the number of obese people by increasing population variance in weight).[92] According to the Endocrine Society, there is "growing evidence suggesting that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight".[93]
Diet
Main article: Diet and obesity
(Left) A world map with countries colored to reflect the food energy consumption of their people in 1961. North America, Europe, and Australia have relatively high intake, while Africa and Asia consume much less.
1961
(Right) A world map with countries colored to reflect the food energy consumption of their people in 2001–2003. Consumption in North America, Europe, and Australia has increased with respect to previous levels in 1971. Food consumption has also increased substantially in many parts of Asia. However, food consumption in Africa remains low.
2001–03
Map of dietary energy availability per person per day in 1961 (left) and 2001–2003 (right)[94] Calories per person per day (kilojoules per person per day)
no data
<1,600 (<6,700)
1,600–1,800 (6,700–7,500)
1,800–2,000 (7,500–8,400)
2,000–2,200 (8,400–9,200)
2,200–2,400 (9,200–10,000)
2,400–2,600 (10,000–10,900)

2,600–2,800 (10,900–11,700)
2,800–3,000 (11,700–12,600)
3,000–3,200 (12,600–13,400)
3,200–3,400 (13,400–14,200)
3,400–3,600 (14,200–15,100)
>3,600 (>15,100)

A graph showing a gradual increase in global food energy consumption per person per day between 1961 and 2002.
Average per capita energy consumption of the world from 1961 to 2002[94]

A 2016 review supported excess food as the primary factor.[95][96] Dietary energy supply per capita varies markedly between different regions and countries. It has also changed significantly over time.[94] From the early 1970s to the late 1990s the average food energy available per person per day (the amount of food bought) increased in all parts of the world except Eastern Europe. The United States had the highest availability with 3,654 calories (15,290 kJ) per person in 1996.[94] This increased further in 2003 to 3,754 calories (15,710 kJ).[94] During the late 1990s Europeans had 3,394 calories (14,200 kJ) per person, in the developing areas of Asia there were 2,648 calories (11,080 kJ) per person, and in sub-Saharan Africa people had 2,176 calories (9,100 kJ) per person.[94][97] Total food energy consumption has been found to be related to obesity.[98]

The widespread availability of nutritional guidelines[99] has done little to address the problems of overeating and poor dietary choice.[100] From 1971 to 2000, obesity rates in the United States increased from 14.5% to 30.9%.[101] During the same period, an increase occurred in the average amount of food energy consumed. For women, the average increase was 335 calories (1,400 kJ) per day (1,542 calories (6,450 kJ) in 1971 and 1,877 calories (7,850 kJ) in 2004), while for men the average increase was 168 calories (700 kJ) per day (2,450 calories (10,300 kJ) in 1971 and 2,618 calories (10,950 kJ) in 2004). Most of this extra food energy came from an increase in carbohydrate consumption rather than fat consumption.[102] The primary sources of these extra carbohydrates are sweetened beverages, which now account for almost 25 percent of daily food energy in young adults in America,[103] and potato chips.[104] Consumption of sweetened drinks such as soft drinks, fruit drinks, iced tea, and energy and vitamin water drinks is believed to be contributing to the rising rates of obesity[105][106] and to an increased risk of metabolic syndrome and type 2 diabetes.[107] Vitamin D deficiency is related to diseases associated with obesity.[108]

As societies become increasingly reliant on energy-dense, big-portions, and fast-food meals, the association between fast-food consumption and obesity becomes more concerning.[109] In the United States consumption of fast-food meals tripled and food energy intake from these meals quadrupled between 1977 and 1995.[110]

Agricultural policy and techniques in the United States and Europe have led to lower food prices. In the United States, subsidization of corn, soy, wheat, and rice through the U.S. farm bill has made the main sources of processed food cheap compared to fruits and vegetables.[111] Calorie count laws and nutrition facts labels attempt to steer people toward making healthier food choices, including awareness of how much food energy is being consumed.

Obese people consistently under-report their food consumption as compared to people of normal weight.[112] This is supported both by tests of people carried out in a calorimeter room[113] and by direct observation.
Sedentary lifestyle
See also: Sedentary lifestyle and Exercise trends

A sedentary lifestyle plays a significant role in obesity.[114] Worldwide there has been a large shift towards less physically demanding work,[115][116][117] and currently at least 30% of the world's population gets insufficient exercise.[116] This is primarily due to increasing use of mechanized transportation and a greater prevalence of labor-saving technology in the home.[115][116][117] In children, there appear to be declines in levels of physical activity due to less walking and physical education.[118] World trends in active leisure time physical activity are less clear. The World Health Organization indicates people worldwide are taking up less active recreational pursuits, while a study from Finland[119] found an increase and a study from the United States found leisure-time physical activity has not changed significantly.[120] A 2011 review of physical activity in children found that it may not be a significant contributor.[121]

In both children and adults, there is an association between television viewing time and the risk of obesity.[122][123][124] A review found 63 of 73 studies (86%) showed an increased rate of childhood obesity with increased media exposure, with rates increasing proportionally to time spent watching television.[125]
Genetics
Main article: Genetics of obesity
A painting of a dark haired pink cheeked obese nude young female leaning against a table. She is holding grapes and grape leaves in her left hand which cover her genitalia.
A 1680 painting by Juan Carreno de Miranda of a girl presumed to have Prader–Willi syndrome[126]

Like many other medical conditions, obesity is the result of an interplay between genetic and environmental factors.[127] Polymorphisms in various genes controlling appetite and metabolism predispose to obesity when sufficient food energy is present. As of 2006, more than 41 of these sites on the human genome have been linked to the development of obesity when a favorable environment is present.[128] People with two copies of the FTO gene (fat mass and obesity associated gene) have been found on average to weigh 3–4 kg more and have a 1.67-fold greater risk of obesity compared with those without the risk allele.[129] The differences in BMI between people that are due to genetics varies depending on the population examined from 6% to 85%.[130]

Obesity is a major feature in several syndromes, such as Prader–Willi syndrome, Bardet–Biedl syndrome, Cohen syndrome, and MOMO syndrome. (The term "non-syndromic obesity" is sometimes used to exclude these conditions.)[131] In people with early-onset severe obesity (defined by an onset before 10 years of age and body mass index over three standard deviations above normal), 7% harbor a single point DNA mutation.[132]

Studies that have focused on inheritance patterns rather than on specific genes have found that 80% of the offspring of two obese parents were also obese, in contrast to less than 10% of the offspring of two parents who were of normal weight.[133] Different people exposed to the same environment have different risks of obesity due to their underlying genetics.[134]

The thrifty gene hypothesis postulates that, due to dietary scarcity during human evolution, people are prone to obesity. Their ability to take advantage of rare periods of abundance by storing energy as fat would be advantageous during times of varying food availability, and individuals with greater adipose reserves would be more likely to survive famine. This tendency to store fat, however, would be maladaptive in societies with stable food supplies.[135] This theory has received various criticisms, and other evolutionarily-based theories such as the drifty gene hypothesis and the thrifty phenotype hypothesis have also been proposed.[136][137]
Other illnesses

Certain physical and mental illnesses and the pharmaceutical substances used to treat them can increase risk of obesity. Medical illnesses that increase obesity risk include several rare genetic syndromes (listed above) as well as some congenital or acquired conditions: hypothyroidism, Cushing's syndrome, growth hormone deficiency,[138] and some eating disorders such as binge eating disorder and night eating syndrome.[2] However, obesity is not regarded as a psychiatric disorder, and therefore is not listed in the DSM-IVR as a psychiatric illness.[139] The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons without psychiatric disorders.[140]

Certain medications may cause weight gain or changes in body composition; these include insulin, sulfonylureas, thiazolidinediones, atypical antipsychotics, antidepressants, steroids, certain anticonvulsants (phenytoin and valproate), pizotifen, and some forms of hormonal contraception.[2]
Social determinants
Main article: Social determinants of obesity
The disease scroll (Yamai no soshi, late 12th century) depicts a woman moneylender with obesity, considered a disease of the rich.
Obesity in developed countries is correlated with economic inequality

While genetic influences are important to understanding obesity, they cannot explain the current dramatic increase seen within specific countries or globally.[141] Though it is accepted that energy consumption in excess of energy expenditure leads to obesity on an individual basis, the cause of the shifts in these two factors on the societal scale is much debated. There are a number of theories as to the cause but most believe it is a combination of various factors.

The correlation between social class and BMI varies globally. A review in 1989 found that in developed countries women of a high social class were less likely to be obese. No significant differences were seen among men of different social classes. In the developing world, women, men, and children from high social classes had greater rates of obesity.[142] An update of this review carried out in 2007 found the same relationships, but they were weaker. The decrease in strength of correlation was felt to be due to the effects of globalization.[143] Among developed countries, levels of adult obesity, and percentage of teenage children who are overweight, are correlated with income inequality. A similar relationship is seen among US states: more adults, even in higher social classes, are obese in more unequal states.[144]

Many explanations have been put forth for associations between BMI and social class. It is thought that in developed countries, the wealthy are able to afford more nutritious food, they are under greater social pressure to remain slim, and have more opportunities along with greater expectations for physical fitness. In undeveloped countries the ability to afford food, high energy expenditure with physical labor, and cultural values favoring a larger body size are believed to contribute to the observed patterns.[143] Attitudes toward body weight held by people in one's life may also play a role in obesity. A correlation in BMI changes over time has been found among friends, siblings, and spouses.[145] Stress and perceived low social status appear to increase risk of obesity.[144][146][147]

Smoking has a significant effect on an individual's weight. Those who quit smoking gain an average of 4.4 kilograms (9.7 lb) for men and 5.0 kilograms (11.0 lb) for women over ten years.[148] However, changing rates of smoking have had little effect on the overall rates of obesity.[149]

In the United States the number of children a person has is related to their risk of obesity. A woman's risk increases by 7% per child, while a man's risk increases by 4% per child.[150] This could be partly explained by the fact that having dependent children decreases physical activity in Western parents.[151]

In the developing world urbanization is playing a role in increasing rate of obesity. In China overall rates of obesity are below 5%; however, in some cities rates of obesity are greater than 20%.[152]

Malnutrition in early life is believed to play a role in the rising rates of obesity in the developing world.[153] Endocrine changes that occur during periods of malnutrition may promote the storage of fat once more food energy becomes available.[153]

Consistent with cognitive epidemiological data, numerous studies confirm that obesity is associated with cognitive deficits.[154][155]

Whether obesity causes cognitive deficits, or vice versa is unclear at present.
Gut bacteria
See also: Infectobesity

The study of the effect of infectious agents on metabolism is still in its early stages. Gut flora has been shown to differ between lean and obese people. There is an indication that gut flora can affect the metabolic potential. This apparent alteration is believed to confer a greater capacity to harvest energy contributing to obesity. Whether these differences are the direct cause or the result of obesity has yet to be determined unequivocally.[156] The use of antibiotics among children has also been associated with obesity later in life.[157][158]

An association between viruses and obesity has been found in humans and several different animal species. The amount that these associations may have contributed to the rising rate of obesity is yet to be determined.[159]
Other factors

A number of reviews have found an association between short duration of sleep and obesity.[160][161] Whether one causes the other is unclear.[160] Even if shorts sleep does increase weight gain it is unclear if this is to a meaningful degree or increasing sleep would be of benefit.[162]

Certain aspects of personality are associated with being obese.[163] Neuroticism, impulsivity, and sensitivity to reward are more common in people who are obese while conscientiousness and self-control are less common in people who are obese.[163][164] Loneliness is also a risk factor.[165]
Pathophysiology
Two white mice both with similar sized ears, black eyes, and pink noses. The body of the mouse on the left, however, is about three times the width of the normal sized mouse on the right.
A comparison of a mouse unable to produce leptin thus resulting in obesity (left) and a normal mouse (right)
Main article: Pathophysiology of obesity

There are many possible pathophysiological mechanisms involved in the development and maintenance of obesity.[166] This field of research had been almost unapproached until the leptin gene was discovered in 1994 by J. M. Friedman's laboratory.[167] While leptin and ghrelin are produced peripherally, they control appetite through their actions on the central nervous system. In particular, they and other appetite-related hormones act on the hypothalamus, a region of the brain central to the regulation of food intake and energy expenditure. There are several circuits within the hypothalamus that contribute to its role in integrating appetite, the melanocortin pathway being the most well understood.[166] The circuit begins with an area of the hypothalamus, the arcuate nucleus, that has outputs to the lateral hypothalamus (LH) and ventromedial hypothalamus (VMH), the brain's feeding and satiety centers, respectively.[168]

The arcuate nucleus contains two distinct groups of neurons.[166] The first group coexpresses neuropeptide Y (NPY) and agouti-related peptide (AgRP) and has stimulatory inputs to the LH and inhibitory inputs to the VMH. The second group coexpresses pro-opiomelanocortin (POMC) and cocaine- and amphetamine-regulated transcript (CART) and has stimulatory inputs to the VMH and inhibitory inputs to the LH. Consequently, NPY/AgRP neurons stimulate feeding and inhibit satiety, while POMC/CART neurons stimulate satiety and inhibit feeding. Both groups of arcuate nucleus neurons are regulated in part by leptin. Leptin inhibits the NPY/AgRP group while stimulating the POMC/CART group. Thus a deficiency in leptin signaling, either via leptin deficiency or leptin resistance, leads to overfeeding and may account for some genetic and acquired forms of obesity.[166]
Public health

The World Health Organization (WHO) predicts that overweight and obesity may soon replace more traditional public health concerns such as undernutrition and infectious diseases as the most significant cause of poor health.[169] Obesity is a public health and policy problem because of its prevalence, costs, and health effects.[170] The United States Preventive Services Task Force recommends screening for all adults followed by behavioral interventions in those who are obese.[171] Public health efforts seek to understand and correct the environmental factors responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct junk food marketing to children,[172] and decreasing access to sugar-sweetened beverages in schools.[173] The World Health Organization recommends the taxing of sugary drinks.[174] When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.[175] There is low quality evidence that nutritional labelling with energy information on menus can help to reduce energy intake while dining in restaurants.[176]
Reports

Many organizations have published reports pertaining to obesity. In 1998, the first US Federal guidelines were published, titled "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report".[177] In 2006 the Canadian Obesity Network, now known as Obesity Canada published the "Canadian Clinical Practice Guidelines (CPG) on the Management and Prevention of Obesity in Adults and Children". This is a comprehensive evidence-based guideline to address the management and prevention of overweight and obesity in adults and children.[88]

In 2004, the United Kingdom Royal College of Physicians, the Faculty of Public Health and the Royal College of Paediatrics and Child Health released the report "Storing up Problems", which highlighted the growing problem of obesity in the UK.[178] The same year, the House of Commons Health Select Committee published its "most comprehensive inquiry [...] ever undertaken" into the impact of obesity on health and society in the UK and possible approaches to the problem.[179] In 2006, the National Institute for Health and Clinical Excellence (NICE) issued a guideline on the diagnosis and management of obesity, as well as policy implications for non-healthcare organizations such as local councils.[180] A 2007 report produced by Derek Wanless for the King's Fund warned that unless further action was taken, obesity had the capacity to cripple the National Health Service financially.[181]

Comprehensive approaches are being looked at to address the rising rates of obesity. The Obesity Policy Action (OPA) framework divides measure into 'upstream' policies, 'midstream' policies, 'downstream' policies. 'Upstream' policies look at changing society, 'midstream' policies try to alter individuals' behavior to prevent obesity, and 'downstream' policies try to treat currently afflicted people.[182]
Management
Main article: Management of obesity

The main treatment for obesity consists of weight loss via calorie restricted dieting and physical exercise.[21][88][183][184] Dieting, as part of a lifestyle change, produces sustained weight loss, despite slow weight regain over time.[21][185][186][187] Although 87% of participants in the National Weight Control Registry were able to maintain 10% body weight loss for 10 years,[188] the most appropriate dietary approach for long term weight loss maintenance is still unknown.[189] Intensive behavioral interventions combining both dietary changes and exercise are recommended.[21][183][190] Intermittent fasting has no additional benefit of weight loss compared to continuous energy restriction.[189] Adherence is a more important factor in weight loss success than whatever kind of diet an individual undertakes.[189][191]

Several hypo-caloric diets are effective.[21] In the short-term low carbohydrate diets appear better than low fat diets for weight loss.[192] In the long term, however, all types of low-carbohydrate and low-fat diets appear equally beneficial.[192][193] A 2014 review found that the heart disease and diabetes risks associated with different diets appear to be similar.[194] Promotion of the Mediterranean diets among the obese may lower the risk of heart disease.[192] Decreased intake of sweet drinks is also related to weight-loss.[192] Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20%.[195] Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child.[196] Intensive behavioral counseling is recommended in those who are both obese and have other risk factors for heart disease.[197]
Medical interventions

Five medications have evidence for long-term use orlistat, lorcaserin, liraglutide, phentermine–topiramate, and naltrexone–bupropion.[198] They result in weight loss after one year ranged from 3.0 to 6.7 kg (6.6-14.8 lbs) over placebo.[198] Orlistat, liraglutide, and naltrexone–bupropion are available in both the United States and Europe, whereas phentermine–topiramate are available only in the United States.[199] European regulatory authorities rejected the latter two drugs in part because of associations of heart valve problems with lorcaserin and more general heart and blood vessel problems with phentermine–topiramate.[199] Lorcaserin was available in the United States and than removed from the market in 2020 due to its association with cancer.[200] Orlistat use is associated with high rates of gastrointestinal side effects[201] and concerns have been raised about negative effects on the kidneys.[202] There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease or death.[5]

The most effective treatment for obesity is bariatric surgery.[6][21] The types of procedures include laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, vertical-sleeve gastrectomy, and biliopancreatic diversion.[198] Surgery for severe obesity is associated with long-term weight loss, improvement in obesity-related conditions,[203] and decreased overall mortality, however, improved metabolic health results from the weight loss, not the surgery.[204] One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.[205] Complications occur in about 17% of cases and reoperation is needed in 7% of cases.[203] Due to its cost and risks, researchers are searching for other effective yet less invasive treatments including devices that occupy space in the stomach.[206] For adults who have not responded to behavioral treatments with or without medication, the US guidelines on obesity recommend informing them about bariatric surgery.[183]
Epidemiology
Main article: Epidemiology of obesity
A map of the world with countries colored to reflect the percentage of men who are obese. Obese males and females have higher prevalence (above 30%) in the US and some Middle Eastern and Oceanian countries, medium prevalence in the rest of North America and Europe, and lower prevalence (<5%) in most of Asia and Africa.
World obesity prevalence among males (left) and females (right) in 2008.[207]
<5%
5–10%
10–15%

15–20%
20–25%
25–30%

30–35%
35–40%
40–45%

45–50%
50–55%
>55%

See or edit source data.
Percentage of males either overweight or obese by year.[208]

In earlier historical periods obesity was rare, and achievable only by a small elite, although already recognised as a problem for health. But as prosperity increased in the Early Modern period, it affected increasingly larger groups of the population.[209]

In 1997 the WHO formally recognized obesity as a global epidemic.[103] As of 2008 the WHO estimates that at least 500 million adults (greater than 10%) are obese, with higher rates among women than men.[210] The percentage of adults affected in the United States as of 2015–2016 is about 39.6% overall (37.9% of males and 41.1% of females).[211]

The rate of obesity also increases with age at least up to 50 or 60 years old[212] and severe obesity in the United States, Australia, and Canada is increasing faster than the overall rate of obesity.[35][213][214] The OECD has projected an increase in obesity rates until at least 2030, especially in the United States, Mexico and England with rates reaching 47%, 39% and 35% respectively.[215]

Once considered a problem only of high-income countries, obesity rates are rising worldwide and affecting both the developed and developing world.[50] These increases have been felt most dramatically in urban settings.[210] The only remaining region of the world where obesity is not common is sub-Saharan Africa.[2]
History
Etymology

Obesity is from the Latin obesitas, which means "stout, fat, or plump". Ēsus is the past participle of edere (to eat), with ob (over) added to it.[216] The Oxford English Dictionary documents its first usage in 1611 by Randle Cotgrave.[217]
Historical attitudes
A very obese gentleman with a prominent double chin and mustache dressed in black with a sword at his left side.
During the Middle Ages and the Renaissance obesity was often seen as a sign of wealth, and was relatively common among the elite: The Tuscan General Alessandro del Borro, attributed to Charles Mellin, 1645[218]
A carved stone miniature figurine depicted an obese female.
Venus of Willendorf created 24,000–22,000 BC

Ancient Greek medicine recognizes obesity as a medical disorder, and records that the Ancient Egyptians saw it in the same way.[209] Hippocrates wrote that "Corpulence is not only a disease itself, but the harbinger of others".[2] The Indian surgeon Sushruta (6th century BCE) related obesity to diabetes and heart disorders.[219] He recommended physical work to help cure it and its side effects.[219] For most of human history mankind struggled with food scarcity.[220] Obesity has thus historically been viewed as a sign of wealth and prosperity. It was common among high officials in Europe in the Middle Ages and the Renaissance[218] as well as in Ancient East Asian civilizations.[221] In the 17th century, English medical author Tobias Venner is credited with being one of the first to refer to the term as a societal disease in a published English language book.[209][222]

With the onset of the Industrial Revolution it was realized that the military and economic might of nations were dependent on both the body size and strength of their soldiers and workers.[103] Increasing the average body mass index from what is now considered underweight to what is now the normal range played a significant role in the development of industrialized societies.[103] Height and weight thus both increased through the 19th century in the developed world. During the 20th century, as populations reached their genetic potential for height, weight began increasing much more than height, resulting in obesity.[103] In the 1950s increasing wealth in the developed world decreased child mortality, but as body weight increased heart and kidney disease became more common.[103][223] During this time period, insurance companies realized the connection between weight and life expectancy and increased premiums for the obese.[2]

Many cultures throughout history have viewed obesity as the result of a character flaw. The obesus or fat character in Ancient Greek comedy was a glutton and figure of mockery. During Christian times the food was viewed as a gateway to the sins of sloth and lust.[20] In modern Western culture, excess weight is often regarded as unattractive, and obesity is commonly associated with various negative stereotypes. People of all ages can face social stigmatization, and may be targeted by bullies or shunned by their peers.[224]

Public perceptions in Western society regarding healthy body weight differ from those regarding the weight that is considered ideal – and both have changed since the beginning of the 20th century. The weight that is viewed as an ideal has become lower since the 1920s. This is illustrated by the fact that the average height of Miss America pageant winners increased by 2% from 1922 to 1999, while their average weight decreased by 12%.[225] On the other hand, people's views concerning healthy weight have changed in the opposite direction. In Britain, the weight at which people considered themselves to be overweight was significantly higher in 2007 than in 1999.[226] These changes are believed to be due to increasing rates of adiposity leading to increased acceptance of extra body fat as being normal.[226]

Obesity is still seen as a sign of wealth and well-being in many parts of Africa. This has become particularly common since the HIV epidemic began.[2]
The arts

The first sculptural representations of the human body 20,000–35,000 years ago depict obese females. Some attribute the Venus figurines to the tendency to emphasize fertility while others feel they represent "fatness" in the people of the time.[20] Corpulence is, however, absent in both Greek and Roman art, probably in keeping with their ideals regarding moderation. This continued through much of Christian European history, with only those of low socioeconomic status being depicted as obese.[20]

During the Renaissance some of the upper class began flaunting their large size, as can be seen in portraits of Henry VIII of England and Alessandro dal Borro.[20] Rubens (1577–1640) regularly depicted heavyset women in his pictures, from which derives the term Rubenesque. These women, however, still maintained the "hourglass" shape with its relationship to fertility.[227] During the 19th century, views on obesity changed in the Western world. After centuries of obesity being synonymous with wealth and social status, slimness began to be seen as the desirable standard.[20]
Society and culture
Economic impact

In addition to its health impacts, obesity leads to many problems including disadvantages in employment[228][229] and increased business costs. These effects are felt by all levels of society from individuals, to corporations, to governments.

In 2005, the medical costs attributable to obesity in the US were an estimated $190.2 billion or 20.6% of all medical expenditures,[230][231][232] while the cost of obesity in Canada was estimated at CA$2 billion in 1997 (2.4% of total health costs).[88] The total annual direct cost of overweight and obesity in Australia in 2005 was A$21 billion. Overweight and obese Australians also received A$35.6 billion in government subsidies.[233] The estimate range for annual expenditures on diet products is $40 billion to $100 billion in the US alone.[234]

The Lancet Commission on Obesity in 2019 called for a global treaty — modelled on the WHO Framework Convention on Tobacco Control — committing countries to address obesity and undernutrition, explicitly excluding the food industry from policy development. They estimate the global cost of obesity $2 trillion a year, about or 2.8% of world GDP.[235]

Obesity prevention programs have been found to reduce the cost of treating obesity-related disease. However, the longer people live, the more medical costs they incur. Researchers, therefore, conclude that reducing obesity may improve the public's health, but it is unlikely to reduce overall health spending.[236]
An extra wide chair beside a number of normal sized chairs.
Services accommodate obese people with specialized equipment such as much wider chairs.[237]

Obesity can lead to social stigmatization and disadvantages in employment.[228] When compared to their normal weight counterparts, obese workers on average have higher rates of absenteeism from work and take more disability leave, thus increasing costs for employers and decreasing productivity.[238] A study examining Duke University employees found that people with a BMI over 40 kg/m2 filed twice as many workers' compensation claims as those whose BMI was 18.5–24.9 kg/m2. They also had more than 12 times as many lost work days. The most common injuries in this group were due to falls and lifting, thus affecting the lower extremities, wrists or hands, and backs.[239] The Alabama State Employees' Insurance Board approved a controversial plan to charge obese workers $25 a month for health insurance that would otherwise be free unless they take steps to lose weight and improve their health. These measures started in January 2010 and apply to those state workers whose BMI exceeds 35 kg/m2 and who fail to make improvements in their health after one year.[240]

Some research shows that obese people are less likely to be hired for a job and are less likely to be promoted.[224] Obese people are also paid less than their non-obese counterparts for an equivalent job; obese women on average make 6% less and obese men make 3% less.[241]

Specific industries, such as the airline, healthcare and food industries, have special concerns. Due to rising rates of obesity, airlines face higher fuel costs and pressures to increase seating width.[242] In 2000, the extra weight of obese passengers cost airlines US$275 million.[243] The healthcare industry has had to invest in special facilities for handling severely obese patients, including special lifting equipment and bariatric ambulances.[244] Costs for restaurants are increased by litigation accusing them of causing obesity.[245] In 2005 the US Congress discussed legislation to prevent civil lawsuits against the food industry in relation to obesity; however, it did not become law.[245]

With the American Medical Association's 2013 classification of obesity as a chronic disease,[22] it is thought that health insurance companies will more likely pay for obesity treatment, counseling and surgery, and the cost of research and development of fat treatment pills or gene therapy treatments should be more affordable if insurers help to subsidize their cost.[246] The AMA classification is not legally binding, however, so health insurers still have the right to reject coverage for a treatment or procedure.[246]

In 2014, The European Court of Justice ruled that morbid obesity is a disability. The Court said that if an employee's obesity prevents him from "full and effective participation of that person in professional life on an equal basis with other workers", then it shall be considered a disability and that firing someone on such grounds is discriminatory.[247]
Size acceptance
United States President William Howard Taft was often ridiculed for being overweight.
See also: Fat acceptance movement, Social stigma of obesity, Health at Every Size, and Fat fetishism

The principal goal of the fat acceptance movement is to decrease discrimination against people who are overweight and obese.[248][249] However, some in the movement are also attempting to challenge the established relationship between obesity and negative health outcomes.[250]

A number of organizations exist that promote the acceptance of obesity. They have increased in prominence in the latter half of the 20th century.[251] The US-based National Association to Advance Fat Acceptance (NAAFA) was formed in 1969 and describes itself as a civil rights organization dedicated to ending size discrimination.[252]

The International Size Acceptance Association (ISAA) is a non-governmental organization (NGO) which was founded in 1997. It has more of a global orientation and describes its mission as promoting size acceptance and helping to end weight-based discrimination.[253] These groups often argue for the recognition of obesity as a disability under the US Americans With Disabilities Act (ADA). The American legal system, however, has decided that the potential public health costs exceed the benefits of extending this anti-discrimination law to cover obesity.[250]
Industry influence on research

In 2015 the New York Times published an article on the Global Energy Balance Network, a nonprofit founded in 2014 that advocated for people to focus on increasing exercise rather than reducing calorie intake to avoid obesity and to be healthy. The organization was founded with at least $1.5M in funding from the Coca-Cola Company, and the company has provided $4M in research funding to the two founding scientists Gregory A. Hand and Steven N. Blair since 2008.[254][255]
Childhood obesity
Main article: Childhood obesity

The healthy BMI range varies with the age and sex of the child. Obesity in children and adolescents is defined as a BMI greater than the 95th percentile.[29] The reference data that these percentiles are based on is from 1963 to 1994 and thus has not been affected by the recent increases in rates of obesity.[30] Childhood obesity has reached epidemic proportions in the 21st century, with rising rates in both the developed and the developing world. Rates of obesity in Canadian boys have increased from 11% in the 1980s to over 30% in the 1990s, while during this same time period rates increased from 4 to 14% in Brazilian children.[256] In the UK, there were 60% more obese children in 2005 compared to 1989.[257] In the US, the percentage of overweight and obese children increased to 16% in 2008, a 300% increase over the prior 30 years.[258]

As with obesity in adults, many factors contribute to the rising rates of childhood obesity. Changing diet and decreasing physical activity are believed to be the two most important causes for the recent increase in the incidence of child obesity.[259] Antibiotics in the first 6 months of life have been associated with excess weight at age seven to twelve years of age.[158] Because childhood obesity often persists into adulthood and is associated with numerous chronic illnesses, children who are obese are often tested for hypertension, diabetes, hyperlipidemia, and fatty liver disease.[88] Treatments used in children are primarily lifestyle interventions and behavioral techniques, although efforts to increase activity in children have had little success.[260] In the United States, medications are not FDA approved for use in this age group.[256] Multi-component behaviour change interventions that include changes to dietary and physical activity may reduce BMI in the short term in children aged 6 to 11 years, although the benefits are small and quality of evidence is low.[261]
Other animals
Main article: Obesity in pets

Obesity in pets is common in many countries. In the United States, 23–41% of dogs are overweight, and about 5.1% are obese.[262] The rate of obesity in cats was slightly higher at 6.4%.[262] In Australia the rate of obesity among dogs in a veterinary setting has been found to be 7.6%.[263] The risk of obesity in dogs is related to whether or not their owners are obese; however, there is no similar correlation between cats and their owners.[264]
References

Informational notes

Professor Nick Trefethen of the University of Oxford recommends an alternative formula which replaces the square of height with a power of 5/2 (along with appropriate recentering of other coefficients), as this is known to scale more accurately for short and tall individuals, an observation dating all the way to the Belgian scientist Adolphe Quetelet who first devised the body mass index, from his own writings in 1842.[8] The power of two was adopted instead for arithmetic convenience in an era that predated electronic calculators.[8] Additionally, European male populations have increased in average height by 10–15 cm (4–6 inches) since the middle of the 19th century,[9] increasing the fraction of the tall male population where the commonly accepted modern BMI distorts human allometry.

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Obesity at Curlie
"Obesity 2015". The Lancet. 2015.
Keller, Kathleen (2008). Encyclopedia of Obesity. Thousand Oaks, Calif: Sage Publications, Inc. ISBN 978-1-4129-5238-5.

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