Tension-type headache

This page was originally based on the International Classification of Headache Disorders from the International Headache Society

Original Editor - Rachael Lowe

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Infrequent episodic tension-type headache

Infrequent episodes of headache lasting minutes to days. The pain is typically bilateral, pressing or tightening in quality and of mild to moderate intensity, and it does not worsen with routine physical activity. There is no nausea but photophobia or phonophobia may be present.

Diagnostic criteria

1. At least 10 episodes occurring on <1 day per month on average (<12 days per year) and fulfilling criteria 2-4
2. Headache lasting from 30 minutes to 7 days
3. Headache has at least two of the following characteristics:
   • bilateral location
   • pressing/tightening (non-pulsating) quality
   • mild or moderate intensity
   • not aggravated by routine physical activity such as walking or climbing stairs
4. Both of the following:
   • no nausea or vomiting (anorexia may occur)
     
   • no more than one of photophobia or phonophobia
5. Not attributed to another disorder

Frequent episodic tension-type headache

Frequent episodes of headache lasting minutes to days. The pain is typically bilateral, pressing or tightening in quality and of mild to moderate intensity, and it does not worsen with routine physical activity. There is no nausea but photophobia or phonophobia may be present.

Frequent tension-type headache often coexists with migraine without aura. Coexisting tension-type headache in migraineurs should preferably be identified by a diagnostic headache diary. The treatment of migraine differs considerably from that of tension-type headache and it is important to educate patients to differentiate between these types of headaches in order to select the right treatment and to prevent medication-overuse headache.

Diagnostic criteria

1. At least 10 episodes occurring on ≥1 but <15 days per month for at least 3 months (≥12 and <180 days per year) and fulfilling criteria 2-4
2. Headache lasting from 30 minutes to 7 days
   
3. Headache has at least two of the following characteristics:
   • bilateral location
   • pressing/tightening (non-pulsating) quality
   • mild or moderate intensity
   • not aggravated by routine physical activity such as walking or climbing stairs
4. Both of the following:
   • no nausea or vomiting (anorexia may occur)
   • no more than one of photophobia or phonophobia
5. Not attributed to another disorder

Chronic tension-type headache

A disorder evolving from episodic tension-type headache, with daily or very frequent episodes of headache lasting minutes to days. The pain is typically bilateral, pressing or tightening in quality and of mild to moderate intensity, and it does not worsen with routine physical activity. There may be mild nausea, photophobia or phonophobia.

Differentiation between this and Chronic migrane can be difficult. It should be remembered that some patients with chronic tension-type headache develop migraine-like features if they have severe pain and , conversely, some migraine patients develop increasingly frequent tension-type-like interval headaches, the nature of which remains unclear.

Diagnostic criteria

1. Headache occurring on ≥15 days per month on average for >3 months (≥180 days per year)1 and fulfilling criteria 2-4
2. Headache lasts hours or may be continuous
3. Headache has at least two of the following characteristics:
   • bilateral location
   • pressing/tightening (non-pulsating) quality
   • mild or moderate intensity
   • not aggravated by routine physical activity such as walking or climbing stairs
4. Both of the following:
   • no more than one of photophobia, phonophobia or mild nausea
   • neither moderate or severe nausea nor vomiting
5. Not attributed to another disorder

Recent Related Research (from Pubmed)

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