Tension-type headache

This is the most common type of primary headache: its lifetime prevalence in the general population ranges in different studies from 30 to 78%. At the same time, it is the least studied of the primary headache disorders, despite the fact that it has the highest socio-economic impact.

Whilst this type of headache was previously considered to be primarily psychogenic, a number of studies have appeared after the first edition of The International Classification of Headache Disorders that strongly suggest a neurobiological basis, at least for the more severe subtypes of tension-type headache.

Tension-type headaches are divided into infrequebt, frequent and chronic. The chronic subtype is a serious disease causing greatly decreased quality of life and high disability. The infrequent subtype has very little impact on the individual and does not deserve much attention from the medical profession. However, frequent sufferers can encounter considerable disability that sometimes warrants expensive drugs and prophylactic medication.

The exact mechanisms of tension-type headache are not known. Peripheral pain mechanisms are most likely to play a role in Infrequent episodic tension-type headache and Frequent episodic tension-type headache whereas central pain mechanisms play a more important role in Chronic tension-type headache.

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