Tension-type headache

What it is

Tension-type headache is one of the primary headaches in the International Classification of Headache Disorders, 2nd ed. (ICHD-2), together with migraine, cluster and other, such as cold stimulus headache. Migraine and tension headaches are more common in females.

How it presents

The headache is bilateral and lasts > 30 min, typically 4-6 hr, and is constant. The pain is steady and band-like, with no aura. One page states there is no photophobia or phonophobia; the diagnostic criteria as written require both of two things together: no nausea or vomiting, with anorexia allowed, either photophobia or phonophobia; and a headache not attributed to another disorder.

How it is diagnosed

The diagnostic criteria for tension-type headache are:

1. Headache lasts 30 minutes to 7 days.
2. Headache has at least two of the following features: bilateral location; pressing or tightening (non pulsating) quality; mild or moderate intensity; not aggravated by routine physical activity such as walking or climbing stairs.
3. Both of the following: no nausea or vomiting (anorexia may occur), either photophobia or phonophobia; and the headache is not attributed to another disorder.

The secondary headaches to keep in mind are those attributed to head or neck trauma, cranial or cervical vascular disorder, nonvascular intracranial disorder, substance use or withdrawal, infection, disturbance of homeostasis or psychiatric disorder, and headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures. If a red flag for a secondary cause of headache is present, MRI of the head should be performed.