Tension-type headache

Last reviewed: 1 Nov 2022
Last updated: 08 Sep 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • generalised head pain
  • frontal or occipital head pain
  • non-pulsatile head pain
  • constricting pain
  • normal neurological examination
More key diagnostic factors

Other diagnostic factors

  • pericranial tenderness
  • sternocleidomastoid muscle tenderness
  • trapezius muscle tenderness
  • temporalis muscle tenderness
  • lateral pterygoid muscle tenderness
  • masseter muscle tenderness
  • photophobia or phonophobia
  • regular analgesic use
  • anxiety and depression
  • somatisation
Other diagnostic factors

Risk factors

  • mental tension
  • stress
  • missing meals
  • fatigue
  • somatisation
  • female sex
  • age 20-39 years
  • lower socioeconomic status
  • analgesic overuse
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • CT sinus
  • MRI brain
  • lumbar puncture
More investigations to consider

Treatment algorithm

ACUTE

acute attack

ONGOING

chronic symptoms (>7-9 headache days/month)

Contributors

Authors

Mark W. Green, MD, FAAN
Mark W. Green

Professor of Neurology, Anesthesiology and Rehabilitation Medicine

Director of Headache and Pain Medicine

Icahn School of Medicine at Mount Sinai

New York

NY

Disclosures

MWG declares that he has no competing interests.

Rachel Colman, MD

Assistant Professor of Neurology

Icahn School of Medicine at Mount Sinai

New York

NY

Disclosures

RC declares that she has no competing interests.

Peer reviewers

Giles Elrington, MBBS (Hons), MD, FRCP

Consultant Neurologist

Barts Health NHS Trust

London

UK

Disclosures

GE is involved in a number of clinical trials on multiple sclerosis sponsored by Genzyme, Roche, Teva, Novartis, Biogen, as well as one funded by the MRC. He is also involved in clinical trials sponsored by Allergan, NMT Medical, GlaxoSmithKline (GSK), Bristol-Myers, the UK's Parkinson's Disease Research Group, and Pharmacia. In addition, he has attended lectures, conferences, and symposia with the following companies: GSK, AstraZeneca, MSD, Almirall, Pfizer, Menarini, Allergan, Biogen, Teva, Conference Plus, Infomed, BMJ.

Marc S. Husid, MD

Director

Walton Headache Center

Augusta

GA

Disclosures

MSH declares that he has no competing interests.

Paul Davies, MA, MD, FRCP

Consultant Neurologist

Northampton General Hospital

Northampton

UK

Disclosures

PD declares that he has no competing interests.

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