Tension-type headache

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Última revisión: 24 Mar 2025

Última actualización: 01 Apr 2025

Tension-type headaches (TTHs) can be either episodic or chronic.

Stress and mental tension are common triggers.

Symptoms include dull, nonpulsatile, bilateral, pressing/pressure-like pain (mild to moderate in intensity); pericranial tenderness is common but not invariable.

Unlike migraine, there is no significant nausea, no vomiting, little or no photophobia or phonophobia, and a lack of aggravation by routine physical activity.

Usually responds to simple analgesics; preventive treatments, including amitriptyline, venlafaxine, and mirtazapine, should be considered in patients with frequent episodic and chronic TTHs.

Nondrug therapies include acupuncture, relaxation, electromyographic biofeedback, cognitive behavioral therapy, and physical therapy.

Definición

TTHs can be either episodic or chronic. They are the most common type of headache, but are rarely disabling and are typically associated with little or no photophobia, phonophobia, or nausea; thus patients do not usually seek medical care and usually successfully self-treat. The attacks are bilateral and generalized throughout the head with a predilection for the frontal and occipital regions. The pain is typically described as being a "tight band" around the head. It does not worsen with routine physical activity.

BMJ talk medicine: tension headache Opens in new window

Anamnesis y examen

Principales factores de diagnóstico

generalized head pain
frontal or occipital head pain
nonpulsatile head pain
constricting pain
normal neurologic examination

Todos los datos

Otros factores de diagnóstico

pericranial tenderness
sternocleidomastoid muscle tenderness
trapezius muscle tenderness
temporalis muscle tenderness
lateral pterygoid muscle tenderness
masseter muscle tenderness
photophobia or phonophobia
nausea
regular analgesic use
anxiety and depression
somatization

Todos los datos

Factores de riesgo

mental tension
stress
missing meals
fatigue
lack of sleep
somatization
female sex
age 20-39 years
lower socioeconomic status
analgesic overuse

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

clinical diagnosis

Todos los datos

Pruebas diagnósticas que deben considerarse

CT sinus
MRI brain
lumbar puncture
polysomnography

Todos los datos

Algoritmo de tratamiento

Agudo

acute attack

En curso

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

Colaboradores

Autores

Mark W. Green, MD, FAAN

Professor of Neurology, Anesthesiology and Rehabilitation Medicine

Emeritus Director of Headache and Pain Medicine

Icahn School of Medicine at Mount Sinai

New York

Divulgaciones

MWG declares that he has no competing interests.

Rachel Colman, MD

Assistant Professor of Neurology

Icahn School of Medicine at Mount Sinai

New York

Divulgaciones

RC declares that she has no competing interests.

Revisores por pares

Sait Ashina, MD

Assistant Professor of Neurology and Anesthesia

Harvard Medical School

Director of Comprehensive Headache Center

Beth Israel Deaconess Medical Centre

Boston

Divulgaciones

SA has received honoraria from and is a consultant for Abbvie/Allergan, Eli Lilly, Linpharma, Lundbeck, Satsuma, Teva, Theranica, Percept, and Impel NeuroPharma. SA is an author of one of the references in this topic.

Giles Elrington, MBBS (Hons), MD, FRCP

Consultant Neurologist

Barts Health NHS Trust

London

Divulgaciones

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.

Paul Davies, MA, MD, FRCP

Consultant Neurologist

Northampton General Hospital

Northampton

Divulgaciones

PD declares that he has no competing interests.

Diferenciales
- Chronic migraine
- Medication overuse headache
- Sphenoid sinusitis
Más Diferenciales
Guías de práctica clínica
- Headaches in pregnancy and postpartum: ACOG clinical practice guideline No. 3
- ACR Appropriateness Criteria: headache
Más Guías de práctica clínica
Folletos para el paciente
Tension-type headache
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Tension-type headache

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

acute attack

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

Colaboradores

Autores

Mark W. Green, MD, FAAN

Divulgaciones

Rachel Colman, MD

Divulgaciones

Revisores por pares

Sait Ashina, MD

Divulgaciones

Giles Elrington, MBBS (Hons), MD, FRCP

Divulgaciones

Paul Davies, MA, MD, FRCP

Divulgaciones

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice