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Tension-type headache

Last reviewed: 1 Nov 2023
Last updated: 08 Sep 2022



History and exam

Key diagnostic factors

  • generalized head pain
  • frontal or occipital head pain
  • nonpulsatile head pain
  • constricting pain
  • normal neurologic 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
  • somatization
Other diagnostic factors

Risk factors

  • mental tension
  • stress
  • missing meals
  • fatigue
  • somatization
  • 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 attack


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



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



MWG declares that he has no competing interests.

Rachel Colman, MD

Assistant Professor of Neurology

Icahn School of Medicine at Mount Sinai

New York



RC declares that she has no competing interests.

Peer reviewers

Giles Elrington, MBBS (Hons), MD, FRCP

Consultant Neurologist

Barts Health NHS Trust




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


Walton Headache Center




MSH declares that he has no competing interests.

Paul Davies, MA, MD, FRCP

Consultant Neurologist

Northampton General Hospital




PD declares that he has no competing interests.

  • Differentials

    • Chronic migraine
    • Medication-overuse headache
    • Sphenoid sinusitis
    More Differentials
  • Guidelines

    • Headaches in pregnancy and postpartum: ACOG clinical practice guideline No. 3
    • ACR Appropriateness Criteria: headache
    More Guidelines
  • Patient leaflets

    Tension-type headache

    More Patient leaflets
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