Summary
Definition
History and exam
Key diagnostic factors
- generalized head pain
- frontal or occipital head pain
- nonpulsatile head pain
- constricting pain
- normal neurologic examination
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
Risk factors
- mental tension
- stress
- missing meals
- fatigue
- somatization
- female sex
- age 20-39 years
- lower socioeconomic status
- analgesic overuse
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- CT sinus
- MRI brain
- lumbar puncture
Treatment algorithm
acute attack
chronic symptoms (>7-9 headache days/month)
Contributors
Authors
Mark W. Green, MD, FAAN

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.
Differentials
- Chronic migraine
- Medication-overuse headache
- Sphenoid sinusitis
More DifferentialsGuidelines
- Headaches in pregnancy and postpartum: ACOG clinical practice guideline No. 3
- ACR Appropriateness Criteria: headache
More GuidelinesPatient leaflets
Tension-type headache
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