Tension-type headache

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Última revisão: 15 Jan 2026

Última atualização: 11 Feb 2026

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.

Definição

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.

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis

Detalhes completos

Investigações a serem consideradas

CT sinus
MRI brain
lumbar puncture
polysomnography

Detalhes completos

Algoritmo de tratamento

AGUDA

acute attack

CONTÍNUA

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

Declarações

MWG declares that he has no competing interests.

Rachel Colman, MD

Assistant Professor of Neurology

Icahn School of Medicine at Mount Sinai

New York

Declarações

RC declares that she has no competing interests.

Revisores

Sait Ashina, MD

Assistant Professor of Neurology and Anesthesia

Harvard Medical School

Director of Comprehensive Headache Center

Beth Israel Deaconess Medical Centre

Boston

Declarações

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

Declarações

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

Declarações

PD declares that he has no competing interests.

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Referências

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Principais artigos

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan 25;38(1):1-211.Texto completo

Ashina S, Mitsikostas DD, Lee MJ, et al. Tension-type headache. Nat Rev Dis Primers. 2021 Mar 25;7(1):24. Resumo

Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010 Nov;17(11):1318-25.Texto completo Resumo

Headaches in pregnancy and postpartum: ACOG clinical practice guideline No. 3. Obstet Gynecol. 2022 May 1;139(5):944-72. Resumo

Banzi R, Cusi C, Randazzo C, et al. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults. Cochrane Database Syst Rev. 2015;(5):CD011681.Texto completo Resumo

Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016;(4):CD007587.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Chronic migraine
- Medication overuse headache
- Sphenoid sinusitis
Mais Diagnósticos diferenciais
Diretrizes
- Headaches in pregnancy and postpartum: ACOG clinical practice guideline No. 3
- ACR Appropriateness Criteria: headache
Mais Diretrizes
Folhetos informativos para os pacientes
Tension-type headache
Mais Folhetos informativos para os pacientes
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Tension-type headache

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

acute attack

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

Colaboradores

Autores

Mark W. Green, MD, FAAN

Declarações

Rachel Colman, MD

Declarações

Revisores

Sait Ashina, MD

Declarações

Giles Elrington, MBBS (Hons), MD, FRCP

Declarações

Paul Davies, MA, MD, FRCP

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice