Tension-type headache

Article section 1 of 15.  Next

By Rashmi B Halker MD

Tension-type headache is also known as or subsumes Conversion headache, Psychogenic headache, Somatoform disorder headache, and Muscle contraction headache. -ed.

Dr. Rashmi Halker outlines the clinical manifestations, etiology, differential diagnosis, diagnostic evaluation, and management of tension-type headache. Recently updated diagnostic criteria from the International Classification of Headache Disorders (ICHD-3) from the International Headache Society on tension-type headache, migraine, and medication-overuse headache are reviewed.

Key points

  • Tension-type headache is bland and characterized as head pain devoid of migrainous characteristics.
  • The fundamental difference between tension-type headache and migraine is that tension-type headache lacks features of sensory sensitivity of any description and lacks the usual triggering associations of migraine.
  • Because of the nonspecific clinical features of tension-type headache, virtually any and all structural and metabolic diseases may cause a phenotypic tension-type headache.
  • First-line acute therapies are simple analgesics and nonsteroidal anti-inflammatory drugs.
  • Preventive medications should be used for chronic tension-type headache when attacks occur more than 2 days a week; first-line preventive therapy is amitriptyline.
  • Electromyography biofeedback has a documented effect; cognitive-behavioral therapy and relaxation training are most likely effective.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited