Tension-type headache

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By Christopher J Boes MD

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

In this clinical article, Dr. Christopher Boes outlines the clinical manifestations, etiology, differential diagnosis, diagnostic evaluation, and management of tension-type headache. Recently published guidelines from the European Federation of Neurological Societies (EFNS) on the treatment of tension-type 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 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.