(See also Approach to the Patient With Headache.)
Tension-type headaches may be episodic or chronic:
The pain of a tension-type headache is usually mild to moderate and often described as viselike. These headaches originate in the occipital or frontal region bilaterally and spread over the entire head.
Unlike migraine headaches, tension-type headaches are not accompanied by nausea and vomiting and are not made worse by physical activity, light, sounds, or smells.
Potential triggers for chronic tension-type headache include
Episodic headaches may last 30 minutes to several days. They typically start several hours after waking and worsen as the day progresses. They rarely awaken patients from sleep.
Chronic headaches may vary in intensity throughout the day but are almost always present.
Diagnosis of tension-type headache is based on characteristic symptoms and a normal physical examination, which includes a neurologic examination. Potential triggers for chronic tension-type headache should be identified and treated.
Tension-type headache should be distinguished from a forme fruste of migraine, which many patients with migraine have; these headaches have only some features of migraine and resemble tension-type headache, but they are mild and respond to migraine-specific drugs.
If severe headaches are thought to be tension-type headaches, the diagnosis should be reconsidered because severe tension-type headaches are often migraines.
Some drugs used to prevent migraine, particularly amitriptyline, can help prevent chronic tension-type headache.
For most mild to moderate tension-type headaches, OTC analgesics (eg, aspirin, acetaminophen) can provide relief. Massaging the affected area may help.
Behavioral and psychologic interventions (eg, relaxation and stress management techniques) are often used and are effective, especially when combined with drug treatment.