Significance, clinical characteristics and treatment of tension-type headache

1. Big picture

Tension-type headache, TTH, is the most common primary headache. It is usually benign, but it is important because it is extremely frequent, may become chronic, may be associated with stress, anxiety or depression, and may lead to excessive use of painkillers.

The key exam idea:

Tension-type headache is a bilateral, pressing/tightening, mild-to-moderate headache, usually without nausea/vomiting, not worsened by ordinary physical activity, and the patient can usually continue daily activity.

It must be distinguished from:

• Migraine: throbbing, moderate-severe, worsened by activity, nausea/vomiting, photophobia/phonophobia.

• Cluster headache: excruciating unilateral orbital pain with autonomic signs and restlessness.

• Secondary headache: tumor, meningitis, subarachnoid hemorrhage, venous sinus thrombosis, glaucoma, temporal arteritis, raised intracranial pressure.

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