Tension Type Headache

Pain onset in tension-type headache can have a throbbing quality and is usually more gradual than onset in migraines. Compared with migraines, tension-type headaches are more variable in duration, more constant in quality, and less severe.


For tension-type headaches two of the following characteristics must be present:

Pressing or tightening (nonpulsatile quality)
Frontal-occipital location
Bilateral - Mild/moderate intensity
Not aggravated by physical activity
Tension-type headache history is as follows:
Duration of 30 minutes to 7 days
No nausea or vomiting (anorexia may occur)
Photophobia and/or phonophobia
Minimum of 10 previous headache episodes; fewer than 180 days per year with headache to be considered "infrequent"
Bilateral and occipitonuchal or bifrontal pain
Pain described as "fullness, tightness/squeezing, pressure" or "bandlike/viselike"
May occur acutely under emotional distress or intense worry
Insomnia
Often present upon rising or shortly thereafter
Muscular tightness or stiffness in neck, occipital, and frontal regions
Duration of more than 5 years in 75% of patients with chronic headaches
Difficulty concentrating
No prodrome
New headache onset in elderly patients should suggest etiologies other than tension headache.