Robert Kaniecki, MD,
Director, The Headache Center
Assistant Professor of Neurology
University of Pittsburgh
Pittsburgh, Pennsylvania
Most will experience “episodic” tension-type headache, a label applied to those reporting headache on fewer than 15
days per month. Those describing headache of greater frequency are termed “chronic.” Most develop tension-type
headache prior to age 30 with peak prevalence in the decade of ages 40 to 49, and a subsequent decrease with age in
both genders. Women are slightly more likely to be affected than men. Tension-type headache is as prevalent as migraine in both children and adolescents. Although no clear genetic underpinnings have been identified, approximately
40 percent will report a family history of some form of headache disorder.
Tension-type headache may be the most common, but it is also the least distinct of all the headache disorders treated
by medical professionals. The symptoms of tension-type headache may be reported by patients with various clinical
issues. Diagnosis requires the exclusion of an underlying medical or neurological problem that might present with the
features of a tension-type headache. Similar headaches may be seen in the presence of conditions as benign as viral
infections or as severe as brain tumors. In addition, many patients with migraine will sometimes experience milder
headache attacks that mimic tension-type headaches. Ultimately, the label of tension-type headache cannot be applied
until other underlying conditions and migraine have been considered and excluded.
The diagnosis of tension-type headache is made on the basis of clinical criteria. No specific testing is available, but
blood work and either head CT or brain MRI scans are sometimes done to exclude other medical or neurological
problems. By definition, the pain of tension-type headache should exhibit two of the following four features:
•bilateral location
•a steady non-throbbing quality
•mild or moderate intensity
•severity either unaffected or improved with physical activity.
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