BMJ  2008;336:88-92 (12 January), doi:10.1136/bmj.39412.705868.AD

Clinical Review

Tension-type headache

¹ Division of Headache and Pain, Department of Neurology, Brigham and Women’s/Faulkner Hospitals, Harvard Medical School, Boston, MA, USA, ² Graham Headache Center, Faulkner Hospital, Boston, MA, USA

The first 150 words of the full text of this article appear below.

Summary points Episodic tension-type headache is the most common cause of headache in the general population and is usually self managed Chronic tension-type headache may be highly disabling and often prompts medical consultation Diagnosis is clinical, based on widely accepted and validated criteria Peripheral factors are implicated in episodic tension-type headache, whereas central factors probably underlie chronic tension-type headache Simple analgesics, especially aspirin, are used for acute treatment Amitriptyline and biofeedback assisted relaxation training have the best evidence of effectiveness for headache prevention

Tension-type headache is a neurological disorder characterised by a predisposition to attacks of mild to moderate headache with few associated symptoms. The diagnosis is based on the history and examination. Over the past few decades research on headache has centred on migraine, and much of the best quality evidence for the treatment of tension-type headache is decades old. Some consensus based treatment guidelines are available (see Additional Educational Resources . . . [Full text of this article]

What is tension-type headache?

Box 1 Diagnostic criteria for tension-type headache*
Infrequent episodic tension-type headache
Frequent episodic tension-type headache
Chronic tension-type headache

What causes tension-type headache?

Who is at risk of tension-type headache?

How does tension-type headache present?

What examinations, tests, or imaging studies are useful?

Box 2 How to evaluate muscle tenderness in tension-type headache*
Box 3 Recommendations for neuroimaging

Who should be treated?

How should tension-type headache be treated?

Individual headache attacks
Preventive treatment

Education, lifestyle advice, and non-pharmacological treatment

When is referral to a specialist warranted?

What is the prognosis for tension-type headache?

Methods
Ongoing research
Unanswered questions
Tips for non-specialists
Additional educational resources
Resources on bmj.com

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