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

Clinical Review

Tension-type headache

Elizabeth Loder, chief1, Paul Rizzoli, director 2

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

Correspondence to: Dr E Loder, 1153 Centre Street, #4970, Boston, MA 02130, USA eloder@partners.org

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


  • 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]


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