What is tension-type headache?
Tension-type headache typically presents as a pressing or tightening quality, bilateral, affecting the forehead, temples or back of the head. The pain is usually mild to moderate, not aggravated by routine physical activity, and lasts from 30 minutes to several days. Nausea is absent or very mild, and photophobia or phonophobia may occur but not both together.
Episodic tension-type headache occurs on fewer than 15 days per month, while chronic tension-type headache occurs on 15 or more days per month for over 3 months. Accurate frequency assessment through diary is essential, as chronic tension-type headache often coexists with migraine and medication-overuse features.
- Pressing or tightening quality, bilateral, forehead or temples
- Mild to moderate intensity, not worsened by activity
- Nausea absent or very mild
- Episodic (<15 days/month) vs chronic (≥15 days/month)
Related: Headache Medicine → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Evaluation and management
Evaluation follows ICHD-3 classification with diary-based frequency assessment. A headache diary captures days per month, severity, associated features and medication use, separating tension-type from overlapping migraine or medication-overuse headache. Red flags are screened systematically before attributing symptoms to tension-type headache.
Management centres on education, lifestyle optimisation and medication review. Sleep hygiene, posture, stress management and regular exercise are foundational. Acute medication is limited to avoid overuse; preventive options such as amitriptyline or mirtazapine are considered for chronic or frequent episodic tension-type headache. Follow-up adjusts the plan based on diary trends.
- ICHD-3 classification with diary-based frequency review
- Sleep, posture, stress and exercise optimisation
- Acute medication limited to prevent overuse
- Preventive options for chronic or frequent episodes