Fast Five Quiz: Test Your Clinical Knowledge of Various Types of Headaches

Amy Kao, MD


November 27, 2018

The International Headache Society (IHS) diagnostic criteria for tension-type headaches state that two of the following characteristics must be present:

  • Pressing or tightening (nonpulsatile quality)

  • Bilateral location

  • Mild/moderate intensity

  • Not aggravated by physical activity

In addition, headaches must fulfill the following characteristics to be classified as tension-type headache by the IHS:

  • Duration of 30 minutes to 7 days

  • No nausea or vomiting (anorexia may occur)

  • Photophobia or phonophobia, but not both

  • Minimum of 10 previous headache episodes; fewer than 12 days per year with headache is considered infrequent, and 12 or more days with headache but less than 180 days per year is considered frequent

Other features of tension-type headaches may include:

  • 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 the neck, occipital, and frontal regions, with increased pericranial tenderness on palpation

  • Duration of more than 5 years in 75% of patients with chronic headaches

  • Difficulty concentrating

  • No prodrome

Tension-type headache onset often occurs during the teenage years and affects 3 women for every 2 men.

On the basis of the IHS criteria, pain in tension-type headache is not throbbing (pulsating); however, many individuals who have frequent tension-type headaches also have migraine without aura. Pain onset in tension-type headache 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 more on tension-type headaches, read here.


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