Pain onset in tension-type headache can have a throbbing quality and 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.
Aspects of tension-type headache history include the following:
May occur acutely under emotional distress or intense worry
Duration of 30 minutes to 7 days
No nausea or vomiting (anorexia may occur)
Photophobia and/or phonophobia
Minimum of 10 previous headache episodes; < 180 days per year, with headache to be considered "infrequent"
Bilateral and occipitonuchal or bifrontal pain
Pain described as "fullness, tightness/squeezing, pressure," or "band-like/vise-like"
Often present upon rising or shortly thereafter
Muscular tightness or stiffness in neck, occipital, and frontal regions
Duration > 5 years in 75% of patients with chronic headaches
New-onset headache in elderly patients should suggest etiologies other than tension-type headache.
International Headache Society diagnostic criteria for tension-type headaches state that two of the following characteristics must be present:
Pressing or tightening (nonpulsatile quality)
Bilateral; mild/moderate intensity
Not aggravated by physical activity
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Cite this: George D. Harris. Fast Five Quiz: Stress-Related Conditions - Medscape - Sep 26, 2019.