Fast Five Quiz: Stress-Related Conditions

George D. Harris, MD, MS


September 26, 2019

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"

  • Insomnia

  • 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

  • Difficulty concentrating

  • No prodrome

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)

  • Frontal-occipital location

  • Bilateral; mild/moderate intensity

  • Not aggravated by physical activity

Read more about the presentation of tension-type headaches.


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