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Last reviewed: 26 Jul 2025
Last updated: 01 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • generalized head pain
  • frontal or occipital head pain
  • nonpulsatile head pain
  • constricting pain
  • normal neurologic examination

Other diagnostic factors

  • pericranial tenderness
  • sternocleidomastoid muscle tenderness
  • trapezius muscle tenderness
  • temporalis muscle tenderness
  • lateral pterygoid muscle tenderness
  • masseter muscle tenderness
  • photophobia or phonophobia
  • nausea
  • regular analgesic use
  • anxiety and depression
  • somatization

Risk factors

  • mental tension
  • stress
  • missing meals
  • fatigue
  • lack of sleep
  • somatization
  • female sex
  • age 20-39 years
  • lower socioeconomic status
  • analgesic overuse

Diagnostic tests

Tests to consider

  • CT sinus
  • MRI brain
  • lumbar puncture
  • polysomnography

Treatment algorithm

Contributors

Authors

Mark W. Green

Professor of Neurology, Anesthesiology and Rehabilitation Medicine

Emeritus Director of Headache and Pain Medicine

Icahn School of Medicine at Mount Sinai

New York

NY

Disclosures

MWG declares that he has no competing interests.

Assistant Professor of Neurology

Icahn School of Medicine at Mount Sinai

New York

NY

Disclosures

RC declares that she has no competing interests.

Peer reviewers

Assistant Professor of Neurology and Anesthesia

Harvard Medical School

Director of Comprehensive Headache Center

Beth Israel Deaconess Medical Centre

Boston

MA

Disclosures

SA has received honoraria from and is a consultant for Abbvie/Allergan, Eli Lilly, Linpharma, Lundbeck, Satsuma, Teva, Theranica, Percept, and Impel NeuroPharma. SA is an author of one of the references in this topic.

Consultant Neurologist

Barts Health NHS Trust

London

UK

Disclosures

GE is involved in a number of clinical trials on multiple sclerosis sponsored by Genzyme, Roche, Teva, Novartis, Biogen, as well as one funded by the MRC. He is also involved in clinical trials sponsored by Allergan, NMT Medical, GlaxoSmithKline (GSK), Bristol-Myers, the UK's Parkinson's Disease Research Group, and Pharmacia. In addition, he has attended lectures, conferences, and symposia with the following companies: GSK, AstraZeneca, MSD, Almirall, Pfizer, Menarini, Allergan, Biogen, Teva, Conference Plus, Infomed, BMJ.

Consultant Neurologist

Northampton General Hospital

Northampton

UK

Disclosures

PD declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan 25;38(1):1-211.Full text

Ashina S, Mitsikostas DD, Lee MJ, et al. Tension-type headache. Nat Rev Dis Primers. 2021 Mar 25;7(1):24. Abstract

Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010 Nov;17(11):1318-25.Full text  Abstract

Headaches in pregnancy and postpartum: ACOG clinical practice guideline No. 3. Obstet Gynecol. 2022 May 1;139(5):944-72. Abstract

Banzi R, Cusi C, Randazzo C, et al. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults. Cochrane Database Syst Rev. 2015;(5):CD011681.Full text  Abstract

Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016;(4):CD007587.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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