Location and Characteristics of Episodic Tension-Type Headache
Episodic tension-type headache is characterized by bilateral location with pressing or tightening (non-pulsatile) quality, mild to moderate intensity, and is not aggravated by routine physical activity. 1
Location
- Typically bilateral (affecting both sides of the head)
- Often described in a "headband" distribution 2
- May involve the occipital region and posterior neck 2
Key Characteristics
Pain Quality and Intensity
- Pressing or tightening quality (non-pulsatile) 1
- Described as a sensation of a tight band around the head 3
- Dull, moderate pain 4
- Mild to moderate intensity 1
- Not aggravated by routine physical activity 1
Duration and Frequency
- Episodes often last from 30 minutes up to a few days 4
- Episodic tension-type headache occurs fewer than 15 times per month 2
- Infrequent episodic: less frequent episodes
- Frequent episodic: more frequent but still less than 15 days/month 3
Associated Symptoms
- Lacks the accompanying symptoms that characterize migraine 1
- No nausea or vomiting (may have anorexia) 1
- No photophobia AND phonophobia (may have one or the other, but not both) 1
- No autonomic or vegetative symptoms 4
Diagnostic Criteria
According to the International Headache Society classification, episodic tension-type headache requires at least two of the following features 1:
- Pressing, tightening, or non-pulsatile character
- Mild to moderate intensity
- Bilateral location
- No aggravation with routine activity
Additionally, both of these features must be present:
- No nausea or vomiting (anorexia may occur)
- No photophobia AND phonophobia (one may be present, but not both)
Clinical Significance
- Most common primary headache disorder with a worldwide lifetime prevalence of 46% to 78% 3
- Causes greater disability and accounts for more missed work days than migraine 3
- While individual episodes are often clinically undemanding, frequent episodes can lead to significant distress 5
Treatment Considerations
- Simple analgesics are the mainstay for acute treatment
- Ibuprofen 400 mg and aspirin 1000 mg are recommended as first-line treatments 6
- Non-pharmacological approaches include electromyographic biofeedback, physiotherapy, and muscle relaxation therapy 6
- For frequent episodic tension-type headache approaching chronic form, preventive treatment may be considered 3
Distinguishing from Migraine
Unlike migraine, tension-type headache:
- Is typically bilateral rather than unilateral
- Has pressing/tightening quality rather than throbbing/pulsating
- Is not aggravated by routine physical activity
- Lacks the combination of nausea, vomiting, photophobia, and phonophobia
Understanding these distinct characteristics is crucial for accurate diagnosis and appropriate management of episodic tension-type headache.