Typical Description of a Tension Headache
A typical tension headache is characterized by bilateral pain with a pressing, tightening, or non-pulsatile quality that is mild to moderate in intensity and is not aggravated by routine physical activity. 1
Key Clinical Characteristics
- Tension-type headaches present with bilateral distribution, affecting both sides of the head simultaneously 2, 1
- The pain quality is described as pressing, tightening, or having a non-pulsatile character, often with the sensation of a tight band around the head 2, 1, 3
- Pain intensity is typically mild to moderate, rather than severe 2, 1
- Unlike migraines, tension headaches are not aggravated by routine physical activity 2, 1
- Pain often radiates in a band-like fashion from the forehead to the occiput and may extend to the neck muscles 4
Associated Symptoms
- Tension headaches typically lack nausea and vomiting (though anorexia may be present) 2, 1
- Patients may have either photophobia (sensitivity to light) OR phonophobia (sensitivity to sound), but typically not both simultaneously 2, 1
- Tension headaches lack the autonomic symptoms seen in cluster headaches such as lacrimation, nasal congestion, or ptosis 2, 5
Distinguishing Features from Other Headache Types
- Unlike migraines, tension headaches are bilateral rather than unilateral, non-throbbing, mild to moderate in intensity, and not worsened by physical activity 2, 1
- Migraines typically feature nausea/vomiting and both photophobia and phonophobia, which are absent in tension headaches 2, 1
- Cluster headaches are distinguished by their strictly unilateral, severe pain lasting 15-180 minutes with ipsilateral autonomic symptoms 5
Epidemiology and Impact
- Tension-type headache is the most common primary headache disorder, with a worldwide lifetime prevalence of 46% to 78% 3
- Despite their typically moderate intensity, tension headaches cause significant disability and account for more missed work days than migraines 3
- Patients with frequent or daily tension headaches may experience significant distress 6
Clinical Pitfalls and Considerations
- Secondary headaches should always be ruled out, particularly when there are "red flags" such as sudden onset, fever, focal neurological symptoms, or onset after age 50 1
- Routine neuroimaging is not indicated for typical tension-type headaches without concerning features on history or examination 1
- Frequent use of analgesics (more than twice weekly) for tension headaches places patients at risk for progression to chronic daily headache 4