Tension-Type Headache
The most likely diagnosis is tension-type headache, given the bilateral, band-like pressure from forehead to neck without migrainous features (no nausea, photophobia, or aura) and absence of cervicogenic reproduction on examination. 1, 2
Clinical Reasoning
This patient's presentation is classic for tension-type headache based on several key features:
Characteristic Features Present
Bilateral distribution: The pain affects both sides of the head in a band-like pattern, which is typical for tension-type headache rather than the unilateral presentation more common in migraine 1, 3
Quality of pain: The "vice-like" pressure and tightening sensation is the hallmark pressing or tightening quality of tension-type headache, not the pulsating/throbbing character seen in migraine 1, 2
Absence of migrainous features: The lack of nausea, photophobia, phonophobia, and prodromal symptoms effectively rules out migraine without aura, which requires at least one of these associated symptoms 4, 2
Severity: The description suggests mild to moderate intensity, consistent with tension-type headache rather than the moderate to severe pain typical of migraine 1, 3
Why Other Diagnoses Are Excluded
Migraine without aura is unlikely because migraine requires at least one associated symptom (nausea/vomiting, photophobia, or phonophobia), and this patient explicitly lacks all of these features 4, 2
Cluster headache is definitively excluded by the bilateral nature of the pain—cluster headaches are strictly unilateral with severe to very severe intensity, last only 15-180 minutes, and are accompanied by ipsilateral autonomic symptoms like lacrimation or nasal congestion 5, 2
Cervicogenic headache is ruled out by the negative cervical spine range-of-motion testing and inability to reproduce the headache with skull palpation 1
Occipital headache is not a distinct diagnostic entity in the International Headache Society classification and would not explain the band-like distribution from forehead to neck 2
Clinical Pitfall to Avoid
The band-like distribution extending to the neck might tempt consideration of cervicogenic headache, but the negative provocation testing (cervical range-of-motion and palpation) effectively excludes this diagnosis 1. Tension-type headache commonly radiates to neck muscles and is described as tightness or pressure in this distribution 3, 6
Diagnostic Confirmation
No neuroimaging is indicated for this typical presentation without red flags (no focal neurological signs, sudden onset, fever, or progressive worsening) 1, 2. The diagnosis is clinical, based on the characteristic bilateral, pressing quality without associated migrainous symptoms 1, 3