Tension headache diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]

Overview

Diagnostic criteria for tension-type headache is specified by the International Classification of Headache Disorders, 3rd edition (ICHD-3).

Diagnostic Criteria For Episodic Tension Type headache

• Episodes of headache, typically bilateral, pressing or tightening in quality and of mild to moderate intensity, lasting minutes to days. The pain does not worsen with routine physical activity and is not associated with nausea, but photophobia or phonophobia may be present. Increased pericranial tenderness may be present on manual palpation.

1. At least 10 episodes of headache fulfilling criteria 2 through 4. Infrequent and frequent episodic subforms of TTH are distinguished as follows:
   • Infrequent episodic TTH: Headache occurring on <1 day per month on average (<12 days per year).
   • Frequent episodic TTH: Headache occurring on 1 to 14 days per month on average for >3 months (≥12 and <180 days per year).
2. Headache lasting from 30 minutes to seven days.
3. At least two of the following four characteristics
   • Bilateral location.
   • Pressing or tightening (nonpulsating) quality.
   • Mild or moderate intensity.
   • Not aggravated by routine physical activity such as walking or climbing stairs
4. Both of the following:
   • No nausea or vomiting.
   • No more than one of photophobia or phonophobia.
5. Not better accounted for by another ICHD-3 diagnosis.

Diagnostic Criteria For Chronic Tension Type headache

• A disorder evolving from frequent episodic tension-type headache, with daily or very frequent episodes of headache, typically bilateral, pressing or tightening in quality and of mild to moderate intensity, lasting hours to days, or unremitting. The pain does not worsen with routine physical activity, but may be associated with mild nausea, photophobia or phonophobia.

1. Headache occurring on ≥15 days per month on average for more than three months (≥180 days per year) and fulfilling criteria 2 through 4
2. Lasting hours to days, or unremitting
3. At least two of the following characteristics:
   • Bilateral location.
   • Pressing or tightening (nonpulsating) quality.
   • Mild or moderate intensity.
   • Not aggravated by routine physical activity such as walking or climbing stairs
4. Both of the following:
   • No more than one of photophobia, phonophobia or mild nausea
   • Neither moderate or severe nausea nor vomiting
5. Not better accounted for by another ICHD-3 diagnosis